Updated: Sep 24, 2022
By Dr. Wendy Sue Swanson, Pediatrician and Chief Medical Officer at SpoonfulOne
How and when to start your baby on solids can feel confusing with advice and guidelines shifting dramatically over the past decade and even in the past few weeks. We want parents to have peace of mind and confidence about their baby’s first feedings. Introducing foods early and often is key in reducing food allergy risk.
Food allergies have doubled from the previous generation, and babies born today are more susceptible to developing a life-threatening food allergy than ever before. Today, nearly six million children (two children in every classroom) in the United States have a food allergy. These statistics can be alarming, but as parents, you can change the risk for your children from the very beginning.
The American Academy of Pediatrics (AAP) recommends starting your child on solids between 4 and 6 months of age. Research now says early and regular dietary exposure to a food — speciﬁcally a food often associated with allergies, like peanuts — helps reduce the risk of a child developing an allergy to that food. The longer you wait to introduce, the greater the risk. Parents can be intentional about getting these foods in!
Food Allergy Research
Research from the LEAP trial showed that early introduction of peanut to infants at high risk for food allergy between 4-11 months of age, fed at least 3x a week, for five years was safe and reduced development of peanut allergy by 86%. This showed the true risk is not introducing peanut, the risk might be in NOT getting it into a baby’s diet early and often.
We also know from the EAT study, that 98% of babies who were fed foods like peanuts, sesame, eggs, fish, and dairy by five months of age and who kept those foods in their diets regularly did not develop a food allergy.
Signs Your Baby is Ready for Solids
All babies are different, and therefore, it’s important to understand the signs of readiness to start solids. Some babies may be ready right at 4 months, while others closer to 6 months. A few signs of readiness as follows:
● Ability to sit up without support ● Ability to maintain head control when sitting ● Opens mouth wide when you offer food on a spoon Follows foods with their eyes and shows eagerness and interest ● Loss of the tongue-thrust reflex so they don’t push the food out of their mouth
How to Feed Your Baby
I frequently get asked if you can offer your baby multiple foods at one time and the answer is, YES! You do not need to introduce foods to your child one a time, wait a few days, and then offer a new food. That’s old advice. The risk of slow, single food introduction is that it can delay the introduction and inclusion of common allergens during the most important window of time (infancy). Some families may want to introduce foods of concern one at a time, one day apart. However, some may feel confident going more quickly to get diet diversity. The newest edition of Caring for Your Baby and Young Child, Birth to Age 5, which is published by the AAP, states:
“In the past pediatricians recommended starting one new food every few days, so that you can see if a reaction occurs to that particular food. New research has shown that it is safe to start multiple foods at once. Within two or three months, your baby’s daily diet should include breast milk, iron-fortified wholegrain cereals, vegetables, meats (including fish), eggs, fruits, and nut butters (but never whole nuts) distributed among three meals.”
However, we know introducing these diverse foods to young children is difficult. How many of us were able to successfully feed our 4-month-olds foods like shrimp, cod, salmon, and sesame? Food allergy prevention solutions are now available to help support parents.
Breastfeeding and Food Allergy Protection
We recommend breastfeeding in partnership with food introduction. You can enjoy both, and there is no need to wean your child off breastfeeding when you start including solid foods in his/her diet. Breastfeeding provides tremendous benefits to babies, but it’s not likely enough to offer them food allergy protection that can come from complementary introduction when starting solids.
Best Solid Foods to Start Your Baby On
There’s no “perfect” first food to start your baby on, but there are lots of great options. In addition to considering your family’s food preferences, here are a few first foods (in very, very small pieces or puree):
Soft-cooked sweet potatoes, squash, and pumpkin
Soft-cooked carrots, green beans, zucchini, and beets
Cereals that are thinned to a near-liquid consistency with expressed breast milk or formula
Very ripe peaches and pears
Peanut butter thinned with water and mixed into oatmeal
There are a few foods you should steer away from when introducing solid foods to your baby.
Honey: rare risk for causing botulism if introduced in infancy
Cow’s milk: Stick with breast milk and formula as a primary liquid until your baby is a year old. Water is okay after six months of age when starting solids.
Nuts, popcorn, whole grapes, and thick/dense nut butters as they are choking hazards.
Feeding your baby should be an enjoyable experience without worry or fear. Following updated guidelines will greatly reduce the likelihood of a food allergy. Let your babies eat and enjoy!
ABOUT THE AUTHOR
Dr. Wendy Sue Swanson is a pediatrician and Chief Medical Officer at SpoonfulOne. Dr. Swanson is an author, a prominent advocate of evidence-based medicine, and has devoted her career to prevention efforts. She has been a leading voice in health care, working to revolutionize health communications to bridge the gap between parents and doctors. This work has been transformative for parents navigating the complex landscape of food allergy prevention.