Introducing solids to baby: Which ones, and when?

The Pediatric Insider

© 2013 Roy Benaroch, MD

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!

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6 Comments on “Introducing solids to baby: Which ones, and when?”

  1. Is the recommendation still to spread out the foods as you introduce them? So say, start with cereal and give it a few days to see if you get a reaction? How much time would I need to wait before I would see a reaction?


  2. Dr. Roy Says:

    Emily, that’s the traditional recommendation, and it does make some sense. But really, it’s probably not necessary to be super-careful about these things. Serious food allergies occur minutes after ingestions, not days later. There’s no good reason to wait more than a day (if that) between new foods.


  3. araikwao Says:

    What about rice cereal? I’ve read about the issue of arsenic and that AAP recommends only giving it 1x/wk – is that just an issue in the US or is it something we need to worry about in other countries too?
    Also, I understood that breastfeeding doesn’t protect against allergy, despite what has been reported for a long time?


  4. Dr. Roy Says:

    The arsenic-rice issue arose after a Consumer Reports article published last year. I have not yet read it yet (it’s behind a paywall, or at least I can’t find it on their website.) It’s a good question, tho, so I will get my hands on that article and review it here in detail. (Email me that article if you’ve got it!)

    Meanwhile, though– I will tell you that I wasn’t impressed last time Consumer Reports raised an arsenic scare. They made a splash in 2011 about arsenic in apple juice, and Dr Oz made a big deal about it on his show. Bottom line: their reference standard was wrong (they used the quality cut off for water, which wouldn’t be the same as juice), and they confused and mixed different kinds of arsenic with differing toxicity. In other words: Consumer Reports blew it on that issue, as they do on other health issues when its obvious that they’re more interested in ratings and making headlines than in offering balanced information. I’m not going to take their word for it, immediately, that rice is unsafe.

    The AAP has not recommended a specific amount of rice cereal that’s appropriate. Their statement from Sep 2011 recommended that rice be part of an ordinary, mixed diet. Starting at 4-6 months, babies be offered a variety of complementary foods.


  5. Dr. Roy Says:

    UPDATE: I found the consumer reports rice-arsenic report via Google:

    Briefly: once again, consumer reports seems to have blown it. I need to write about this in more detail, and I will shortly. But bottom line: they again used the standard for drinking water, like they did with apple juice, as the safety threshold for rice. That’s inappropriate– people don’t consume as much rice as water, not by a long shot. They used 5 ppb (water threshold); buried in their article is the tidbit that international organizations consider upper safe limit 200-300 ppb. Yes, many of the rice samples CR tested were above 5; none were anywhere close to above 200.

    We do need to reduce the use of chemicals like arsenic in agriculture, and study ways to reduce toxicity. But scare articles like CR likes to publish are not helping anyone stay healthy.


  6. araikwao Says:

    Thank you!! I saw something about it on SeattleMamaDoc, but hadn’t gone chasing the article yet. But given that I have an almost-four-month-old, it is rather pertinent! Thanks so much for following it up for me.


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