Feeding Your 4- to 7-Month-old With CF

Starting solid foods is very important for the development and health of babies with cystic fibrosis.

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What Can Eating Solid Foods Do for Babies With CF?

Eating new foods adds to the calories babies with CF get in breast milk or formula and helps them get closer to eating the calories needed for good nutrition and growth. Eating solid foods gives babies the chance to practice important skills including moving the tongue, using the gums and swallowing.

Starting a wide range of solid foods over a long time helps babies eat a variety of foods and flavors as they get older. This makes your job easier in the long run.

How Do You Know If Babies Are Ready for Solid Food?

The American Academy of Pediatrics suggests that solid foods be added when babies are able to hold their head up, keep food in their mouth and sit up with some help. This normally happens when babies are 4 to 6 months. When your baby is ready for the highchair, have him sit at the table. This is a great time to have your baby start eating dinner with the rest of the family.

Where Do I Start?

Babies should get solid food when they show signs of hunger, such as when they are ready for a bottle. It is easier to feed babies solid foods when they are calm. If your baby is too hungry, you may need to give a few ounces of breast milk or formula before offering solids. It is hard to learn a new skill, like eating solid foods, when a baby is really fussy. If your baby needs to gain weight, your CF dietitian may advise you to offer high-calorie formula or breast milk before feeding your baby solid food.

Rice cereal is a common and good first food. It is high in iron, which is important for babies. Strained meats make a good second food to try. They are high in iron and calories. Plain strained meats have more protein than combination foods such as vegetables with meat.

Babies can eat a variety of pureed foods. Slowly adding a variety of strained fruits, vegetables and meats will help achieve a balanced diet and good eating habits. Try one food at a time to make sure that your baby does not develop a rash or have diarrhea. Call your doctor if you think your baby may have a rash or diarrhea because of food.

There are no clear rules about the order in which foods need to be started as long as your baby can swallow safely. Ask your CF dietitian how to get started.

What Do I Do If My Baby Refuses to Eat Solid Food?

The main goal during the first few weeks of eating solid foods is to allow your baby to practice the new eating skills. These skills are keeping the food in the mouth, working food toward the back of the mouth and swallowing.

Babies need to overcome the reflex (which is out of their control) to push anything other than liquids out of their mouths. Infants as young as 6 months old are able to show interest (or lack of interest) in food and eating. Some actions that show lack of interest:

  • Swatting at the spoon.
  • Turning the head away from food.
  • Tightening the lips when the spoon comes near the mouth.
  • Spitting out food that enters the mouth.
  • Crying.

Because infants love any response from parents, it is very important to remain calm and keep offering foods when your baby does any of the things listed above. Do not say anything to your baby, and try not to get angry when the baby refuses food or spits it out. Even talking about this by saying, “Oh, you don't like your peas” can give your baby the attention that he or she loves. Your baby may be more likely to spit out food in the future to get your attention.

During the first few weeks of learning to eat solids, your baby may eat only a few tablespoons of food at each meal. This is OK. Babies get most of their nutrition and calories from breast milk or infant formula.

When babies make faces when trying a new food, it does not always mean that they do not like the food. It just means that it is new. Give very small amounts of new food. You may have to give a food 8 to 10 times before your baby starts to like it.

Expect messes. Older infants want to feed themselves. At this age, making messes is a part of learning to eat. A baby needs to learn to move food around in his mouth, and grip and pinch with his hands in order to eat on his own. This may include spitting food out, as well as making messy art on the highchair tray.

It is important not to force-feed your baby. This can make mealtimes stressful, and your baby will not be excited to eat. Save your energy and show your excitement (e.g., clapping, smiling) when he or she tries and eats new foods.

What Does My Baby Need to Eat and Drink to Grow?

Work with your CF dietitian to make a plan. Most babies are born knowing when they are hungry and full. Your baby will not eat more food than other babies at this age, no matter how hard you try.

Here are some daily amounts and suggested serving sizes for all children, including those with CF. You can also offer strained or pureed foods, one teaspoon at a time.

Food Group Food Daily Amounts Suggested Serving Size
 Milk Breast milk On demand  
  Formula 4-6 feedings 6-8 ounces
Grain Iron-fortified baby cereal 2 1-2 tablespoons

Some babies need more calories to help them grow. If this is needed, the trick is to look for ways to add more calories in formula and foods without adding more food for your baby to eat. You will work with your CF dietitian and learn how to add calories to food. Here are a few to start:

  1. Mix your baby's cereal with high-calorie breast milk or formula in a bowl. You can ask your CF dietitian how to make high-calorie formula.
  2. Add oils (olive, canola or safflower), butter or margarine to fruits and vegetables (1 teaspoon to a ½ cup or 4 ounces). With time your baby will get used to the taste of the oil and butter.
  3. Check food labels to find the baby food with the highest calories.


Babies with CF need vitamin supplements because it is difficult for them to absorb vitamins well. Vitamin supplements help prevent low levels of fat-soluble vitamins A, D, E and K. Your CF dietitian will tell you which type and dosage of vitamin supplements are best.


Your baby may need pancreatic enzyme replacements (enzymes) to help digest and absorb food. Enzymes must be prescribed by your baby's doctor.

Enzymes may be started if your baby has any or all of these symptoms:

  • Poor weight gain, even when your baby likes to eat and eats a lot.
  • Lots of large, loose stools.
  • Dirty diapers that smell very bad or are oily or have mucus.
  • Lots of gas or stomach pain.
  • Bloating or a full-looking tummy.

Enzymes come as capsules. Each capsule contains many small enzyme beads. For babies, you should open the capsules and sprinkle the beads on a small amount of acidic food such as baby fruit or applesauce that you then feed with a spoon. The beads have a coating that helps them dissolve in the small intestine. This is where most foods are broken down and absorbed into the blood.

Infants with CF who do not digest their food well need enzymes every time they eat. When your baby has breast milk, formula, or food, you will need to give enzymes. Put beads in food right before feeding. Do not change the enzyme dose without talking to your CF dietitian or health care provider.

Some very young babies may spit out the beads. If this happens, gently scoop the bead mixture back into the baby's mouth until the entire dose of enzymes has been given. It may take time for your child to learn how to swallow beads because of the new texture. Enzymes do not have a taste.

Hear more tips from other parents like you by watching this video. A dietitian and parents of children with CF discuss how to give enzymes, provide proper nutrition and calories, and look for signs of malabsorption.


People with CF lose a lot of salt in their sweat. The more they sweat, the more salt they lose. In hot weather, your baby may need more salt. Your CF dietitian or health care provider may tell you when and how to add extra salt to your baby's formula or food.

In general, the guidelines are to add:

  • 1/8 teaspoon of salt daily from birth to 6 months
  • 1/4 teaspoon of salt for infants ages 6 months or older

Use a measuring spoon, not a household spoon, to measure. Do not add more salt than recommended. Salt may be added to formula or to applesauce used to give enzymes.

Tube Feedings

Tube feedings are formula feedings through a tube into the stomach. Some infants with CF have a very hard time gaining weight. Tube feedings are a great way to help these babies grow and feel better.

Tube feedings are not a last resort. They do not mean failure. Don't forget: Higher body weight seems to be linked to better lung function. Do what is needed to help your baby get to a healthy weight.

Talk With Your CF Center

Be sure to talk to your CF center dietitian at every visit about your baby's eating. A small amount of spitting up or throwing up is normal, but a large amount of throwing up is not normal. This may mean that your baby has reflux. Reflux can lead to slow weight gain and poor growth.

Your CF dietitian also is a good resource for making decisions about food choices, how to add calories, getting your baby to eat and making mealtime fun. The earlier you ask the better.

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Caring for a Child With CF | Nutrition
Feeding Your 4- to 7-Month-old Download (PDF)
Nutrition for Your Infant (Birth to 1 Year) Download (PDF)
Early Nutrition and Growth for Your Young Child With Cystic Fibrosis Download (PDF)
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