Introducing Complementary Foods to the Infant at Risk for Allergy

The Academy of Pediatrics (AAP) and World Health Organization (WHO) recommend infants receive breast milk or formula exclusively until around 4 to 6 months of age.

The AAP has a great guide detailing the general introduction of solid foods for healthy infants—learn specific recommendations here. The essentials include:

1. Developmental milestones: infant is able to sit up with good head and trunk control.
2. Food safety precautions:
   • No honey (due to risk of botulism contamination).
   • Food is offered in a texture they can safely manage, i.e, no choking hazards, no small round hard items like nuts, cherry tomatoes, grapes, raisins, hot dogs, etc.
3. High-quality and nutritious foods are given:
   • No cow’s milk until after 12 months of age (to prevent anemia since cow’s milk is a poor source of dietary iron).
   • For exclusively breastfed babies, consider offering an animal meat—this is a good source of iron and zinc, which is needed by 4 to 6 months of age.
   • Try nutrient-dense, homemade, single-item foods made fresh and without added sugar or salt, or commercially prepared infant food.
   • For most babies, it does not matter what foods are introduced first.
4. Frequency of foods introduced: Once your baby learns to eat one food, gradually give her/him other foods. Give your baby one new food at a time, and wait at least 2 to 3 days before starting another.

Infants with eczema or a close relative with food allergy are at high risk for developing food allergy themselves. For these children, the first three recommendations are the same, but it may be very important whether certain foods are introduced early, or delayed.

Previously, doctors recommended delaying “allergenic” foods until children were older than 1 year. These recommendations were changed in 2008 because of increasing rates of food allergy. In 2014-2015 allergists realized the delayed introduction of solid foods may actually increase the risk of allergy. These findings have been confirmed for peanuts by a randomized open-label control trial, “Learning Early About Peanut Allergy (LEAP),” that showed earlier introduction of peanuts at 4 to 11 months of age was associated with a lower risk of developing peanut allergy. This is the first randomized trial to show benefit of early introduction of a major food allergen, and may not apply to all infants or all foods. So, what does this mean for your baby? As allergic reactions are often very individual, ask your allergist or pediatrician what recommendations make sense for your family.

When introducing food to your infant, he or she might make a face or spit out that first bite of pureed sweet potato. This is part of normal development and doesn’t mean they don’t like the food. Try the food a few times on different days before giving up. Be careful to immediately discontinue the food and call your doctor if you see a rash; call 911 for severe problems like difficulty breathing. If any food causes a significant and ongoing problem, talk to your doctor or a registered dietitian. Together, you can establish a plan that is best for your baby.