New Guidelines for Solid Food Introduction
Baby’s 1st Foods
Over the past year, new guidelines have been recommended for solid food introduction for infants and the main point is to introduce more “highly allergenic” foods early. This topic can be very confusing and alarming to parents as the guidelines are a complete 180 from the previous solid food introduction schedule from 2000.
The previous guidelines advised that breastfeeding mothers of infants at high risk for developing allergy should avoid cow’s milk, egg, fish, peanuts and tree nuts. Parents were also instructed that solid foods should not be introduced into the diet of high-risk infants until 6 months of age, with dairy products deferred until 1 year, eggs until 2 years, and peanuts, nuts and fish until 3 years of age.
Note: “High risk”children are defined as babies with a sibling or parent who have atopic conditions such as food allergies, hay fever, eczema or asthma. A child who already has an atopic condition before or at the start of food introduction DOES NOT fall into this solid food introduction schedule.
New Guidelines For Solid Food Introduction
As a Naturopathic Doctor, these new guidelines differ dramatically from what I was taught in school and have been advising my patients over the years. However, after looking into all the research and and compiling scientific evidence, my advice has changed.
Breastfeeding and Formula -Breastfeeding or formula should continue to be the main source of nutrition while food introduction is the childs exploration into new tastes and textures. Research has shown that high risk babies which are exclusively breast fed until 4-6 months of age have reduced risk of eczema, asthma and cow milk allergy. If using formula, look for a hydrolyzed whey formula. Preliminary research on hydrolyzed formula has been shown to be more effective in preventing atopic conditions.
Where To Start? Solid food introduction should wait until babe is 6 months of age. This age is best, as the gastrointestinal tract, enzymes and immune system will be more mature and ready to take on new foods. When starting, you will introduce 1 food at a time at a rate of 1 food every 3-5 days. Baby will let you know when they are ready as they will reach for the spoon, open their mouth or cut their first few teeth.
The Starting Line -Ready, Set, Food! Babies thrive on routine. Choose a time when you and baby will be most rested. Start with one solid feeding per day, about 2 tsp of food and work up gradually to 3 servings a day.
The Mush Stops Here- Keep First Foods Chunky Contrary to the old “puree everything” motto, first foods should mimic what your family is having at the dinner table. Make sure the foods are soft or chunky so that baby can mash them up themselves. This allows your little one to experiment with different textures and allows them to work on feeding themselves. Cut up steamed carrots, sweet potato, banana or avocado. Or try cooked beans, shredded chicken, lentils or pieces of toast. Research has shown that babies fed chunky textures during food introduction are less picky and more likely to eat healthier foods such as fruits and veggies later on.
Which Food First? Gone are the days of complex solid food introduction schedules. The goal now is to start with a few of the 1st foods listed below and then get most of the highly allergenic foods into the diet as early as possible, while still maintaining the 1 new food every 3-5 days rule. There are no rules on only fruit and veggies first or that meat needs to be first. They are basically all first now.
- 1st Fooods – Sweet potatoes, carrots, squash, avocados, bananas, pears, shredded meats (beef, chicken, lamb, game) beans, lentils and rice.
- Allergenic Foods- If baby tolerates a few of the 1st foods well, start introducing fish, whole eggs, peanut butter, wheat, yogurt, cheese, strawberries, shellfish soy, grains (oat, barley) in small amounts
- 2 Exceptions- Wait until 9-12 months of age before the introduction of homogenized cow’s milk and wait until 12 months of age before introducing honey. Do not offer skim milk before 2 years of age..[/list]
Highly Allergenic Foods- What to do? Although this may come as a surprise, foods considered highly allergenic should be introduced during the first few months of food introduction. Foods such as fish, peanut butter, whole eggs, and wheat should now be eaten earlier rather than later. According to current research, delaying the introduction of solid foods, especially the highly allergenic foods, may increase the risk of food allergy or eczema. Remember to try small amounts of these foods at home 1st and watch for potential reactions. If no reaction occurs, include this as a new food in their regular diet.
What if a Reaction Occurs? If your child develops eczema or has an immediate reaction to a food, delay any further introductions of highly allergenic foods. Children with one underlying food allergy are usually allergic to to other foods such as peanuts, milk or eggs. Reactions may include: bloating, rashes, runny nose, dark circles under the eyes, diarrhea, mucous in the stool, ear infections, fussiness and vomiting. Continue with foods that do not aggregate and then try the aggravating foods again in 3 weeks. If reactions continue, seek the advice of your health care practitioner or Naturopathic Doctor for continued advice and support.
Last but Not Least- Sippy Cups Again, another myth busted! Gone are the days of the sippy cup. Give your child an open cup to sip water. You can start giving water in an open cup when your child start solids. It will take time for baby to master this skill but the open cup supports the development of mature feeding skills.
Final Thoughts – As a Naturopathic Doctor, in my option, I think all children should be assessed on an individual basis for solid food introduction. Generalized feeding schedules may not be perfect for all children. The child’s risk should be assessed before food intro. Such concerns may be a family history of atopic conditions or autoimmune disease, vaginal vs. C-section birth, if baby was able to be breast fed or if probiotics have been used. A one size fits all is never the answer, but the new solid food recommendations suggest that if we introduce highly allergenic foods early, as a way of immunotherapy, children should be a lower risk of asthma, allergies and asthma.
The Journal of Allergy and Clinical Immunology In Practice: https://www.jaci-inpractice.org/article/S2213-2198(12)00014-1/fulltext
Healh Canada: https://www.healthycanadians.gc.ca/healthy-living-vie-saine/infant-care-soins-bebe/nutrition-alimentation-eng.php
The Townsendletter: https://www.townsendletter.com/April2014/introbaby0414.html
The American Academy of Pediatrics- https://www.aap.org/en-us/Pages/Default.aspx