Preventing allergies: When to introduce solid foods

Dr. P's Pediatric Journal Club

The study
Data on 2,612 German infants was gathered from birth as part of an ongoing study looking at when solid food was first introduced and the development of allergies by two years of age.

What the study found

• Waiting until after 6 months of age to start solid foods did not have a protective effect on the development of eczema ("atopic dermatitis") or other recognized allergies at age 2 years.
• Waiting until 4 months of age to introduce solid foods may or may not have had a protective effect on the development of allergies. The data were not clear.
  

Dr. P comments
My WebMD Message Board is filled with parents who are agonizing about what, when and how to introduce solid foods to their infants. It's also filled with a ton of different opinions - "I fed my baby cereal at 2 months and she is fine!"... "Hold off until she is past 6 months or she will have allergies!" ... "My pediatrician says that 4 months is OK, but only cereal!" The only similarity between the varying opinions is that each side is 100% certain that their way is the right way!

Whenever there is such diversity in parents' and pediatricians' advice, you can bet it's because kids do fine almost no matter what the parents do, and because there isn't much scientific evidence to guide us one way or the other. (Interestingly, these are often the parenting issues about which the various camps feel most passionately.)

As the authors of this study state: "Scientific evidence supporting a delayed solid food introduction for the prevention of atopic diseases [allergies] is scarce, inconsistent, and based on a few studies only." This study helps by demonstrating there to be no benefit in waiting for more than 6 months, and suggesting that it's still up for grabs whether there is really a benefit in waiting 4 months.

Truth be told, this is a common scenario for pediatricians: often there is insufficient scientific evidence to strongly recommend one practice over another. So we essentially fly by the seat of our pants and make our best judgment based on meager evidence and our experience, and wait for definitive research to clarify the issue.

So here's my seat-of-the-pants advice on starting solid foods:

• Hold off the introducing solid foods until 4-6 months. (Remember that cereal does not increase sleeping through the night!)
• Introduce one new food every few days, so if there is a digestive problem or apparent allergic reaction, you will know what may have caused it.
• Always be sure the texture of the food is such that your baby doesn't cough and sputter when it is introduced.
• Introduce the small amount of the new food when your baby is hungry - before, not after, he has had her milk. Then gradually increase the amount.
• Don't let "neophobia" (fear of new foods) discourage you. Even if your infant doesn't take well to some (or all!) solid foods, never try to force feed him. Remember that milk alone can serve the baby's nutritional needs until at least 6 months. Gently and cheerfully reintroduce the hated taste/texture at another time.
• Most importantly: keep meal time fun and pleasant for all. In the long run, that's much more important than whether your bundle of joy eats his broccoli or not. More than anything else, emotional warmth and support at mealtime is what promotes a love of eating in the child and makes family meals a joy.

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Article cited:
"Timing of solid food introduction in relation to atopic dermatitis and atopic sensitization". Zutavern A, et al. Pediatrics, February, 2006, pp.401-411.

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