Introducing solids and the fear of allergies

Introducing solids to infants is fun and exciting, but food allergies can cause problems ranging from rashes to life-threatening reactions.

As a pediatrician, parents come to me every day with questions about introducing solids and concerns about food allergies, especially as new research suggests it’s better to introduce foods that are considered as highly allergenic earlier than previously thought. As a mom of a 6-month-old, I’m living this at home. My daughter recently tried carrots, squash and green beans. Up next are peanut butter and eggs!

Foods that commonly trigger allergic reactions include eggs, milk, soy, wheat, peanuts and tree nuts, fish and shellfish. Using your pediatrician’s guidance as to how to proceed can take away any worries or concerns parents have for introducing new foods to your baby. Here is a brief summary of current recommendations.

Introducing solids

Babies can fulfill all of their nutritional needs from breast milk and/or formula when they’re 4 to 6 months old. There are multiple factors that influence the readiness of an infant to start solid foods. The risk of sucking food into the airway is there, but another risk is the intestinal development of certain digestive enzymes.

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Some babies are ready by 4 months old, but in general introducing solids at 6 months is recommended. As mentioned above, newer research suggests to introduce highly allergenic foods as early as 6 months. As a matter of fact, delaying the introduction of these foods may increase your baby’s risk of developing food allergies. However, cow’s milk and honey are still not recommended until after the first birthday.

Proceeding with caution

Parents should first test tolerance of less allergenic foods, one at a time, such as pureed vegetables, fruit and rice or oat cereal before gradually testing higher allergenic foods. New foods can be introduced every three to five days to give enough time for delayed reactions to be recognized.

But wait, how do I give a baby nuts? Nuts in whole form and spoonfuls of nut butters are choking hazards and should be avoided until babies are much older. One easy and safe way you can introduce nuts is through nut butters mixed with pureed fruits and vegetables. I’ve even seen products in powder form containing small amounts of allergens that can be mixed with pureed food.

Other foods such as fish can be flaked into small pieces or pureed. Eggs can be scrambled and given in small pieces.

If you have a family history or an older child with food allergies, it’s best to talk to your pediatrician about how to proceed. Your pediatrician may recommend allergy testing. 

Recognizing intolerance

Some kids will be allergic regardless of when highly allergenic foods are introduced. Some signs of allergic reaction include hives, wheezing, vomiting or swelling of the face or tongue. If wheezing, paling or swelling of the face or tongue occurs, call 911 immediately. You should also contact your pediatrician if you suspect a food is not being tolerated. They can help you determine if further tests are needed or if a reaction is something outside of allergies. For example, some foods may cause eczema to flare in young children. 

Other concerns

Sometimes breastfeeding moms ask if they need to restrict allergens from their diets. If a child is well, restricting a nursing mother’s diet of specific allergens is not usually recommended. Breast milk is the ideal way to nourish your baby and is the least likely to trigger an allergic reaction.

As always, it’s best to bring your concerns about food allergies and anything else to your pediatrician. We are your best resource.

Melanie Custer, MD Pediatrician West Bend Pediatrics

The Children's Wisconsin Clinical Nutrition team believes that every child deserves the best and is dedicated to helping each child reach their potential through optimal and personalized nutrition. Our team of Registered Dietitians (RDs) works with children and their families throughout the hospital, both inpatient and outpatient, across multiple specialties to help each child thrive.