Introducing solids: What do we know about allergy prevention?

Author: Dr Jane Watson
Accredited Practising Dietitian

As parents, we often receive lots of well-intentioned advice about feeding our babies and young children. The advice is often divergent and it can be very difficult to sort out fact from fiction. When it comes to introducing solids, you may hear ‘Don’t start them too soon’, ‘Don’t leave it too late’, ‘Don’t give them ‘windy’ foods’, ‘The first food you should start with is X’….

So. Much. Information!

To add to the confusion, science continues to uncover new things about what’s best for our babies. Food allergies are on the rise and recommendations for introducing solids have recently changed to reflect our current understanding of food allergy prevention. But what does this mean and how does it change what we should be doing with starting solids?

Here’s my Survival Guide – based on current scientific evidence and a good dose of personal experience.

When?

At around 6 months, but not before 4 months, start to introduce a variety of solid foods. Your baby is ready to start solids when they show the following signs:

  • can sit up with support and has good head and neck control
  • seems interested in food, for example, by looking or reaching out for food
  • has lost the reflex that automatically pushes any food out of their mouth
  • opens their mouth when you offer food.

To give your baby the best chance of developing good chewing skills and getting the nutrients they need for growth and development, introduce solids after 4 months and around 6 months. Starting solids earlier than 4 months or later than 6 months can affect healthy growth and development and delaying the introduction of the common allergy causing foods does not prevent food allergy.

What?

Introduce foods that the rest of the family usually eats. The aim is that babies are eating family foods by the time they are 12 months old. Some meals will need adapting so that they are a suitable texture, but generally babies can eat what we’re eating – as long as they are unprocessed foods and don’t have added salt or sugar.

There is no evidence for introducing solid foods in any specific sequence or at any specific rate (https://jandonline.org/article/S0002-8223(04)00084-7/abstract). At 6 months, babies need more iron than is available in breastmilk or formula, so it is generally recommended to introduce iron-rich foods in the first month while continuing breastmilk or formula. Soft, pureed meat (beef, lamb) is the richest source of iron, along with iron-fortified cereals. Other iron-containing foods include: chicken, fish, pork, egg, wholegrains, chickpeas, lentils and bean mix.

Before 12 months of age, all babies should be given peanut butter, cooked egg, fish, dairy and wheat products. This includes babies from all families, including those with siblings or parents that already have food allergies or other allergic conditions. Delayed introduction of allergenic foods has been shown to increase the chance of developing food allergy.

There is good evidence that for infants with severe eczema and/or egg allergy, regular peanut intake (twice weekly) before 12 months of age can reduce the risk of developing peanut allergy. Well-cooked egg should be given before 8 months. There is moderate evidence that introducing cooked egg into an infant’s diet before 8 months of age, where there is a family history of allergy, can reduce the risk of developing egg allergy.

Introduction of daily fresh fruit and vegetables might decrease the risk of asthma. Along with iron-rich foods, introduce fruit and vegetables when your baby starts solids in textures that your baby can manage.

Breastfeeding during the period that solid foods are first introduced to infants from around 6 months may help reduce the risk of the infant developing allergies. If formula is used, specialised formulas are not recommended for the prevention of allergies.

If your baby already has an allergy or you are worried about reactions to food, discuss this with your GP, child and family health nurse, accredited practising dietitian, paediatrician or allergy and immunology specialist. You may choose to offer foods one at a time to help with identifying the foods that cause any reactions. Offering a variety of foods is important for your baby’s growth development, so it is important to get help with what your baby can eat to ensure they get the nutrition they need, while managing any food-related reactions.

How?

First foods might be smooth, mashed or in soft pieces, followed by minced foods and then chopped foods when your baby can manage them. By offering a variety of food textures, your baby will develop chewing skills which helps with speech development. It also helps to encourage self-feeding when possible to develop feeding skills as your baby develops.

When you first start introducing solids, offer them after a feed of breastmilk or formula and at a time when you and your baby are relaxed. Try small amounts to begin with and increase according to your baby’s appetite. Your baby will only eat as much as they need, so it’s important to allow them to respond to their hunger and stop offering food once they show signs they don’t want more – such as turning their head away or clamping their mouth shut.

You can offer your baby cooled, boiled water in a cup from six months onwards. But fluids other than breastmilk or formula aren’t really needed at this age.

Wait until 12 months before offering cow’s milk as a drink. Cow’s milk can be included in meals and snacks from around 6 months of age (such as with cereal) but wait until 12 months before offering cow’s milk as a drink. Goat’s milk, sheep’s milk and other mammal milks are not recommended before 2 years.

Calcium-fortified soy milk may be offered from 12 months but other milk alternatives, such as almond milk, rice milk, coconut milk and other nut and cereal milks are not recommended for babies or young children before 2 years unless advised by your GP, child health nurse or dietitian. Fruit juice, cordial and softdrink are not recommended for babies or children of any ages because of their high sugar content. Stick to fresh fruit and water.

There are some foods to avoid until your baby is a certain age:

  • honey until 12 months old
  • raw or runny eggs and foods containing raw eggs (eg. homemade mayonnaise) until 12 months
  •  reduced-fat dairy until 2 years old.

It’s normal for babies to spit out new foods, make funny faces and make a mess! It takes time for them to get used to new tastes and textures. Continue to offer a variety of foods, including the ones they haven’t seemed to like previously. Your baby’s will be very messy and slow until they master the skill of eating, including how to get food to their mouth. Allowing your baby to explore their food by touching it them will help them learn about new foods and will help with expanding the menu, as well as developing fine motor skills.

To prevent choking, always supervise babies and young children while they are eating. Foods that are more likely to cause choking are nuts, apple, grapes, sausages/frankfurts and meat with small bones. Ensure babies and children are sitting down when they eat to reduce the risk of choking. Doing a first aid course is also a good idea for parents.

If there is any allergic reaction to any food, that food should be stopped and you should seek advice from a doctor with experience in food allergy. Some foods can irritate the very sensitive skin on babies faces and cause redness- such as citrus, tomatoes, berries, other fruit and vegemite. This is not food allergy. Smearing food on the skin will not help to identify possible food allergies.

If you are concerned about what your child is (or isn’t) eating, see your GP, child health nurse or Accredited Practising Dietitian specialising in infant and child nutrition.

Resources for Families:
Raising Children Network www.raisingchildren.net.au/babies/breastfeeding-bottle-feeding-solids/solids-drinks/introducing-solids
Australian Society for Clinical Immunology and Allergy: www.allergy.org.au/images/pcc/ASCIA_PCC_How_to_introduce_solid_foods_2016.pdf
Nip Allergies in the Bub (National Allergy Strategy website): www.preventallergies.org.au

Enriching Your Child’s Future!

Enrol now button to lead to enrolment enquiry page.

Enrol