If there is a history of food or environmental allergies in your family, your baby may be at risk for developing food allergies.
In the past, doctors recommended lengthy delays in introducing certain foods to at-risk babies. However, recent research has shown that delaying the introduction of allergenic foods may actually increase the risk of developing severe food allergies.
In 2008, the American Academy of Pediatrics (AAP) changed its guidelines for introducing solids to babies and toddlers that are at-risk for food allergies. The AAP now recommends exclusive breastfeeding or hypoallergenic formula for the first 4 to 6 months of age, then a gradual introduction of solid foods, one at a time.
The First Four Months
Your newborn needs only liquid nourishment. The AAP recommends exclusively breastfeeding your baby or feeding your baby hypoallergenic formula.
Both milk-based and soy-based infant formulas have been shown to increase the risk of developing food allergies in at-risk babies. If you are unable to breastfeed or if your baby reacts to food proteins in your breastmilk, talk to your baby’s pediatrician about prescription hydrolyzed formula for your baby.
There is no evidence that avoiding certain foods while breastfeeding will prevent food allergies or reduce the risk of your baby developing food allergies. However, there have been some studies that have found that babies with atopic dermatitis may have fewer flare-ups when their mothers avoid some foods such as eggs and cow’s milk.
Four to Six Months
When your baby is able to sit upright with support and is interested in solid foods that others are eating, she is ready for her first solid foods. At first, only feed your baby one or two tablespoons of thinned cereal or pureed foods once or twice a day.
For your baby at risk for food allergies, it is important to introduce foods one at a time. The AAP recommends introducing a new food for three days before moving on to a new food, so that you can monitor any potential delayed reactions to the food.
The AAP recommends first introducing fruits, vegetables, and grain cereals. The NIAID clinical guidelines for food allergies state that there is no medical evidence for delaying the introduction of potentially allergenic foods, including major allergens such as eggs, peanuts or wheat.
There is some research that has found that delaying the introduction of potentially allergenic foods beyond six months of age may actually increase the potential of developing an allergy later in childhood. Talk to your pediatrician about your plans for introducing solids.
The AAP recommends introducing foods one at a time. However, most jarred baby purees and baby cereals have multiple ingredients. You may be able to find a few first foods that contain only one food, but there is no guarantee that the food has not been cross-contaminated in the manufacturing plant. The safest way to introduce new foods to your baby is to make your own baby food, so that you have control over the production and know exactly what is in the food.
Six to Nine Months
As your baby expands her diet, it is easy to lose track of which foods you have introduced and which foods may be a problem. Keep a list taped to the fridge of foods that you have introduced and any reactions you have observed. If you think a food may have caused fussiness, GI symptoms, or eczema, stop feeding that food for 4 to 6 weeks and then try re-introducing the food. The reaction you observed may have been a coincidence – your baby may have had a cold or was teething at the time you introduced the food the first time.
Once your baby has incorporated a food into her diet, it is safe to mix that food with other foods that you know are safe. Within a few months of starting solid foods, your baby can eat a wide variety of foods, including:
- Breastmilk or formula
- Fruits and vegetables
- Cereal grains
- Tofu or other soy foods
- Foods that contain peanut or nut ingredients (but no whole nuts)
Nine to Twelve Months
Your baby can begin to eat finger foods at around eight or nine months. Some favorite early finger foods are bananas, teething biscuits, chunks of cooked sweet potato, and o-shaped cereal.
If your baby has not developed any food allergies, you can begin to feed him small portions of foods that the rest of the family is eating. If you have a food mill, you can simply grind up a few tablespoons of the family dinner. Otherwise, you can separate out foods that your baby can handle, such as some noodles or a portion of baked potato.
It is safe to feed your baby small amounts of cheese or yogurt, but do not give him cow’s milk to drink until after his first birthday.
If your baby has developed a food allergy, finding teething biscuits and other prepared finger foods can be a challenge. You will need to learn to read food labels to make sure prepared foods are safe for your baby.
Foods You Should Delay Until Your Baby Has Reached 12 Months
Some foods should be delayed until after your baby’s first birthday, for nutritional or food safety reasons. They include:
- Cow’s milk: Cow’s milk is nutritionally different than human milk or infant formula, which has been made to resemble human milk. Feeding your baby cow’s milk can cause nutritional deficiencies. After your baby’s first birthday, you can feed him whole cow’s milk as part of a balanced diet.
- Honey: Honey can contain botulism spores, and your baby’s stomach is not acidic enough to destroy the spores like older children and adults.
- Nuts or peanuts: Whole nuts are a choking hazard for babies and toddlers. Peanut butter can be a choking hazard for children under 2. If there is a family history of severe nut or peanut allergy, talk to your pediatrician about doing an oral food challenge in the doctor’s office before introducing peanut or nut butter.
- Other choking hazards, such as popcorn, whole grapes, hot dog pieces, cheese cubes, chunks of uncooked vegetables or fruits, or sticky foods such as peanut butter.
Dealing with Conflicting Advice
Peanuts and peanut butter are choking hazards for babies, yet some research indicates that delaying introduction of these foods beyond six months of age may increase the risk of developing a peanut allergy. What is a concerned parent to do?
Because new studies are constantly being published, feeding guidelines can change from year to year. The best way to handle conflicting advice like this is to talk to your baby’s pediatrician or pediatric allergist. He or she can take into account your baby's medical history and risk level for developing food allergies, as well as the most recent feeding guidelines and give you personalized advice about introducing solids to your baby.
American Academy of Pediatrics. Switching to Solid Foods. Accessed online 7/7/2001/ http://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/pages/Switching-To-Solid-Foods.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token
Greer FR, Sicherer SH, Burks AW; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology.Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008 Jan;121(1):183-91.
Koplin, J, et al. Can early introduction of egg prevent egg allergy in infants? A population-based study.The Journal of Allergy and Clinical Immunology. Volume 126, Issue 4. October 2010
NIAID-Sponsored Expert Panel. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel. The Journal of Allergy and Clinical Immunology. Volume 126, Issue 6, December 2010
Nwaru BI, et al. Age at the introduction of solid foods during the first year and allergic sensitization at age 5 years. Pediatrics 2010;125:50-9.
Poole JA, et al. Timing of initial exposure to cereal grains and the risk of wheat allergy. Pediatrics 2006;117:2175-82.
Thygarajan A, Burks AW. American Academy of Pediatrics recommendations on the effects of early nutritional interventions on the development of atopic disease. Curr Opin Pediatr. 2008 Dec;20(6):698-702.