Should I give a four-month-old baby solids?

When should babies start solids? My first child was gobbling up runny baby cereal at three months. Two decades later (my child-bearing was spread out), the rules had changed to nil by mouth except breast milk until six months. Not only that, but solids were increasingly a thing to be afraid of. Wheat, egg, peanut, shellfish (does anyone actually feed their child lobster?) were all on the scary list of foods that can cause allergic reactions and should be avoided for as long as possible. Cow’s milk, soy, sesame and nuts from trees such as almonds, cashews and chestnuts are also potentially allergic for some babies. An estimated 5% of children have food allergies, so the problem is real, and allergic reactions to food are terrifying. So advice about when to start your infant on solids, an emotive subject at the best of times, has become complicated by concerns that getting it wrong could give your child a food allergy.

The solution

The Canadian Medical Journal this week wades into the debate with a review of the evidence. Dr Elissa Abrams, from the University of Manitoba, argues that giving babies solids from four months – including some of these scary foods – may be protective. She cites evidence from the LEAP study published in the New England Journal of Medicine earlier this year. This study showed that giving a puffed peanut snack (not peanuts themselves) to children from four to 11 months who were known to be at high risk from peanut allergy actually reduced the likelihood of them being allergic to the nuts at the age of five. High-risk babies include those with severe eczema and allergy to eggs, and Abrams includes those who have siblings with peanut allergies. If there is any doubt about food allergies in your family, you should ask your doctor.

Abrams is adamant that parents shouldn’t throw caution to the wind. With healthy babies, The American Academy of Allergy, Asthma and Immunologysuggests introducing new foods that are age-appropriate and won’t cause choking every three to five days. Foods should be introduced alongside breastfeeding if possible. Start with mashed vegetables and fruit such as cooked carrots, sweet potato and bananas. Introduce potentially allergic foods (unless there is a family history of allergy, or your infant has severe eczema, in which case you should ask your doctor) between four to six months in small amounts and at home, so you can keep a watchful eye. Gluten, according to current evidence, may best be introduced between four and six months.

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