Starting your infant on solid foods is an exciting time as they are introduced to new flavours and textures. These early experiences with food are important as they have a strong effect on your child’s health and attitudes to food later in life1. The skills infants learn at this time, as well as the variety of tastes and textures they are exposed to, form the foundation of future eating behaviours2.
Why do parents of infants with CMA find introducing solids so difficult?
Introduction of solids can be challenging for any parent but it can be even more daunting for parents of infants with CMA. Many foods that are traditionally introduced early on, for example yoghurt, cheese and custard, contain cow’s milk protein. As your child progresses onto different textures, pre-prepared foods like certain baked goods, cereals and breads may also contain cow’s milk protein. Parents of children with CMA have the added challenge of needing to learn how to read the food labels in order to be able to choose the ones that are appropriate for their child.
Another concern of many parents of children with CMA is when to introduce other foods that are known to be allergenic. Foods like egg, soy, wheat and nuts are also common food allergies in children and infants3. Parents are understandably cautious when it comes to feeding their child these foods.
Introducing solids is further complicated by restrictions on when certain foods can be commenced in your child’s diet. Soy based infant formula is not recommended for use in infants under 6 months of age due to potential risk of allergy3. Other types of milk, like rice, nut (i.e. almond) and oat milk are also not recommended for use in infants under 12 months of age1. This is due their inadequate nutrients and energy. If these milks are to be introduced at 12 months, this should be done under the supervision of a health care professional.
Fortunately there is help available, through your doctor and dietitian. They can help to make the transition to solids a smooth and stress free transition.
How can a dietitian help?
Accredited Practising Dietitians are experts in food and nutrition. They can advise parents on how to confidently navigate the introduction of solids for an infant with food allergies.
An Accredited Practising Dietitian can advise parents on:
When to introduce solids
Australian guidelines recommend that for infants with food allergies, introduction of solids should happen between four and six months of age, while continuing breastmilk or infant formula3. The point at which to commence solids within this timeframe depends on when your infant is developmentally ready. An Accredited Practising Dietitian can help you identify the signs of readiness for solid food and work with you, the parents, to introduce solids at the right time for your child.
Signs of developmental readiness include1,2:
- Showing interest in food
- Increased appetite
- Sitting upright with limited support
- Progressing from sucking to biting and swallowing when feeding
The introduction of new textures into your child’s diet helps them learn the skills that are needed for eating. The texture and consistency of foods offered to your infant at each age should be right for their developmental stage1:
- From 4-6 months foods offered should be pureed, progressing to mashed, then to minced and chopped foods
- By 8 months most infants can manage ‘finger foods’. This stage helps to develop hand eye co-ordination
- By 12 months infants should be consuming a wide range of nutritious foods. Generally they can eat the same foods as the rest of the family
Offering a wide variety of flavours helps to maximise your child’s willingness to accept new foods. Australian Infant Feeding guidelines recommend that the first foods that are introduced should contain iron, for example iron enriched infant cereal, pureed legumes, meat, chicken or fish1. This can then be followed by pureed fruits and vegetables. The order in which new foods and flavours are introduced is up to the family, as long as iron rich foods are introduced first1. For infants with allergies, like CMA, new foods can be added in every 2-3 days so that any possible adverse reactions can be seen3. In the first 12 months of life foods that are included in the diet should be without added honey, salt or sugar1.
Are there any foods that should be avoided when introducing solids to infant’s with CMA?
There is no need to delay the introduction of other foods that commonly cause allergies, even for infants with CMA3. These foods include cooked eggs, wheat products and peanut butter. Foods should be introduced when your infant is developmentally ready for that texture. The types of foods that are introduced should be in line with what your family usually eats. There is even some evidence that including certain foods that commonly cause allergies early on, may be protective against developing an allergy to that food in the future3.
Some infants with CMA, however, will still develop allergies to other foods. If this happens it is important to stop that food and seek advice from your doctor
In order to safely introduce new foods into the diet of your infant with CMA it is recommended that3:
- New foods are introduced one at a time and start with single ingredients
- Introduce new foods 2-3 days apart to allow time for any adverse reaction to be observed
- Discuss clear steps with your doctor to follow in case of an allergic reaction to a food, particularly what to do if your child’s breathing is affected.
- Try to introduce new foods earlier during the day, so that you can observe any possible reactions and get advice if necessary.
For some new and allergy free recipes go to:
Starting your infant on solid foods is an exciting time as they are introduced to new flavours and textures
- NHMRC 2012 Australian Infant feeding guidelines: Information for health workers National Health and Medical Research Council, viewed 20 May 2016, Available: https://www.nhmrc.gov.au/guidelines-publications/n56
- Australian Department of Health, 2011, Introducing Solids, Australian Government, viewed 20 May 2016, Available: http://www.health.gov.au/internet/publications/publishing.nsf/Content/gug-director-toc~gug-solids
- ASCIA, 2014, Food Allergy Clinical Update for Health Professionals, Australian Society of Clinical Immunology and Allergy, viewed 21 May 2016, Available: https://www.allergy.org.au/health-professionals/hp-information/asthma-and-allergy/food-allergy