First Foods for a Baby Born Early: Does It Matter When You Start?

What two recent studies of babies born prematurely, one from the Netherlands (Vissers et al., 2025) and one from Vienna (Gsoellpointner et al., 2026), tell families about starting solid foods

For families of babies born early, starting solid foods can feel like one more decision with no clear answer. Two recent studies suggest that starting solids between about three and four months after the due date made no measurable difference to weight at age two, and that how parents feed changes a baby's nutrients more than their growth. Parents seem to have more freedom than they are often told.

Why the question matters so much for families of premature babies

Most feeding advice for babies is written for babies born at full term. In the general guidance for those babies, solid foods begin around six months of age, or somewhere between four and six months [[1]]. Babies born early are different. They leave the hospital smaller, often need to catch up in growth, and may have had a long road with feeding along the way. Doctors and parents therefore often felt they were working without a clear map, and professional groups have written advice based largely on expert opinion because good studies were rare [[2]].

There is also a worry behind the caution. In children born at full term, some research has linked starting solid foods very early to a higher chance of being overweight later in childhood [[3]]. It is natural for parents and doctors to wonder whether starting solids early might do the same for a baby who was born small. Babies born early also count their age from their due date, not their birthday, a "corrected age" that makes the timing of milestones different from what friends with full-term babies experience.

What earlier studies had already found

Before these two studies, only a few trials, meaning studies in which babies are assigned to one approach or another by chance, had asked when premature babies should begin solids. In one early study of 68 premature babies, those who started solids a little earlier grew slightly faster in length, by a fraction of a millimetre per week, than those who started later [[4]]. Later, a larger study of 373 babies born before 34 weeks in India compared starting at four months with six months and found no difference in weight at one year [[5]]. A study in Vienna of babies born under 1,500 grams (about 3 pounds 5 ounces) compared two starting points, a few weeks apart, using a standard set of foods, and again found no meaningful difference in growth [[6]]. Still missing was information on what happens up to age two in the larger group of babies who are born only a little early.

The Dutch study: starting at three months or four months after the due date

The SPOON trial was run in 17 hospitals across the Netherlands between 2016 and 2021, with families followed until December 2023 [[7]]. It included babies born between 30 and 36 weeks of pregnancy (a full-term pregnancy is about 40 weeks). Babies with serious health problems that would interfere with steady growth were not included, so the results speak most clearly to relatively healthy babies born a little early [[7]].

When babies were 10 weeks past their due date, families were assigned by chance to one of two plans. One group started first foods at about 12 weeks after the due date (roughly three months), and the other at about 17 weeks (roughly four months). Parents knew which group they were in. The researchers then measured the children at 1 and 2 years [[7]]. In all, 255 babies were assigned, and 226 of them were measured at age two, so most families stayed in the study. Another 159 babies born at full term were followed for comparison [[7]].

What the Dutch researchers found

At age two, the weight picture in the two groups was almost the same. About 6 of every 100 children in the earlier-start group, and about 5 or 6 in the later-start group, were classed as overweight, and fewer than 2 in 100 in either group were classed as having obesity [[7]]. Height, weight and body mass measures were also very close. Tests of how the children were learning and developing did not differ between groups either [[7]].

There were a couple of small differences on other measures, such as a few more skin rash scores in the moderate range at one year in the earlier group. These were not present by age two, and with so many measures examined, occasional differences can appear by chance [[7]]. One finding may be especially comforting: children born early remained leaner than children born at full term, of whom about 9 in 100 were overweight [[7]]. In other words, the premature children in this study were not tipping toward too much weight, whichever timing their family had followed.

The Vienna study: what is on the spoon may matter more than when it starts

A second study, from the Medical University of Vienna, asked a different question. It compared babies born under 1,500 grams whose families had followed a set plan using commercial jarred baby foods, with babies whose parents chose what to feed without a plan [[8]]. The two groups came from two earlier studies, one a chance-assignment trial (whose nutrient intake the same team had examined earlier) and one an observational study in which researchers watched what families did [[6], [9], [10]]. Parents wrote down everything their baby ate for three days at 3, 6, 9 and 12 months after the due date, so the researchers could work out the nutrients [[8]]. Because these were two separate groups rather than one head-to-head comparison, the results are best seen as clues [[8]].

Growth was similar. What differed was nutrition. Babies whose parents chose the foods took in more protein and fat, along with more of two fatty acids, arachidonic acid and docosahexaenoic acid. Babies who followed the jar plan got more iron and zinc from about six months onward [[8]]. Neither group reached the suggested amount of one of the fatty acids, and only the parent-led group reached the other, and only for a few months [[8]].

What this could mean for your baby

These studies do not replace advice from your baby's own doctors, who know your baby's health history. But they offer some reassurance. In the ranges studied, whether solids began earlier or later did not appear to change a premature baby's weight at age two [[7]]. The Dutch team concluded that families can choose a starting point within this window based on their preferences, their situation, and their baby's readiness [[7]].

Readiness still matters. Your baby's care team can help you judge when your baby seems ready. The researchers stress looking at the whole picture, including development, health conditions, allergy risk, how parents are feeling, and getting enough vitamins and minerals [[7]]. Milk feeds remain the foundation, and many hospitals encourage responsive feeding, following baby's cues for hunger and fullness. You can read about how this connects with growth in our article on responsive feeding and two-year growth.

The Vienna results suggest a few useful questions to ask your baby's doctor or dietitian. Where do we get enough iron? Are there foods with healthy fats that suit babies? Is a supplement worth considering? Iron-rich and zinc-rich foods stood out as areas where parent-led feeding fell behind, while jarred foods provided less protein and fat [[8]]. Combining approaches, such as commercial products plus added protein and healthy fats, may sound sensible, but that idea has not yet been tested.

Limits to keep in mind

The Dutch team had hoped to enroll 600 babies and reached 255. Only about one in ten eligible families agreed to join, often because parents preferred to choose the timing themselves [[7]]. Because of this, the study was smaller than planned, and it might miss small differences. The researchers argue that because the two groups looked so alike, a large hidden difference is unlikely [[7]]. The results apply best to moderate-to-late preterm babies in a high-income country, and may not apply to babies born much earlier or in places where clean food and water are harder to guarantee [[5]]. The Vienna comparison did not assign babies by chance, and the groups differed in when they began solids and in how many were breastfed [[8]]. Weight at two years is also only one measure of health.

What researchers are working on next

The Vienna researchers call for studies that compare feeding approaches head to head rather than across separate groups [[8]]. The limits of the studies described here point to other priorities too: including babies born much earlier, following children into later childhood, when weight and health patterns become clearer, and designing trials that respect family preferences, since so many parents want a say in timing.

The takeaway for families

If your baby was born a little early, the studies so far suggest you do not have to worry that starting solids between roughly three and four months after the due date will push your child toward overweight, and you have room to choose a start date that suits your baby and family. What may deserve more of your attention is the quality of the foods themselves, especially iron, zinc, protein and healthy fats. Talk with your baby's care team about your baby's readiness and about a plan that fits.

References

  1. Fewtrell M, Bronsky J, Campoy C, et al. Complementary feeding: a position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2017;64(1):119-132. doi:10.1097/MPG.0000000000001454 ↩
  2. Baldassarre ME, Panza R, Cresi F, et al. Complementary feeding in preterm infants: a position paper by Italian neonatal, paediatric and paediatric gastroenterology joint societies. Ital J Pediatr. 2022;48(1):143. doi:10.1186/s13052-022-01275-w ↩
  3. Huh SY, Rifas-Shiman SL, Taveras EM, Oken E, Gillman MW. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics. 2011;127(3):e544-e551. doi:10.1542/peds.2010-0740 ↩
  4. Marriott LD, Foote KD, Bishop JA, Kimber AC, Morgan JB. Weaning preterm infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2003;88(4):F302-F307. doi:10.1136/fn.88.4.F302 ↩
  5. Gupta S, Agarwal R, Aggarwal KC, et al. Complementary feeding at 4 versus 6 months of age for preterm infants born at less than 34 weeks of gestation: a randomised, open-label, multicentre trial. Lancet Glob Health. 2017;5(5):e501-e511. doi:10.1016/S2214-109X(17)30074-830074-8) ↩
  6. Haiden N, Thanhaeuser M, Eibensteiner F, et al. Randomized Controlled Trial of Two Timepoints for Introduction of Standardized Complementary Food in Preterm Infants. Nutrients. 2022;14(3):697. doi:10.3390/nu14030697 ↩
  7. Vissers KM, Feskens EJM, van Goudoever JB, Janse AJ; SPOON Study Group. Timing of Complementary Feeding in Preterm Infants and Prevalence of Overweight and Obesity: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(4):e252968. doi:10.1001/jamanetworkopen.2025.2968 ↩
  8. Gsoellpointner M, Thanhaeuser M, Kornsteiner-Krenn M, et al. Nutritional intake and growth in very low birth weight infants: a comparison of standardized versus parent-led complementary feeding. Eur J Clin Nutr. 2026; published online 8 August 2026 (article 1809). doi:10.1038/s41430-026-01809-z ↩
  9. Gsoellpointner M, Eibensteiner F, Thanhaeuser M, et al. Effects of early introduction of solid foods on nutrient intake in preterm infants during their 1st year of life: a secondary outcome analysis of a prospective, randomized intervention study. Front Nutr. 2023;10:1124544. doi:10.3389/fnut.2023.1124544 ↩
  10. Thanhaeuser M, Gsoellpointner M, Kornsteiner-Krenn M, et al. Introduction of Solid Foods in Preterm Infants and Its Impact on Growth in the First Year of Life. Nutrients. 2024;16(13):2077. doi:10.3390/nu16132077 ↩