Introducing solid food to baby is an exciting time! Learn when, how and what to offer your baby based on current research on allergy prevention and the nutritional needs of infants. Presented by Dr. Lisa Watson, ND - a naturopathic doctor practicing in Toronto, Ontario, Canada.

1. Baby Food:
The art and science of solid food
introduction and nutrition in the first
year

2. Breast is Best
Health Canada, UNICEF and the
World Health Organization (WHO)
all agree that babies should be
exclusively breastfed until 6 months

3. Why Wait Until 6
Months?
1. Tongue-thrust reflex diminishes at 4-6 months
2. First teeth come in between 5-7 months
3. Swallowing solid foods is difficult before 4 months
1. Baby’s digestive system matures by 6-7 months. The
intestines are able to filter food and secrete IgA, preventing
allergic foods from entering the bloodstream and potentially
inducing allergic sensitization
2. Baby can turn head towards or away from food and express
hunger (open mouth) and fullness

4. Signs of Readiness
o Baby can sit up
o Baby shows an
interest in food
o Baby opens his mouth
when food is offered
o Baby can turn head
away from spoon
when he’s full
o Baby can pick up
pieces of food for
self-feeding

5. Setting the Table –
Preparing for Baby’s First Meal
Create a relaxed, distraction-free
environment
Sit your baby in a high chair at
eye level
Let baby guide the
process!

6. Setting the Table –
Preparing for Baby’s First Meal
Be patient. It can take 15-20
tries before babies will accept
some foods!
Consider using both purees and
finger foods to allow
baby more choices
(“baby led weaning”
– more on this later.)

7. Did you know?
Babies develop their sense of taste
and smell while still in the uterus.
Strong flavours like garlic, curry and
cumin are detectable in the amniotic
fluid, which is swallowed by baby.
Research shows that babies who
were exposed to strong flavours
during development are more
accepting of these flavours
during infancy.
Schaal B, Marlier L, Soussignan R. Human Foetuses Learn Odours from their Pregnant
Mother's Diet. Chemical Senses 2000;25:729–737.

8. Selecting First
Foods dense
o Nutrient
o Rich in iron and/ or zinc
o Easily digested
o Free of preservatives,
added salt or sugar
o Offer a variety of
textures, flavours and
nutritional value

9. Importance of Iron for Infants
Babies are born with enough stored
iron to last them until around 6
months of age
Iron deficiency is the most common
nutrient deficiency in childhood and
has long-term impacts on health.
Iron is necessary for growth, and is
critical for brain development.

10. Zinc for Growth and
Development
Zinc is one of the most important
nutrients during times of growth. It is
used by the body to make proteins
and DNA.
Zinc is also used by our immune system
to produce immune peptides that fight
off viruses and bacteria.

11. How to Introduce Foods to Baby
o One at a time
o Give once or twice daily for 2-3 days
o Watch for allergic reactions
o If any symptoms develop, remove that food
from the diet and do not reintroduce for at
least 6 weeks

12. Signs of Food Intoleranc
o Gas, bloating
o Rash around mouth or
diaper rash
o Irritability, fussiness
o Spitting up or vomiting
o Diarrhea or constipation
o Nasal congestion
o Eczema or dry skin

13. Foods to Avoid
o Honey
o Peanuts
o Potential choking
hazards

14. Allergies and Food
Introduction – The
Controversy
Parents are often
counseled to postpone
introduction of allergenic
foods to prevent
development of food
allergies.

15. Allergies and Food
Introduction – The
Controversy
However, recent research
suggests that delaying
certain foods does NOT
reduce incidence of food
allergy and may in fact
increase food allergies.

16. Food Allergy and Solid Food
Introduction Research
Early introduction of fish decreased the incidence of
eczema in the first year of life. Egg and milk introduction
had no impact on development of eczema.
Alm B, Aberg N, Erdes L, Mollborg M, et al. Early introduction of fish
decreases the risk of eczema in infants BMC Pediatrics, 2008
Later introduction (after 6 months) of formula or
rice/wheat cereal decreased incidence of food allergy.
Kumar R, Caruso D, Arguelles L, et al. Early life eczema, food introduction
and risk of food allergy in children. Pediatric Allergy, Immunology, and
Pulmonology. 23:3, 2010.

17. Food Allergy and Solid Food
Introduction Research
No protective effect was seen at 6 years of age against
development of asthma, allergic rhinitis, food or environmental
allergies in children with delayed introduction of solid foods
beyond 6 months of age.
Zutavern A, Brockow I, Schaaf B, et al. Timing of solid food introduction in relation
to eczema, asthma, allergic rhinitis and food and inhalant sensitization at the age
of 6 years: results from the prospective birth cohort study LISA. Pediatrics, 2008
A review of 13 studies found no strong evidence to support an
association between early introduction of solid food and
development of persistent asthma, food allergy, allergic rhinitis
or animal dander allergy. There may be an increased risk of
eczema.
Tarini BA, Carroll AE, Sox CM, Christakis DA. Systemic review of the relationship
between early introduction of solid foods to infants and the development of
allergic disease. Archives of Pediatric and Adolescent Medicine, 2006.

18. Food Allergy and Solid Food
Introduction Research
No protective effect against the development of eczema is seen on
delayed introduction of allergenic foods after the sixth month of
infancy.
Filipiak B, Zutavern A, von Berg A, et al. Solid food introduction in relation to
eczema: results from a four-year prospective birth cohort study. Journal of
Pediatrics, 2007
Longer delay in introduction of cow’s milk is associated with
a higher risk for eczema. Delayed introduction of other food
products was also associated with an increased risk of atopy
by 2 years of age.
Snijders BE, Thijs C, van Ree R, van den Brandt. Age at first introduction of
cow milk products and other food products in relation to infant atopic
manifestations in the first 2 years of life: the KOALA birth cohort study.
Pediatrics, 2008

19. Food Allergy and Solid Food
Introduction Research
Late introduction of egg and milk is associated with an increased
incidence of eczema, and a slight increase in incidence of wheezing.
Zutavern A, von Mutius E, Harris J, et al. The introduction of solids in relation to
asthma and eczema. Archives of diseases in childhood, 2004

20. Selecting First
Foods

21. First Food Groups - Grains
A popular first choice because grains are:
o Easy to prepare and feed
o Can be fortified with iron
o Are a natural source
of zinc
o Easily digested

22. First Food Groups - Grains
If using commercial baby “cereals” select
ones with:
o Single grains (not blends)
o No added salt or sugar
o Organic grains

23. First Food Groups - Grains
You do NOT need to feed your baby
commercial baby cereals! These cereals
are encouraged as a source of IRON.
If your baby is consuming other iron-rich
foods they do not need baby cereal.

24. First Food Groups - Grains
Great Grains for Babies
Food Nutrient
Brown rice Protein, B vitamins, zinc
Quinoa Protein, fiber, iron, zinc, magnesium
Oats Protein, fiber, iron, zinc, magnesium
Millet Protein, iron, fatty acids
Amaranth Protein, fiber, iron, calcium
Barley Fiber, B vitamins, iron

25. First Food Groups -
Vegetables provide an important source of
Vegetables
nutrients and fiber in baby’s diet
Easy to prepare and provide baby with a variety
of colours, flavours and textures.

26. First Food Groups -
Vegetables vegetables contain nitrates and
Some cooked
should not be given to babies under 4-6 months
of age.
Nitrates can cause baby to develop
methemoglobinemia – a condition in which
blood cells do not transfer oxygen efficiently.
Baby can begin to handle nitrates after 6 months
of age.

27. First Food Groups -
Vegetablesmay contain nitrates:
Foods that
o Spinach
o Beets
o Turnip
o Carrot
o Green bean
o Banana

28. First Food Groups -
VegetablesVeggies for Babies
Favourite
Vegetable Nutrients
Broccoli Iron, fiber, chlorophyll, potassium, calcium
Carrot Fiber, carotenes, calcium
Cauliflower Iron, fiber
Green peas Iron, fiber, chlorophyll, calcium
Mung bean sprouts Iron, fluid, fiber, enzymes
Sweet potato Carotenes, potassium
Chard, spinach Magnesium, chlorophyll, fiber, iron
String beans Fiber, magnesium
Squash Vitamin C, vitamin A, fiber

29. First Food Groups -
Fruit
Fruits are popular choices
for both parents and
babies.
They are easy to prepare
(most don’t require
cooking) and are sweet
and palatable to baby.

30. First Food Groups -
Fruit
Don’t worry about baby
rejecting vegetables once
fruits are introduced.
Breast milk is a very sweet
food and baby is going to
be interested in trying lots
of different flavours.
Keep trying new foods -
not just the favourites!

31. First Food Groups -
Favourite Fruits Fruit
Fruit Nutrients
Applesauce Fiber, fluids, vitamin C
Apricot Vitamin C
Avocado Healthy fats
Banana Potassium, vitamin C
Berries Fiber, vitamin C
Kiwi Vitamin C, enzymes
Pear Vitamin C, fiber

32. First Food Groups –
Meats and Alternatives
Considered by experts to be
one of the best first foods for baby.
Meats and alternatives are
rich in iron, zinc and protein
which meet the nutritional needs
of baby during rapid growth.

33. First Food Groups –
Meats and Alternatives
Food Nutrients
Fish Protein, fatty acids
Chicken Protein, iron
Turkey Protein, iron
Egg yolk Protein, iron, calcium
Tofu Protein, iron, calcium
Beans Fiber, protein, iron, calcium
Red meats Protein, iron, zinc
Dairy Protein, calcium, vitamin D

34. Iron Rich Foods
o Red meats
o White, black and kidney beans
o Lentils
o Chickpeas
o Barley
o Rice
o Fortified cereals
o Spinach, swiss chard
o Tofu, edamame
o Eggs
o Chicken, turkey

35. Zinc Rich Foods
o Red meats, pork
o Chicken
o Fortified cereals
o Baked beans
o Yogurt
o Cheese
o Chickpeas
o Kidney beans
o Green peas

36. Baby-Led Weaning
The practice of allowing baby to fed himself small pieces of whole
food – typically the same food as the family is eating.
Baby is able to decide what,
how much and how quickly he
would like to eat.

37. Baby-Led Weaning
Whole foods (not purees) are offered to baby that are of a size and
shape that he can pick up and feed himself – typically stick shaped.
A wide range of foods is
suggested as appropriate first
foods – fruit, vegetables, meat,
cheese, eggs, toast, pasta and
fish.
Baby-led weaning
starts introducing
foods at six months
of age.

38. Baby-Led Weaning
It has been suggested that baby-led weaning leads to greater
acceptance of a variety of foods.
Baby-led weaning also allows
baby to develop appropriate
energy self-regulation skills
and may decrease the
incidence of obesity
in childhood and adults.

39. Children with Allergic
Family Members
Children with family members who have
allergies are more likely to develop
allergies.
If you or your immediate family members
have allergies, you may choose to wait to
introduce the top 8 allergenic foods until
your baby has tried a number of other
foods.

40. The Top Eight
Allergenic Foods
1. Cow’s milk dairy
2. Egg white
3. Peanut
4. Tree nuts (cashew,
almond, walnuts)
5. Fish
6. Shellfish
7. Soy
8. Wheat/ gluten

41. Vitamin D for
Allergy Prevention
Vitamin D is necessary for
absorption of calcium and for
healthy immune functioning.
Emerging research also suggests
that it may have a roll in
decreasing allergy development.

42. Vitamin D for
Allergy Prevention
Epidemiological studies show
that allergies are more prevalent
in areas with endemic vitamin D
deficiency (northern US vs
southern US).
More studies are needed, but
early evidence suggests that the
daily vitamin D supplement may
be more important than initially
thought.

43. Probiotics for
Allergy
Prevention
Studies have shown that
supplementation with
probiotics during pregnancy,
and in the first year of life
are both protective against
the development of allergy
and eczema.

44. Probiotics for
Allergy
Prevention
This effect was especially
pronounced in children of
mothers who have allergies.
Probiotics are able to induce
regulatory T cells, and help
decrease over-reactivity of
the immune system.

45. References
World Health Organization. Global strategy for infant and young child
feeding. 2003
Available online at:
http://www.who.int/nutrition/publications/gs_infant_feeding_text_
eng.pdf
Health Canada. Infant Feeding. 2012. Available online at:
http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/index-
eng.php
Alm B, Aberg N, Erdes L, Mollborg M, et al. Early introduction of fish
decreases the risk of eczema in infants BMC Pediatrics, 2008
Kumar R, Caruso D, Arguelles L, et al. Early life eczema, food
introduction and risk of food allergy in children. Pediatric Allergy,
Immunology, and Pulmonology. 23:3, 2010.
SnidersBE, Thijs C, van Ree R, van den Brandt. Age at first
introduction of cow milk products and other food products in
relation to infant atopic manifestations in the first 2 years of life: the
KOALA birth cohort study. Pediatrics, 2008
Zutavern A, von Mutius E, Harris J, et al. The introduction of solids in
relation to asthma and eczema. Archives of diseases in childhood,
2004

46. References
Zutavern A, Brockow I, Schaaf B, et al. Timing of solid food introduction
in relation to eczema, asthma, allergic rhinitis and food and inhalant
sensitization at the age of 6 years: results from the prospective birth
cohort study LISA. Pediatrics, 2008
Tarini BA, Carroll AE, Sox CM, Christakis DA. Systemic review of the
relationship between early introduction of solid foods to infants and the
development of allergic disease. Archives of Pediatric and Adolescent
Medicine, 2006.
Filipiak B, ZutavernA, von Berg A, et al. Solid food introduction in
relation to eczema: results from a four-year prospective birth cohort a
study. Journal of Pediatrics, 2007
Abrahamsson TR, Jakobsson T, Bottcher MF, Fredrikson M, Jenmalm MC,
Bjorksten B, et al. Probiotics in prevention of IgE-associated eczema: a
double-blind, randomized, placebo- controlled trial. Journal of Allergy
and Clinical Immunology. 2007; 119:1174–80.
Rautava S, Kalliomaki M, Isolauri E. Probiotics during pregnancy and
breast-feeding might confer immunomodulatory protection against
atopic disease in the infant. Journal of Allergy and Clinical Immunology.
2002; 109:119–21.

47. References
Pali-Scholl I, Renz H, Jensen-Jarolim E. Update on allergies in pregnancy,
lactation, and early childhood. Journal of Allergy and Clinical
Immunology. 2009; 123(5):1012-1021.
Cameron S, Heath A-L, Taylor R. How feasible is baby-led weaning as an
approach to infant feeding? A review of the evidence. Nutrients. 2012;
4:1575-1609.
Leo S, Dean J, Chan ES. What are the beliefs of pediatricians and
dietitians regarding complementary food introduction to prevent
allergy? Allergy Asthma and Clinical Immunology. 2012; 8:3.
Friel JK, Hanning RM, Isaak CA et al. Canadian infants’ nutrient intakes
from complementary foods during the first year of life. BMC Pediatrics.
2010; 10:43.
Thygarajan A, Burks W. American academy of pediatrics
recommendations on the effects of early nutritional interventions on
the development of atopic disease. Current Opinions in Pediatrics.
2008; 20(6): 698-702.
Robinson S, Fall C. Infant nutrition and later health: A review of current
evidence. Nutrients. 2012; 4: 859-874.

48. References
Kuo AA, Inkelas M, Slusser WM, et al. Introduction of solid foods to
young infants. Maternal and Child Health Journal. 2011; 15:1185-1194.
Gaffin JM, Sheehan WJ, Morrill J, et al. Tree nut allergy, egg allergy, and
asthma in children. Clinical Pediatrics. 2011; 50(2): 133-139.
Huh SY, Rifas-Shurman SL, Taveras EM, et al. Timing of solid food
introduction and risk of obesity in preschool-aged children. Pediatrics.
2011; 127: e544-e551.

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