Pearls:

Peanut containing products can and should be introduced to infants in form of melted peanut butter for younger infants and peanut puffs for older infants.

When an infant is ready to start solid foods, classically allergenic foods, such as eggs and fish, can be introduced in a manner the infant can texturally handle.

Some healthy foods to start with include avocados, green vegetables, and fish. Salmon is one of the healthiest things babies can get use to eating early. Altmann likes this because infants are exposed to the healthy omegas and develop a taste for fish. Infants can really be fed anything except for honey and choking hazards.

As per the LEAP (Learning Early About Peanut Allergy) study, released in 2015, infants introduced to peanut produces at a younger age have decreased changes for peanut allergies later in life.

What are the AAP recommendations for starting solids and advancing diets? In 2008, the AAP guidelines changed in terms of waiting until 1 year old to introduce traditionally allergenic foods. For example, peanut products, egg whites, fish, shellfish, if prepared properly, can be introduced to infants starting solid foods. It is important to start nutritious healthy food and stay away from processed foods and juices.

Du Toit, G et al. Randomized trial of peanut consumption in infants at risk for peanut allergy.

N Engl J Med. 2015 Feb 26;372(9):803-13. PMID: 25705822

What about rice cereal? Altmann does not usually recommend rice cereal as a first food because white rice, especially, is a plain carbohydrate with little taste and little nutritional value, other than added iron. Meats, for example, are much better sources of iron and zinc for infants. There have been recent reports of high arsenic levels in rice cereals.

Karagas MR, et al. Association of Rice and Rice-Product Consumption with Arsenic Exposure Early in Life. JAMA Pediatr. 2016 Apr. Epub. PMID: 27111102

How should these foods be prepared? Infants should be fed food in a consistency they can handle. Some babies can handle fork mashed and others need to start with completely pureed foods. The families can toss in almost any foods they are eating into a blending, add a little breastmilk or water, so it is a liquid consistency, and feed that to the baby. At restaurants, families can ask for foods on the side and fork mash them for the babies at the table.

The nice thing about homemade baby food is that it tastes a little different and has a little different consistency everyday. This way, babies get used to different flavors and textures.

The goal is to slowly increase the texture and size so that around 1 year old, children are eating regular table food with the rest of the family.

What about baby food pouches? While convenient, pouches may teach babies and toddlers to slurp and inhale their food. One technique is to squirt the food onto a spoon and have the child eat with the spoon. This also helps the child learn portion control. As with jarred baby food, it is important to read the labels on jars and pouches to see how many and what ingredients are actually in the jar or pouch.

What are the differences between the different milk products available? Dairy products provide nutrients such as calcium, Vitamin D, proteins and potassium. If families are sensitive to dairy and/or do not want to feed dairy products to their children, education is important. For example, almond milk has less than half the amount of protein per serving than cow’s milk. Almonds as a nut are very healthy. Soy milk has an equivalent amount of protein as cow’s milk. Rice milk and almond milk, especially, are fine as beverages, but should not be used as a substitute for nutrition.