Introducing Solids to Baby: Which Ones, and When?

Pediatric Blog

Anna posted: “I have a question about starting solids and grains. I am starting my 6 month old on solids. A friend recently told me that babies younger than 1 year cannot digest grains as they don’t have the necessary enzymes. Is there any truth to this? Also, one of the pediatricians in our practice told me we can start eating red meat- isn’t it too early?”

There’s been a big change in the thinking about solids over the last ten years or so. In the past, it had been recommended to delay certain foods—the ones thought to be the most likely allergens—until certain ages. The thinking was that this would somehow prevent allergies. You can still find these elaborate schedules on the internet: avocado at 33 weeks, egg whites at 34 ½ weeks, chopped venison au poivre at 36 weeks, all very specific, and all very strict. It turns out that was all nonsense, too.

A 2008 AAP statement threw all of those recommendations out of the window, pointing out that there was never any evidence that delayed introduction of any foods decreased allergy risk. In fact, evidence was accumulating from here and abroad that foods started earlier were LESS likely to become foods that children would become allergic to. Cultures with earlier consumption of peanut, for instance, had far less peanut allergies than places where peanuts were not part of an infant diet.

Now, the allergists have formally agreed, with their own recommendations from the American Academy of Allergy Asthma and Immunology (the AAAAI—how do they pronounce that?) Start complementary foods, any ones you’d like, at 4-6 months. That could include egg, peanut butter, fish, berries, you name it. There is no reason to delay certain foods—that’s quite unlikely to prevent allergy, and might well make allergy more likely.

Some further evidence-based guidelines about food allergies from the AAP and AAAAI: there is no reason for pregnant women to avoid any foods, unless they themselves are actually allergic. (There are foods to avoid for infection reasons, I’m only talking about allergy issues here). And breastfeeding prevents allergy, too.

Anna, whatever you’ve heard about babies lacking enzymes to digest grains, that’s just weird internet rumor. Babies do fine with ordinary grains like rice, oats, barley, and wheat (though they don’t need anything but breast or formula for the first 4-6 months of life.) And meat is fine to introduce at 4-6 months—in fact, in many countries, meat is a first weaning food, before cereal. It’s easy to digest and a good source of protein and iron.

So: these firm rules about exactly what and when to feed babies can be ignored. You do need to avoid choking hazards (no peanuts, no hot dogs for infants!), and you need to avoid raw unprocessed honey until 12 months to prevent botulism. Other than that, starting at 4-6 months, your baby can taste what you’d like her to taste. Yummy!

© 2013 Roy Benaroch, MD

This blog was originally posted on The Pediatric Insider