ASCIA Information on how to introduce solid foods to babies for allergy prevention

Parent information: Frequently asked questions (FAQ) 

pdfASCIA PCC How to introduce solid foods FAQ 2018184.56 KB

how to introduce solid foods to babies for allergy prevention 2018This information aims to provide practical advice on how to introduce solid foods to your baby and is based on currently available evidence for food allergy prevention. This advice is relevant for all babies, particularly those with severe eczema, or existing food allergy or a family member (parent or sibling) with allergies.

Fast facts
  • Start to introduce solid foods around 6 months (not before 4 months) and when your baby is ready. If possible, continue to breastfeed your baby while you are introducing solid foods.

  • When introducing solid foods to your baby, include common allergy causing foods by 12 months in an age appropriate form, such as well cooked egg and smooth peanut butter/paste. These foods include egg, peanut, cow’s milk (dairy), tree nuts, soy, sesame, wheat, fish and other seafood. Studies show that this may reduce the chance of developing food allergy in babies with severe eczema or egg allergy.

  • Once introduced, continue to give these foods to your baby regularly (twice weekly) as part of a varied diet, to maintain tolerance. Trying a food and then not giving it regularly may result in food allergy development.

  • It is important to note that some babies may still develop a food allergy despite following this advice. If your baby has an allergic reaction, stop giving that food and seek medical advice.

Q 1: Why should egg and peanut be introduced by 12 months of age? 
  • All babies should be given common allergy causing foods by 12 months, including egg and peanut in an age appropriate form such as well cooked egg and smooth peanut butter/paste. This includes babies who have severe eczema, another food allergy, or a family member with food allergy, even though they may have a higher chance of developing food allergy.

  • Parents are sometimes worried about giving egg and peanut to their babies, as they commonly cause food allergies. However, it is best to offer your baby well cooked egg and smooth peanut butter/paste regularly (twice weekly), starting before 12 months of age. Delayed introduction of these foods has been shown to increase the chance of developing food allergy.

Q 2: How should egg and peanut be introduced?
  • Introduce well cooked egg and smooth peanut butter/paste in small amounts to start with, as you would with other foods. You may choose to do this during daytime rather than the evening, so that you can watch your baby and respond if they have an allergic reaction.

  • If you require some guidance you may wish to:

  • Mix a small amount (¼ teaspoon) of hard-boiled egg or peanut butter/paste into your baby’s usual food (such as vegetable puree)

  • Gradually increase the amount if your baby is not having any allergic reactions, for example ½ teaspoon the next time.

  • You can rub a small amount of the food inside your baby’s lip as a starting point. If there is no allergic reaction after a few minutes, you can start giving small amounts of the food as described above.

  • Never smear or rub food on your baby’s skin, as this will not help to identify possible food allergies.

Q3: What should you do if your baby has an allergic reaction?
  • If you notice any swelling of the lips, eyes or face, hives or welts, vomiting, or any change in your baby’s well-being (becoming very unsettled) soon after giving a new food, your baby could be having an allergic reaction. You should stop feeding your baby that food and seek medical advice.

  • Call an ambulance immediately if there are signs of a severe allergic reaction (anaphylaxis) such as difficult/noisy breathing or your baby becomes pale and floppy, or if there is tongue swelling.

  • Allergic reactions usually occur quickly, within minutes, while other reactions to foods may be delayed.

  • It is important to note than minor redness around the mouth is most often due to skin irritation and is not usually due to an allergic reaction.

  • Information about the signs and symptoms of mild to moderate and severe allergic reactions (anaphylaxis) is on the ASCIA website: allergy.org.au/patients/about-allergy/anaphylaxis 

Q 4: What should you do if your baby already has food allergies? 
  • Make sure you have appropriate medical advice, including an accurate diagnosis and management plan.

  • Babies with cow’s milk, wheat or multiple food allergies should also be seen by a dietitian to help maintain nutritional intakes, as avoiding these foods can impact growth and development.

  • If your baby has cow’s milk and/or egg allergy (including reactions to lightly cooked cow’s milk or egg) but does not have allergic reactions to baked foods containing cow’s milk or egg (such as muffins, cakes or biscuits), continue to give these baked foods. If you are uncertain that the baked foods are tolerated, discuss this issue with your doctor or dietitian before introducing these foods at home.

  • It is important to replace the food your baby is allergic to with nutritionally equivalent foods. For example:

  • If your baby is allergic to wheat, alternatives such as white or brown rice, corn, quinoa, buckwheat and millet should be included in their diet.

  • If your baby is allergic to cow’s milk they should continue to be breastfed or given an appropriate cow’s milk free formula. 

Q 5: What should you do if other family members have food allergies?

If other family members have food allergies, it is still important to introduce those foods to your baby.

To keep the family member with food allergies safe, you can:

  • Give the food to your baby whilst they are in a high chair.

  • Wash your hands, your baby’s hands and your baby’s face after giving the food.

  • Consider having a separate coloured face washer to wipe up your baby’s spills or spits.

  • Thoroughly wash all utensils used with the food the family member is allergic to, in warm soapy water.

  • Initially consider giving the food to your baby when the family member with food allergy is not at home.

  • Discuss introducing foods with your dietitian or Allergy & Anaphylaxis Australia or Allergy New Zealand.

Q 6: How do you know if your baby is ready to start solid foods?

Your baby should be ready to start eating solid foods around 6 months (not before 4 months) when they:

  • Have good head and neck control and can sit upright when supported.

  • Show an interest in food, for example, when they look at food on your plate and watch you eat.

  • Reach out for your food.

  • Open their mouth when offered food on a spoon.

These signs happen at different times for different babies. If your baby is not eating solid foods by 7 months of age, discuss this with your child health nurse, doctor or dietitian.

Q 7: How should solid foods be introduced? 
  • Learning to eat solid foods takes time, so be patient with your baby.

  • Offer your baby foods that are the right texture for their developmental stage, such as:

  • smooth foods (pureed or mashed) from around 6 months (not before 4 months)

  • lumpy foods and finger foods by 8-9 months

  • cut up foods by 12 months.

  • Aim for your baby to be eating healthy family meals by 12 months of age.

  • If your baby does not seem interested in eating or trying new foods, wait a few days and try again.

  • Babies with food allergies may take longer to get used to eating new foods and new textures of foods.

  • If your baby is having feeding problems discuss this with your child health nurse, doctor or dietitian.

Q 8: In what order should solid foods be introduced? 
  • Solid foods can be introduced in any order. However, iron rich foods need to be included around 6 months (not before 4 months). These include iron enriched (fortified) cereals, meats, poultry, fish, well cooked egg, tofu and legumes (such as chick peas).

  • You may choose to introduce one new food at each meal time so that if an allergic reaction occurs, the problem food can be more easily identified.

  • If a food is tolerated, continue to give this food regularly as a part of a varied diet, to maintain tolerance. Trying a food and then not giving it regularly may result in food allergy development.

Q 9: Why is it important to give your baby a variety of foods?
  • Babies need to learn to eat a variety of foods, from each food group, to receive adequate amounts of important nutrients including fat, protein, vitamins and minerals, such as calcium, iron and zinc.

  • It is therefore important to continue to regularly give foods that you have introduced to your baby so that they are eating a wide variety of foods from each food group by 12 months, including:

  • Cereal foods - such as bread, crackers, pasta, iron fortified cereals. Offer a variety of grains including wheat, rice, oats, corn.

  • Dairy foods - such as yoghurt, cheese, cow’s milk on cereal. Cow’s milk should not be given as the main milk (instead of breastmilk or formula) for babies under 12 months.

  • Meat and alternatives - such as beef, lamb, poultry, well cooked egg, fish, other seafood, legumes, nut butters/pastes, tofu.

  • Vegetables and fruits – Offer a wide range and grate, cook, puree or mash to prevent choking.
Q 10: How can you prevent your baby from choking on hard pieces of food? 
  • Do not give babies foods with small hard pieces such as raw apple or carrot, whole or chopped nuts.

  • Grate, cook, puree or mash hard fruits or vegetables.

  • Use smooth nut butters/pastes (or nut flours if available) when introducing nuts to babies.

  • Give suitable finger foods for babies such as steamed vegetables, roasted vegetable wedges, strips of meat, fish or chicken, soft fruits, bread or toast and crackers.

  • Always supervise babies or young children while they are eating and ensure they are seated.

Q 11: What drinks should you give your baby? 
  • Breast milk or formula will continue to provide important nutrients once your baby is eating solid foods.

  • From 8 months, offer water, breast milk, cow’s milk based formula or other formula from a cup.

  • As your baby eats more solid foods they will demand fewer breast milk or formula feeds. However, take care not to replace milk feeds too quickly with solid foods. 

Q 12: Where can you obtain further information?

Visit the ASCIA website for infant feeding/allergy prevention and food allergy information: www.allergy.org.au/patients/allergy-prevention   www.allergy.org.au/patients/food-allergy

For patient support contact:

© ASCIA May 2018

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand

Website: www.allergy.org.au
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Postal address: PO Box 450 Balgowlah NSW 2093 Australia 

Disclaimer:

This document has been developed and peer reviewed by ASCIA members and is based on expert opinion and the available published literature at the time of review.  Information contained in this document is not intended to replace medical advice and any questions regarding a medical diagnosis or treatment should be directed to a medical practitioner. Development of this document is not funded by any commercial sources and is not influenced by commercial organisations.

Content created May 2018

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