4-6 Months Feeding advice:
Infant Feeding advice and Concerns about Allergies
Allergies are more common now than ever. One in 3 children will be allergic to something. As a parent it can be a minefield and conflicting advice will make you crazy. Some children have 2-3 allergies, and some have none. Nut allergy is one of the more serious and difficult for parents to manage. So, introducing solids can fill you with fear and trepidation, especially if you have experienced a food allergy yourself. Getting medical advice and testing is difficult and costly. Trial and error play a part in discovering food allergies so go slowly and carefully.
The Australasian Society of Clinical Immunology (ASCIA) Has developed advice to help infant feeding. (
Breastfeeding and formula:
There are many benefits to breastfeeding for mum and baby. Breastfeeding may help to counteract allergies as solids are being introduced. Breastfeeding is recommended for 6 months until the mother wants to stop. Women can breastfeed beyond 12 months if they wish. However, excluding allergenic foods from the mother’s diet does not prevent allergies in children.
If formula milk is needed during the first 6 months, then hydrolysed formula reduces the risk of allergies in high risk infants, where there is a history of allergy in the family. Hydrolysed formula or hypoallergenic (HA) has been processed and the proteins have been broken down. This can reduce the risk of cow’s milk protein allergy in children. And for children diagnosed with cow’s milk protein allergy; these are usually given extensively hydrolysed formula (EHF) which must be prescribed by a doctor.
Generally, however, children are not likely to get an allergy to the milk they have already been given and tolerated well. Breastmilk or formula should be the main drink of choice until 12 months when fresh cow’s milk can be used. Soy milk or goat’s milk are not recommended for allergy prevention.
Introducing Solids:
Signs of Readiness: Introduce solids at around 4-6 months of age with signs of readiness. Do not start solids before 4 months of age. There is no evidence that delaying the introduction of solids until after 6 months helps to prevent allergies. In fact, doing so earlier may increase the risk of allergies. There is also no evidence that avoiding potentially allergic foods such as eggs, fish, nuts, wheat, or cow’s milk will prevent allergies and eczema. It is important to give a variety of foods when the baby is showing signs of readiness to eat.
When the baby has good head and neck control, and baby is looking interested in food and grabbing out for it, put a spoonful of food in their mouth when they open it. Introduce a new food every 2-3 days, such as apple, pear, avocado, carrot, and pumpkin. Use a small soft spoon like a plastic teaspoon and bowl. Do not let the baby suck from ready-made pouches. It does not help them develop the skills they need for feeding; they need hand feeding. Baby led weaning is not optimal for growth and development.
How to introduce solids:
4-6 months: Start with smooth, silky, pureed food: Plain cereals, rice, oats, semolina, smooth cooked vegetables, and fruits.
6-8 months: Move onto mashed and finger food: meat, fish, vegetables, fruits, cereals, and legumes. You can also introduce yoghurt; egg custard and nut paste such as peanut butter.
8-12 months: Move onto chopped texture and more whole foods. You can also introduce a Sippy cup. Increase the variety of foods as above, add in bread, crackers, pasta, wheat cereal, cow’s milk on cereal but not as the main drink; eggs, fish, seafood, and nuts.
Choking:
Most parents are wary to try new or whole foods for fear of the baby choking. Babies and children have a gag reflex so they can protect their own airway. Feed the baby or toddler in a comfortable seated position, not running around. Feed them slowly and patiently, do not rush. Do not give the baby fruits or vegetables that are hard, such as raw apple, carrot, or whole nuts. Always cut grapes in half as they can block off the airway completely. Seek medical advice if they do inhale or choke on foods and you cannot help. They can get lodged in the oesophagus (food pipe) or in the lungs. If they do choke or food gets stuck in the gullet, first give 5 firm back slaps and 5 chest thrusts, then apply two rescue breaths and call an ambulance or go to the emergency department. They need urgent medical attention and to check the food is not stuck in the lungs or oesophagus; they may need an x ray to see it.
Peanut butter and Egg:
“Parents are sometimes worried about giving egg and peanut to their babies, as they commonly cause food allergies. However, it is best to offer your baby well cooked egg and smooth peanut butter/paste regularly (twice weekly), starting before 12 months of age. Delayed introduction of these foods has been shown to increase the chance of developing food allergy.”
(https://allergy.org.au/patients/allergy-prevention/ascia-how-to-introduce-solid-foods-to-babies)
Signs of food allergy:
Red raised rash or welts on the skin and itching are mild signs. If you see this, you can just stop giving the food and give some antihistamine. Moderate to severe reactions include facial swelling to the lips, eyes and face, tongue, severe rash, shortness of breath, loss of consciousness or wheezing: anaphylaxis. Call an ambulance immediately as symptoms can worsen quickly and become life threatening.
If the baby already has allergies:
Some children will develop allergies. Make a note of what they have eaten and avoid it until medical advice is given. Children with eczema are at high risk of food allergy. See a GP or paediatric specialist for a management plan. If you need to avoid food groups such as wheat or dairy you would benefit from seeing a dietician to discuss alternatives as this may impact on the baby’s growth and development.
What if the family have food allergies?
It is still important to introduce these foods to your baby. The baby may not be allergic to these foods and need them as part of a healthy mixed diet. You can introduce them slowly while protecting yourself from contact with those foods by wearing gloves and washing down equipment.
What order should I give foods in?
“Solid foods can be introduced in any order. However, iron rich foods need to be included around six months (not before four months). These include iron enriched (fortified) cereals, meats, poultry, fish, well cooked egg, tofu and legumes. You may choose to introduce one new food at each meal time so that if an allergic reaction occurs, the problem food can be more easily identified. If a food is tolerated, continue to give this food regularly as part of a varied diet, to maintain tolerance. Trying a food, and then not giving it regularly may result in food allergy development.” (www.allergy.org.au)2019