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Are there foods that should be delayed when introducing solids to your baby?

As late as 2008, there were many "forbidden foods" that pediatricians recommended a baby should not
have until he reached a certain age. These forbidden baby foods included egg whites, peanut butter,
shellfish, crustaceans and citrus. As of 2012, the guidelines have firmly changed; "forbidden foods" are
no longer off the table!

In a recent interview with Dr. Jatinder Bhatia, neonatologist and chair of the American Academy of
Pediatrics' Committee on Nutrition, Dr. Bhatia noted that, "There is no evidence that the introduction of
any sequence of foods is better than any other."

Many foods are listed as they may pose a certain health risk but not necessarily an allergy risk. You may
find some items not listed as these items pose neither an allergy risk nor do they pose an immediate
health risk (i.e. sugar and salt - though sugar and salt should not be added to baby's meals.) Read more
about Baby Food and Allergies

Is this chart really relevant and is there a need for "forbidden foods" since the AAP report (and others)
came out in 2008?

In 2008, the AAP released a clinical report entitled Effects of Early Nutritional Interventions on the
Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction,
Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas

There are many who believe that due to this clinical report, there is no longer a need to delay any foods,
of any kind, when beginning to introduce solid foods to babies. The report notes the following:

"Although solid foods should not be introduced before 4 to 6 months of age, there is no current
convincing evidence that delaying their introduction beyond this period has a significant protective
effect on the development of atopic disease regardless of whether infants are fed cow milk protein
formula or human milk.

This includes delaying the introduction of foods that are considered to be highly allergic, such as fish,
eggs, and foods containing peanut protein."

The AAP states in its clinical report that: "In summary, the evidence from these conflicting studies, in
balance, does not allow one to conclude that there is a strong relationship between the timing of the
introduction of complementary foods and development of atopic disease. This raises serious questions
about the benefit of delaying the introduction of solid foods that are thought to be highly allergic (cow
milk, fish, eggs, and peanut-containing foods) beyond 4 to 6 months of age; additional studies are
needed."

The report, and others released since 2008, does not state nor does it recommend that solid foods of
any kind be introduced earlier than 4-6 months of age. The AAP also goes on to say that "Nor is there
sufficient evidence that any dietary intervention after 4-6 months of age prevents allergic disease. This
includes delaying the introduction of complementary foods."
You will continue to find pediatricians differing on their recommendations; some pediatricians
remain cautious while others give the green light to any food at any age.

So what exactly does this mean, can I give my 7 month old peanut butter?

It is most important that you discuss introducing possible allergenic foods with your baby's
pediatrician. The bottom line is that peanuts and eggs have not been proven safe for infants prior to 12
months or older; nor have these items in particular been proven unsafe. It is interesting to note a 2009
study regarding peanuts that has prompted the medical community to give more thought as to how
children are introduced to peanuts in particular.

In the 2009 a study published in the AAP's Pediatrics journal "Early Consumption of Peanuts in Infancy
Is Associated With a Low Prevalence of Peanut Allergy it was found that Israeli infants and children
have fewer peanut allergies than their United Kindgom counterparts. One possible reason is that Israeli
children are introduced to peanuts in infancy. "This study demonstrated a strong inverse association
between peanut consumption in infancy and the prevalence of PA [Peanut Allergy] in childhood. It is
compelling that the early introduction of frequent and high doses of peanut protein in infants may lead
to oral tolerance. Although there is inherent selection bias and recall bias with questionnaires in general,
the authors of this study attempted to reduce both of these factors. Until recently, dietary avoidance of
peanut during pregnancy, breastfeeding, and early childhood was recommended in the United
States. This article prompts us to question our practices and recommendations in terms of introduction of
peanut into our children's diet and how it may affect their propensity to develop PA."

This forbidden food chart will remain on Wholesome Baby Food for those parents interested in learning
about what foods may pose issues - and for posterity. Several of the recommendations on the chart are
there because delaying the introduction of certain foods is not due to possible allergic reactions. These
recommendations are due to other possible health risks. As we mentioned prior, many foods listed
should not be given until a certain age due to possible health issues:

Honey for example, could cause prompt infant botulism due to the immaturity of a baby's
intestinal tract.

Whole milk should not be introduced as a replacement for breast milk or formula until after
12 months. This recommendation is due to the fact that whole cow milk cannot properly sustain
a growing infant. It simply does not have all the nutritional components needed for healthy
growth and development. There is also a bit of difficulty in the digestion of whole milk proteins.
Yogurt and cheese are cultured and thus tend to be more easily digested.

Citrus is very acidic and many infants under the age of 12 months old suffer rashes and
tummy upsets due to the acidity. This has nothing to do with allergies.
Strawberries and Shell Fish, and even Peanuts, can prompt severe, life threatening allergic
reactions. The recommendation continues to be one of caution and delay.

Here are a few other examples of why it might be prudent to delay the introduction of
certain foods. Broccoli for example is known to cause gas in many people. Offering broccoli to
an infant who is 6 months of age is really not a good idea. You may not want offer a 6 month old
baby beans either, as these too may cause painful gas.

Common foods that, traditionally, should wait to be introduced to babyuntil baby has reached a
certain age
Please note "recommendations changed" or "unchanged" status considering new studies

Honey After 1 year


(not an allergen but may cause botulism in infants under 1yr old) recommendation unchanged

After 1 or 2 years*

Peanut Butter recommendations changed


- anywhere from 6 months to 2
years old

After 1 or 2 years*

(Tree) Nuts
recommendations changed
(also may pose a choking hazard)
- anywhere from 6 months to 2
years old
Citrus or Acidic Fruits After 1 year
Not an allergen but may cause rash & digestive upset due to
acidity. Using a dash of lemon or pineapple juice in a whole fruit recommendations changed
puree is NOT the same as giving a baby pureed or sliced oranges, - anywhere from 6 months to
pineapple et al. 12 months

Just because a fruit, like tomato, is not in the citrus family does not
mean that it is not acidic.

After 1 year**
Raw Strawberries, Raspberries, Blackberries- learn about
why processed strawberries may not pose an allergy risk recommendations changed
- anywhere from 6 months to
(Blueberries and Cranberries
12 months
are NOT included in this)

After 1 year

Corn
recommendations changed
(possible allergen and not very nutrient rich)
- anywhere from 6 months to
12 months

After 1 year
Egg Whites
(many pediatricians will say it is fine for an older infant to have recommendations changed
baked goods that include whole eggs) - anywhere from 6 months to
12 months

Whole Milk - as a drink


Lactose and milk proteins may cause allergic reactions and may also After 1 year
cause tummy troubles as they are hard to digest - yogurt and
cheese are exceptions. Milk also hinders proper absorption of iron; recommendations unchanged
iron is crucial during the 1st year

After 9-10 months or 1 year

Wheat recommendations changed


Many suggest that for the infant who has had no issues with gluten - anywhere from 6 months to
in Oats and/or Barley, and who has no history of wheat allergy or 12 months
gluten intolerance, that offering wheat products (such as wheat
toast) is fine around 8+ months - Read more at our topic Wheat for
Baby

Grapes After 10 months or 1 year **


(not a high allergen but may pose a choking hazard - use extreme
caution if offering your older infant or toddler grapes)

After 1 or 2 years ***


Shellfish/Crustaceans recommendations changed
(may be a high allergen) - anywhere from 6 months to
12 months

* Peanuts and Tree Nuts have varied age recommendations for introduction. Typical ages for
introduction are:

After One (1) Year for the Non Food Sensitive/Non-Allergic Child;

After Two (2) or Three (3) Years for the Food Sensitive/Allergic Child.

Some Medical Authorities even suggest holding off Peanuts and Tree Nuts until after Seven (7) Years
old. You should introduce these items with the consultation and recommendation of your baby's
Pediatrician.

Peanuts and Tree Nuts Please ask your pediatrician about introducing peanuts and tree nuts to
your baby! Reactions to these food items may be deadly.

Recommendations for introduction of peanuts and tree nut have changed to anytime from 6-12
months.

** Strawberries Please note that the current recommendation for introducing strawberries was after a
baby has reached 12 months of age. Commercial Stage 2 baby foods contain strawberries because it is
said that processing strawberries at such a high temperature "kills" the protein that causes the allergic
response. Visit our Strawberry page to learn more.
Recommendations for introduction of [fresh] strawberries have changed to anytime from 6-12
months.

** Grapes are not a high allergen but may pose choking hazards. Visit our Grape page to learn about
ways to safely offer your baby grapes.

*** Shellfish/Crustaceans introduction depends on a baby's history of food allergies as well as the
family's history of food allergies.

Recommendations for introduction of fish and shellfish have changed to anytime from 6-12 months.
Please ask your pediatrician as shellfish reactions may be deadly.

The Forbidden Foods chart, and accompanying information, is not to be taken as a replacement
for advice given from your baby's pediatrician.

As with the solid food charts, this forbidden baby food chart is somewhat conservative in nature
compared to guidelines from other sources. It has been researched and compiled from various medical
authorities such as private pediatricians, the AAP, the AAFP, and the WHO. Remember, always consult
with your pediatrician regarding introducing solid foods to your baby and specifically discuss any foods
that may pose allergy risks for your baby.

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