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Introducing Solids is an exciting milestone for mother and baby and also a period of great learning. Recent changes around recommendations for the introduction of allergies, have resulted in much confusion when it comes to how, when and what to introduce when it comes to solids. Paediatric Dietitian and nutritionist, Olivia Bates, clears up the confusion!
When?
Over the years, the recommended timing for commencing solids has changed in line with recommendations for the introduction of allergens. The current guidelines from the World Health Organisation and the Australasian Society of Clinical Immunology and Allergy (ASCIA) state that complementary foods should be introduced around 6 months but not before 4 months. This covers a window from 4 to 6 months, when baby is showing these key signs of being ready to commence solid:
• Good head and neck control, ability to sit upright when supported
• Showing an interest in food
• Reaching out for your food
• Opening mouth when offered food on a spoon
• Gradual disappearance of the tongue’s push extrusion reflex
What?
What to introduce is really dictated by individual cultures. The key consideration, is to ensure from 6 months of age that iron rich foods are offered to bub.
Iron rich foods include:
• Meat
• Poultry
• Eggs
• Fish
• legumes
• fortified cereals
It is also important to ensure foods are the appropriate texture for bub. When first starting solids, foods should be a smooth puree (unless doing baby led weaning*) and contain no added salt or sugar. The texture of purees should be gradually progressed from smooth to mashed then chopped. By 8-9 months bubs should be consuming finger foods.
Babies have an innate craving for sweet foods so current recommendations, encourage introduction of vegetables before fruit, to increase their acceptable. It is also important not to sweeten vegetables with fruit purees such as apple and pear as it gives baby a false appreciation of the real taste of veg and will likely result in rejection down the track when you offer the unsweetened version.
How?
Initially new foods should be introduced one at a time and at least two days apart to allow you to observe for any adverse reactions. Allergic reactions will take place almost immediately (2 minutes to 2 hours), while intolerances may take longer to take effect. New foods should also be introduced in the first half of the day and after a nap so bub can be observed for at least 2 hours before going down for another nap.
The latest revision of the ASCIA guidelines, recommends that all allergen foods (eggs, peanuts, tree nuts, soy, wheat, shellfish and cow’s milk protein) be introduced by 11 months of age, and eggs be one of the first foods to be consumed. This reflects the most up to date research which has shown that the introduction of peanut to infants with severe eczema and/or egg allergy before 12 months can reduce the risk of these infants developing peanut allergy by around 80% (1, 2).
1. Du Toit G et al. Effect of avoidance on peanut allergy after early peanut consumption. N Engl J Med. 2016. DOI: 10.1056/NEJMoa1514209
2. Du Toit G et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015 Feb 26;372(9):803-13
