April 8th, 2019

We now know that immune tolerance is critical to developing a balanced immune response to food proteins and thus maintaining a non allergic phenotype. Knowing this to be true, what is the ideal time to start eating real food as an adjunct to breastfeeding?
For years, pediatricians told parents to wait until after 1 year to start with the major allergenic proteins like eggs, peanut or shellfish. We also, wrongly, told parents to start with pure sugar as rice cereal at 4 months of age! Boy were we wrong!

The LEAP study answered question number one. It turns out that the ideal time to introduce proteins is at 6 months of age. This makes complete sense when you think about evolutionary biology. (Du Toit et. al. 2015) All babies start to put everything in their mouths at 6 months of age in order to train their immune system. I believe that if the inner microbial intestinal garden is well grown, then introducing food proteins at 6 months of age is ideal. However, based on the LEAP study, where they did not isolate the type of microbiome or whether it was dysfunctional, the longer you wait to introduce a food protein the higher the risk of developing a food allergy or intolerance. In the LEAP study they focused only on peanut protein in high risk children with severe eczema, egg allergy or both. However, immunologically it would stand that this food timing pattern persists for all food proteins in all children regardless of genetic risk.
To recap, introducing solid foods of all types should occur at the 6 month post delivery mark. I especially would focus on the big 8 trouble makers: corn, dairy, egg, peanut, tree nut, shellfish, soy, wheat. These 8 foods are identified here because they are notoriously the most common allergenic and intolerant triggers.
The first food! Current thinking is that we should eat real whole food all the time as most processed foods are not good for any of us. Here we are at 6 months of age and staring at junior sitting in his high chair with his mouth wide open as he eyes your fork full of tender vittles.
I routinely recommend avocado, sweet potato and vegetables as first foods. Red peppers, cooked broccoli or carrots are all great choices. The key is to start with high quality non sugar spiking whole foods that are real, clean and fresh. Smash, purée or chop these foods into tiny pieces and your babe will lap them up as they mentally prepare for more complex foods as time progresses. Remember that they are fully aware that your fork has some interesting and different stuff on it that they WANT!!!!
Introducing different whole foods every few days is the current recommendation although this is not rooted in science so much as it just works. Adding in the big 8 should occur soon after the first foods are begun. I encourage all parents to vary the diet based on seasonally fresh foods and what they are eating.
I do not think that puréed foods purchased at the store are necessary unless you want them for convenience. If you do choose them, choose organic high quality types that are in glass containers.
Another important early thought is to avoid: 1) honey - can cause a bacterial disease called botulism. Clostridium botulinum bacteria releases a toxin called botulinum toxin that causes paralysis and can lead to death in infants. 2) raw meat and fish - raw meats and fish can carry pathogenic bacteria and parasites that are dangerous to infants as they can cause dysentery and other infectious diseases.

Parent Pearl: How often does a parent need to put a new food in princess's mouth before she may accept it? The average toddler will need 10-13 trials of a novel food before they will accept the new food.

Dr. M
Du Toit Article NEJM