First Foods

August 2, 2011. Posted in: Solid Foods

In what order should I introduce foods?

According to the American Academy of Pediatrics Committee on Nutrition, the order in which other foods are added to your baby’s diet is not that important as long as baby’s breastmilk intake is adequate. Keep in mind that the recommendations here are aimed at babies starting solids at around 6 months or later – babies starting solids earlier are much more prone to food allergies.

Cereal is not at all necessary, particularly the baby cereals. Regular (whole grain) oatmeal is more nutritious for your baby. Many doctors recommend iron-fortified rice cereal as baby’s first food because it is less likely to cause an allergic reaction and because most babies sometime after the 6th month require an additional iron source other than mother’s milk. If your baby starts solids around 6 months or later, there is much less chance of allergic reaction to foods. It’s debatable whether healthy breastfed babies need the extra iron (you can get baby’s iron levels checked if you’re worried about this). In addition, infants need lots of protein and cereal has a low protein-calorie ratio (even lower when mixed with water or fruit). Many experts (including LLL) suggest giving meat or other foods naturally rich in iron instead of foods with added iron. For more information on iron, see Is Iron-Supplementation Necessary?

Trivia: Ever wonder why cereal mixed with breastmilk doesn’t stay thick? Breastmilk contains amylase, which is an enzyme that digests carbohydrates. The longer the mixture sits, the thinner it will get!

For breastfed babies, some nutrition experts suggest skipping the carbohydrates (cereal) as a first food, since breastmilk is already high in carbohydrates, and concentrating on meat or other protein sources. Here is some great info from LLL on meats as one of baby’s first foods: Introducing Complementary Foods. This article also discusses starting solids early for a baby whose working mom is having problems pumping enough milk.

Moms are often told that vegetables should be introduced before fruits “so baby doesn’t develop a sweet tooth.” Keep in mind that breastmilk is quite sweet! Some experts suggest that fruit may be a good first food for a breastfed baby since the taste is closer to that of breastmilk – baby may be more likely to enjoy this new and novel experience if the taste isn’t so unfamiliar. Also, since birth baby has been tasting different flavors as they are passed through into mom’s milk – many feel that this ever-changing flavor of breastmilk is likely to make breastfed babies more likely to enjoy the varying tastes of solids and less likely to be picky eaters in the long run.

LLL suggests this progression when introducing your baby (6 months or older) to solid foods:

 

  • Ripe banana, avocado, yam, or sweet potato (sweet like breastmilk)
  • Meats
  • Whole-grain breads and cereals (rather than baby cereals)
    [wheat and corn are usually delayed until baby is 9-12 months old]
  • Fresh fruits
    [citrus fruits are usually delayed until baby is 9-12 months old]
  • Vegetables
  • Dairy products after 9 months
    [cow's milk is usually delayed until baby is 12-18 months old]

Another source (Marnie Ko in A Detailed Guide to Feeding Your Child: Uncovering the Myths of Infant Nutrition) suggests that bananas and meat are both hard to digest, and shouldn’t be used as first foods. She recommends rice, potatoes, yams, pear and millet as a baby’s first foods.

Recognizing and avoiding food allergies

Most experts recommend that you begin with single-ingredient foods and space the introduction of each new food at least one week apart, particularly if your baby is younger than 6 months (as introduction of solids is not recommended before 6 months) or if there is a history of food allergy in your family. If you introduce new foods in this manner, you will know which food is the problem if your baby has an allergic reaction. According to the American Academy of Allergy, Asthma and Immunology, approximately 2-4% of children experience allergic reactions to foods.

Following are some reactions that may help you recognize an allergy in your baby:

  • Bloating, gassiness
  • Skin rashes (for example, a sandpaper-like raised red rash on the face), eczema, hives
  • Runny nose, stuffiness, constant cold-type symptoms
  • Red itchy eyes, swollen eyelids, dark circles under the eyes, constant tearing
  • Diarrhea, mucousy stools, intestinal upset
  • A red rash around the anus
  • Generally cranky behavior, fussiness, irritability, colic
  • Vomiting or increased spitting-up
  • Asthma
  • Ear infections
  • Poor weight gain due to malabsorption of food

According to the American Academy of Allergy, Asthma and Immunology, six foods account for 90% of food allergies in children: cow’s milk, eggs, peanuts, wheat, soy and tree nuts (walnuts, pecans, etc.). Other allergenic foods include: pork, fish and shellfish, oranges and other citrus fruits, berries, chocolate, tomatoes, corn, and food additives.

Suggested ages for introducing allergenic foods

Here are some recommended ages for introducing some of the more allergenic foods. If there is a strong family history of allergies or if your baby is known to have food allergies (see below), many of these foods should be introduced even later.

Suggested ages for introducing allergenic foods
(for babies who are not at increased risk for food allergies)
NO solids (this includes cereal) or juices
0-6 months
Wheat
Oranges and other citrus
Cheese
Yogurt
Soy
Peas and other legumes (except peanuts)
Egg yolk
Corn
9-12 months
Cow’s milk (including cottage cheese, ice cream)
Pork
Tomatoes
12 – 18 months
Egg whites
Berries
18 – 24 months
Chocolate
2 years
Fish & seafood
Nuts (except peanuts)
2 – 3 years
Peanuts
3 years
Sources:
Prevention of Allergies and Asthma in Children from the American Academy of Allergy, Asthma and Immunology
PDF Preventing or Delaying the Onset of Food Allergies in Infants by the Food Allergy and Anaphylaxis Network
Preventing Allergies in Infancy and Childhood from Allergy New Zealand

What if baby has an increased risk for food allergy?

If your baby is known to have food allergies or eczema, or if there is a strong family history of food allergies, then you will want to introduce certain foods later than you would if your baby were not at risk for food allergy. Following are a few resources:

Sequence of Adding Solid Foods for the Allergic Infant, from Dietary Management of Food Allergies & Intolerances, A Comprehensive Guide by Janice Vickerstaff Joneja, PhD

AAP Policy Statement on Hypoallergenic Infant Formulas “Solid foods should not be introduced into the diet of high-risk infants until 6 months of age, with dairy products delayed until 1 year, eggs until 2 years, and peanuts, nuts, and fish until 3 years of age.”

Preventing Allergies in Infancy and Childhood from Allergy New Zealand

Dairy and other Food Sensitivities in Breastfed Babies @

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