Newborns and Rice Cereal: Is It Safe to Give Rice Cereal to a Baby Under 4 Months?

If your newborn spits up all the time or wakes up frequently, a well-meaning friend or relative may have suggested trying rice cereal. Evidence, however, suggests that mixing rice cereal in baby’s bottle does little to help with reflux or sleep. Medical consensus suggests sticking to breastfeeding and/or formula feeding for the first six months of baby’s life. You should wait to introduce solids, including rice cereal, until baby’s at least 4 months old.

“For a lot of families, feeding decisions can be super overwhelming. There are so many mixed messages—so much information out there,” says Victoria Mitre, MD, MEd, a board-certified pediatrician with Texas Children’s Hospital. “As a pediatrician, I like to focus on what’s developmentally appropriate, what’s nutritionally necessary and what’s safe for babies at each stage.” This means not giving baby solids until they’re developmentally ready.

So, what should you know about newborns and rice cereal to keep baby safe? Ahead, experts answer your most burning questions about rice cereal for babies.

Key Takeaways

• Wait to offer rice cereal for infants to reduce choking and aspiration risk. Newborns lack the swallow coordination and upper body strength required to eat solids. Until babies are 6 months old, they get all the nutrients they need from breast milk or formula.
• Don’t use rice cereal for reflux. For most babies, spitting up is normal, but if you’re concerned, talk to your pediatrician. To reduce reflux, try upright holds, frequent burps and smaller, more frequent feeds.
• Start solids at 4 to 6 months. Go by developmental signs—not just age—like good head and neck control, sitting with support, loss of tongue-thrust and interest in food. Serve by spoon, not in a bottle.
• Limit rice because of arsenic. Rice contains higher arsenic levels than other grains, so diversify to oats, barley and quinoa, and keep rice occasional.

The Medical Consensus: Can Newborns Have Rice Cereal?

Experts say you shouldn’t offer baby rice cereal—or any other foods—until they start solids. Both the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) recommend breastfeeding and/or formula feeding until babies are 6 months old and avoiding all solids, including rice cereal, until at least 4 months of age.

The dangers of early solid food introduction

Before they’re about 4 to 6 months old, babies haven’t outgrown the tongue-thrust reflex—their tongues automatically rise to the top of the mouth and push solid food out, instead of pushing it back—and they lack the swallowing coordination necessary to safely handle solid foods like rice cereal. That puts them at increased risk of choking and aspirating (aka breathing in) solid foods. Younger babies also don’t yet have the upper-body strength to sit up to chew and swallow. “Under the age of 4 months, developmentally, they’re just not quite ready,” says Nick DeBlasio, MD, MEd, a board-certified pediatrician with Cincinnati Children’s Hospital. What’s more, “breast milk and formula have been specifically designed for childhood nutrition up to those first six months,” explains Mitre. Filling up on rice cereal might mean that babies don’t get enough of the protein, fats, vitamins and minerals that they need and would otherwise get in milk.

The Reflux Question: Is Rice Cereal Safe for Newborns With Reflux?

You may have heard that adding rice cereal to a bottle will “weigh down” baby’s milk and stop reflux. While doctors do very rarely recommend special thickening formulas for some babies with severe reflux, they stress that adding rice cereal to a newborn’s bottle to manage spitting up isn’t necessary and may even be dangerous.

Why the AAP advises against rice cereal for reflux

The AAP warns against rice cereal for babies with reflux because their digestive systems aren’t ready for it yet and it could lead to GI distress, including constipation. They risk the likelihood of gagging and/or aspirating the thickened mixture into their lungs. Plus—while it’s hard to overfeed baby with milk alone—feeding them rice cereal before they’re ready can definitely lead to overfeeding issues. And again, exposure to solids before they’re 4 months old can even lead to developing food allergies down the road, the AAP adds.

“We get this question all the time, but for most babies, reflux is normal. It’s physiologic. This is the category that we like to call ‘happy spitters’ in pediatrics,” says Mitre. Infant reflux is in most cases expected, rarely bothers babies and typically goes away on its own by 12 months of age, or sooner.

Again, very rarely, babies do have serious reflux that requires treatment. They’re usually very fussy during and after feedings and have other symptoms including poor weight gain, forceful vomiting, constipation, blood in the stool or abdominal distension. In this case, your doctor might recommend adding thickener to their formula or breast milk, or changing to a different formula.

It’s still critical to check in with your healthcare provider before giving baby thickened milk. Reflux has other common causes, including allergies to milk or soy proteins, which do need to be treated—and won’t be helped with rice cereal or a thickener.

Keep in mind, too, that rice has higher levels of arsenic than other grains. While this doesn’t mean you should avoid rice cereal altogether when baby’s old enough to start solids, pediatricians now generally recommend diversifying baby’s first grains.

Safe alternatives to help baby reflux

Doctors recommend several other tactics to reduce baby’s reflux, including:

• Holding baby upright for 20 to 30 minutes after feeds
• Regularly burping baby during and after feedings
• Smaller, more frequent feedings
• In the rare case of severe reflux, your practitioner may recommend a prescription reflux medication. And when reflux seems to be caused by a cow’s milk protein allergy, your practitioner will likely suggest that you avoid eating potentially allergenic foods (like dairy or soy products) if you’re breastfeeding, or that you switch to an extensively hydrolyzed infant formula.

The “Bottle” Question: Can You Add Rice Cereal to Baby’s Bottle?

Many parents have been advised to add rice cereal to baby’s bottle to help them sleep. But doctors warn that adding any solid food to a bottle increases the risk of choking and aspiration, as well as overeating. “Our goal with solid foods isn’t only from a calorie standpoint,” says DeBlasio. “What we don’t want is to shove a bunch of food into a bottle, because you’re not actually teaching your kid how to eat. And those are kids that often go on to have issues with textures and actually eating solid food.”

What’s a “knock-out” bottle—and is it safe?

While the “knock-out” bottle is sometimes advertised as helping babies sleep better by filling them up before bed, there’s no evidence this improves sleep. In fact, it can be dangerous, increasing the risk of overfeeding and aspiration. “Bottom line is no one really knows if that’s actually helpful or not, so we don’t recommend adding rice cereal for sleep purposes,” says DeBlasio.

Safety Alert: Arsenic in Rice Cereal—Is Rice Cereal Bad for Babies?

Arsenic is an element that’s naturally present in the soil and water. Rice absorbs more arsenic than other grains, which is why the U.S. Food and Drug Administration (FDA) and AAP recommend minimizing rice cereal consumption, regardless of age, in favor of a variety of first foods, like oatmeal.

“Over the last several years, we’ve moved away from recommending rice cereal as one of the first foods,” says Mitre. Although small amounts aren’t harmful, repeated exposure, especially when young babies’ nervous systems are still developing, has been linked to higher risk of cognitive and neurobehavioral issues as well as certain cancers.

When Can Babies Have Rice Cereal?

Babies are ready to start eating solid foods—including rice cereal—when they’re 4 to 6 months old. Every baby’s different—and developmental readiness signs matter more than age. These include the ability to sit up unassisted; good head, neck and trunk control; the loss of the tongue-thrust reflex; showing an interest in solid foods; and bringing their hands to their mouths. Not sure if your baby is ready? Talk to your pediatrician.

To Sum It Up

Exclusive breastfeeding or formula feeding for the first six months of life fulfills all of baby’s nutritional needs. Introducing solids like rice cereal too early may cause choking and aspiration, as well as increase baby’s future risk of food allergies and obesity. You can begin to introduce solids, including rice cereal, when baby’s developmentally ready (typically between 4 to 6 months of age). Just serve it with a spoon, and never add it to baby’s bottle. While rice cereal used to be the go-to first food for baby, rice contains higher levels of arsenic, a naturally occurring element. High levels can harm baby’s cognitive and behavioral development. So while it’s okay to feed baby some rice cereal starting at between 4 to 6 months of age, aim to incorporate a variety of grains into baby’s diet, such as oats, barley and quinoa.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.