Introducing foods to a baby

One of the more confusing issues as a parent feeding your little one is when to start feeding them different foods. A reasonable guideline for when to first feed an infant is at 6 months. Before this time a child’s gut is not fully developed and can have trouble digesting and absorbing certain foods. Basically their gut is not designed for solid food before the age of 6 months, and this is now recognized by the World Health Authority(1).

Most parents probably expect a gudeline saying this is what you should feed over months 6-8, and this is what you add over months 8-10 etc. However, individual requirements vary and families need to make it work for their situation. As such, it makes more sense to be sure which principles apply for the 1st few months of feeding, rather than following a set plan.

Starting requirements

When weaning a baby from breast milk, or bottle they need initially to get used to chewing solid foods and swallowing larger lumps. Break foods up into small pieces to start with and either allow baby to feed itself (baby-led weaning) or use plastic spoons, tipping them up as you withdraw the spoon from the mouth.

It is best to introduce new, potentially allergenic foods one at a time and at least 3 days apart to allow any symptoms of allergy to become apparent. These are rashes, abdominal discomfort, fussiness, bloating, diarrhea and vomiting. Facial swelling and difficulty breathing are more serious and you should seek immediate medical help if these occur.

Note that if a breastfeeding mum has eaten a particular food, then unless baby has had a reaction within a couple of days it is less likely to react to that food when it is weaned onto it.

Baby’s gut development

After 6 months of age a baby’s intestines become less permeable to potentially allergenic proteins in foods, and so at that stage it becomes possible to consume most foods. It really is not necessary or even desirable to use special baby products. These are the baby equivalent of processed junk food. As a general rule baby will start off eating the same as its parents with a few exceptions covered below.

Note that baby’s gut microbiota will change to an adult configuration after stopping breast feeding and not on the introduction of solid foods.

Babies with allergy

If your baby has either hay fever, asthma or eczema, then it will be at increased risk of food allergy. The sensible procedure in this case is to introduce possible allergenic foods one at a time, giving a minimum of 3-4 days between each one. The foods to be careful with in decreasing order of prevalence are:

  1. milk – may be delayed until 12 months
  2. eggs
  3. wheat – may be delayed util 12 months
  4. nuts – also a choking hazard unless crushed into small pieces
  5. seeds – another choking hazard
  6. fish - bones are a choking hazard
  7. shellfish

There are of course reasons other than allergy for delaying the introduction of certain foods and this is covered below.

Foods of concern

Fish

o        Fish and toxins. Some authorities worry that fish can contain large amounts of mercury. Mercury is particularly damaging to fetus’s during pregnancy, affecting brain development. However, this is only really of concern with 4 particular species, marlin, whale, swordfish and shark which contain a greater amount of mercury than protective selenium. Selenium binds to mercury preventing it being absorbed. Other species contain a better ratio of mercury to selenium and can be considered relatively safe for a baby.

o        Fish and omega 3 oils. The upside of consuming fish and especially oily fish such as salmon, trout, sardines and herrings is that they all contain plenty of easy to absorb omega 3 oils such as DHA and EPA. These are particularly important in helping infants brains develop.

o        Fish and allergy. It has been found that omega 3 oils taken in pregnancy reduce the incidence of allergic skin complaints after birth. When baby is being weaned it is sensible to include oily fish as this can also help reduce risk of atopy. The only fish to avoid are the 4 mentioned above.

o        Summary: Introduce at 6 months, avoid marlin, whale, swordfish and shark, include some omega 3 containing fish, ensure the fish doesn’t contain bones that could be a choking hazard.

Meat

o        Red meat contains iron which is easily absorbed. When your baby starts being weaned it is quite important to include sources of easily absorbable iron in your baby’s diet. The best sources are organ meats such as liver and kidneys as well as beef and lamb. A meat such as lamb may need stewing for over 2 hours to be tender. Other good sources include egg yolks, chicken and seafood. A baby can be started on meat from 6 months as long as it is divided into small enough pieces.

Shellfish

o        Shellfish are generally smaller than fish and therefore contain less toxic mercury and fewer damaging plastics, as both these accumulate higher up the food chain. For comparison a typical shrimp contains around 1/100th of the amount of mercury when compared to a swordfish.

o        Shellfish cause allergic reactions in many people. However it is safe to introduce it to babies from the age of 6 months. The caveat is that if your baby has chronic eczema or if allergy runs in the family then it is wise to start your baby off on other foods and only introduce shellfish a month or two down the line, while carefully monitoring your baby for any reactions.

Alliums

o        Babies are quite often allergic to onions and garlic. There is no need to delay introduction of these foods after 6 months, but do monitor your child for any reactions once introduced and do introduce it 3 days separated from any other new foods.

Eggs

o        A few babies (0.5-2.5%) are allergic to some of the proteins in egg whites(2). This is thought to be the 2nd most common infant food allergy after cow’s milk. However, the cholesterol, saturated fat and fat soluble vitamins inside the yolk are needed for good health. If your child is allergic to egg then it may well be OK to feed it yolks. Scrambled egg are an easily digestible form.

o        Summary. Introduce from 6 months, start with scrambled eggs and then after a few months boiled eggs and omelettes, which are harder to swallow, will be able to be eaten.

Wheat/gluten

o        Wheat and its constituent gluten in the form of bread and cereals, have been used for weaning babies for many years, but they are not the best choice. Studies show that incidence of celiac disease before age 5, and intolerance to wheat is minimised when wheat containing foods are introduced after baby’s first birthday.

Fermented foods

o        Most fermented foods can taste quite sour. However they generally contain organisms such as friendly bacteria and yeast that can help regulate your baby’s gut and strengthen its immune system, making it less likely to get eczema, asthma and other allergic diseases.

Nuts, seeds and peanuts

o        These can be choking hazards and can also cause allergy. Peanuts in particular are associated with deadly allergic reactions and should not be introduced before 6 months of age. All nuts can be choking hazards and care must be taken to crush them into small enough pieces if feeding them to your baby.

Processed foods

o        I’d advise not using any foods out of packets for your child, just as I would for an adult. All specially formulated baby foods come into this category. The problem with processed foods is that they often contain additives to help preserve them, make them more palatible and give them exciting colours. Many of these additives are not good for your childs health.

Choking hazards

o        Grapes can be choking hazards for infants and it is important to ensure these are broken into small enough pieces for your child.

o        Foods that are not of concern can still cause choking if they are undercooked or too hard. Test foods out with a knife to ensure they are soft enough to slip down the throat. Our little girl soon got going with large pieces of banana and courgette. The whole piece the size of a large cigar would get sucked up, and then an unforgettable expression as the whole piece was swallowed. Certainly worrying the first time, but they get better at managing what size they can swallow as they get older! 

 

At 1 years old

It is considered acceptable by some authorities to introduce cow’s milk at this stage, although if you are breastfeeding still, this may not be sensible.

It is also the age at which wheat can be introduced without increasing the risk of celiac disease(3).

Summary

A baby from 6 months of age can eat anything. There are reasons to delay the introduction of gluten (wheat, pasta, bread, cereals etc.) as well as cow's milk, but most other foods are fine. The key is to make foods easy enough to chew and swallow at the start and to take more care with the specific foods mentioned above if your baby is showing any signs of allergy.

References:

1. http://www.who.int/nutrition/topics/infantfeeding_recommendation/en/ WHO guidelines

2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3069662/  Egg allergy prevalence.

3. http://chriskresser.com/does-early-introduction-of-gluten-prevent-celiac-disease-in-kids/