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Food safety

GF FAQ Image Safety

What should be baby's first foods, and how much?

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Veggies, veggies, veggies, flavor, flavor, flavor! A baby’s first foods are not about nutrition, but rather, the experience and the exposure. In fact, how much a baby ingests in these very early stages are, more often than not, not very much at all! For the first 2, 5, or 15 times, it might be at most a teaspoon or two. All babies are different and all progress at different rates so it is important to listen to them and progress when they are ready (also known as responsive feeding) [36]. Remember, all his nutrition is coming from milk right now, so use this opportunity to build on a range of flavor exposures and experiences. Experiment and have fun and you just might be surprised! It might take several times for him to accept a new flavor, that’s normal.

Repetition (a spoonful or two is all that is required) and persistence is the key to building acceptance and preference. [5, 9, 91] The good news is, studies have shown that this persistence pays off. Exposure to a wide variety of minimally processed vegetables, spanning right across the flavor profiles, in their single form (i.e. not mixed with a sweet puree), on multiple occasions, can dramatically increase his chances of solidifying healthy preferences for life. [2, 3, 7, 10, 19, 21, 32, 45, 51] Unfortunately, this can go both ways. If his dietary exposures are predominantly over-processed (infant cereal), sweet (the use of fruit and sweet vegetables to mask savoury or bitter flavors), or salty (as are most savory snacks), it is likely these will be the preferences he will take with him into the future. So, veggies in their single form first, veggies in variety, and veggies in repetition.

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How do I go about offering baby those first foods?

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Be prepared. Starting solids is messy, it rarely goes as straightforward as parents would hope, and you can guarantee there will be bumps along the way! That said, it can also be a rewarding experience and a journey you can enjoy together as a family. 

  • Step 1: Choose a time of day free of stress, when he is not overly hungry or tired. [21]
  • Step 2: Ensure he is sitting correctly: Upright, not slumped forward, off to one side or too far back. You may need to place some extra support around him, e.g. rolled-up towels or cushions. A footrest can also provide extra stability. If his legs don’t quite reach the footrest you can tape an old shoebox to the footrest in the interim. Also check the tray height. It should be sitting below his breastbone so his elbows can sit on the tray without being hunched. Again, you might need to sit him on a folded towel to lift him up a bit. 
  • Step 3: Stimulate the senses. Eating is a sensory experience. In fact, without being aware, our digestion process starts long before the food touches our stomachs. Watching food being prepared, its smell and feel, and the anticipation of eating, all stimulate a response that signals the release of digestive juices (saliva), thus preparing the body for receiving food. So involve him in this process. Even if the food comes in a packet, talk about it—the smell, the color, its yummy goodness, where it comes from—and when possible have some in its physical form. Show him what a whole carrot looks like. And don’t forget to eat some yourself, smile, and describe it encouragingly. 
  • Step 4: Choose a spoon. Ensure the spoon is small enough to fit in his mouth and flat enough that his lips can be used to suck off the puree. There are plenty of baby spoons on the market, so you might have to try a couple to find one that works for him.
  • Step 5: If he is getting agitated trying to sit up or use the spoon, stop there for the day. Remember, this is a learning experience for him and keeping it a positive and enjoyable one will pay dividends later! So if at any stage in the process the wheels come off, it is important not to show frustration but to praise him, and yourself, for getting this far and try again tomorrow. His emotional wellbeing [link 10] is equally important in his sensory journey as the food itself.
  • Step 6: Start small. Offer half a teaspoon of puree on the end of the spoon. Putting too much on the spoon in the initial stages can be frightening for him and difficult for him to swallow. Keep in mind that this is a sensory journey of tastes and experiences, not about nutrition. Don’t be tempted to scrape the top of the spoon on his upper lip. This encourages the tongue-thrust reflex (pushing food out) rather than sucking food to the back of the mouth. This is an important skill to learn to progress onto accepting different textures. If he struggles with this concept of sucking off a spoon right away you can try placing a little on a clean finger and offering him that first. 

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Should I cut back on the breast milk/formula when he starts solid foods?

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Breast milk or infant formula remains the most important nutrient source for the first year of life, and complementary foods must not be given in amounts that will dramatically reduce milk intake. This can be achieved by giving a milk feed before giving solid foods, which are then used as a ‘top-up’ at the end of the meal. At around 8 to 9 months of age, complementary foods can be offered before the milk feed. Gradually, complementary foods displace milk feeds, but breast milk or infant formula should remain a prominent part of an infant’s diet until at least 12 months old.

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Are there foods that aren’t safe to give my baby?

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Apart from the obvious ones of sugar and salt, there are a number of other food products you should avoid in the first year of life [75]. These include:

  • Honey due to the risk of botulism
  • Fennel due to unknown levels of estragole, a naturally occurring carcinogen
  • Rice drinks due to risk of exposure to arsenic, a first-level carcinogen
  • Fruit juice [52]

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What are healthy feeding practices?

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Infants and toddlers rely entirely on their caregivers to teach them what, when, and how to eat. Healthy feeding practices foster responsive parenting [36], which in turn lay down the foundations for long-term healthy eating habits and behaviors.

  • You provide, let him decide. You provide what is on offer, and he decides when he has had enough. It is important not to pressure him to finish or eat more than he wants to at any given sitting. Not only can this have detrimental effects on his ability to regulate his appetite (increasing risk of obesity), but can also lead to anxiety and a poor relationship with food. This can then manifest in poor appetite, food refusal, and increasingly stressful mealtimes. 
  • Keep mealtimes happy and stress-free. A child’s relationship with food begins from a very early age so ensuring this is a positive one will help to eliminate unnecessary anxieties associated with food. Not only can this result in fussy eaters but also eating disorders later in life. 
  • Remove unnecessary distractions such as television, phones, or overactive pets.
  • Ensure he is sitting comfortably and facing you and other family members. Eating is a social activity and children are much more likely to eat something if a caregiver is eating enthusiastically in front of them. [62, 63, 64]
  • Respond to hunger and fullness cues [36] and leave behind expectations of how much you want him to eat. [31]
  • Feed slowly and patiently, encouraging him to eat but not forcefully or coercively. [28] 
  • Do not resort to unhealthy foods you know he will eat to ensure he “just eats something.” Feeding nutrient-poor foods can lead to a vicious cycle of even poorer appetites and therefore less interest in the healthy options. Remember, while on milk feeds he is not going to go hungry and/or disrupt sleep patterns from missing a meal. Offering unhealthy alternatives, especially sweet (e.g. fruit), can actually have detrimental effects on sleep due to the spike in blood sugar levels followed by a slump. 

Only offer food for hunger and not for any other reason. Offering food to infants and children for comfort, entertainment, or as bribery can lead to long-term problems with emotional eating and overeating [18]. It can also serve to increase his dislike of healthy food if an unhealthy alternative is offered as bribery.

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What if my baby chokes?

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This is the number-one fear for all parents when starting babies on solids. The truth is, choking is not as common as you may think, especially if you take precautions to prevent it [41]. What is more common is gagging. It can be no less frightening for parents, however, it is important to know what the difference is and a plan of action if required. [56] 

Signs of gagging include:

  • Noisy cough and splutter
  • Eyes may water
  • May push their tongue forward or out of their mouth
  • May make a retching sound
  • May vomit
  • Generally not too fazed

Gagging is normal. In young infants the gag reflex is very prominent. This natural automatic response is actually a protection mechanism to prevent choking. This strong tongue-thrust reflex, when food stimulates the back of the mouth, is why you should wait until at least 4 to 5 months before introducing solids. Even still, this can make those early feeding sessions quite difficult (and messy!) until he gets used to moving food to the back of the throat. As he gets older, this sensitivity in the back of the mouth will slowly diminish and he will be able to manage larger and more complex texture more independently. 

It is important we don’t intervene when he is gagging as this can actually interrupt his ability to cough/gag food back up and may even cause food to dislodge further down into his airway. Rather, offer praise and support and don’t show any anxiety or fear. Remember, we want to foster a good relationship with food and mealtimes. Showing our own anxieties unnecessarily can be detrimental in overly sensitive children. 

Signs of choking include:

  • Trouble breathing
  • Cough or gasp as they try to draw a breath in
  • Look scared 
  • Unable to make a sound
  • May start to go blue in the face
  • If no action is taken to dislodge the object he may go limp and/or unconscious

Choking, on the other hand, is a lot more serious and it is important we all know what to do if it does happen, before it happens. Choking happens when something is stuck in the back of the throat and he is unable to cough/gag it back out. As it can obstruct the airway and stop the ability to breath, it can be life threatening. It is therefore strongly recommended that caregivers are skilled in knowing what to do in the unlikely event of a choking episode. [56] 

  • If you can see the item that is stuck, try and remove it. If you can’t see anything, or can’t easily remove it, do not repeatedly poke your fingers into his mouth as you can accidentally push the object further in.
  • If he starts to cough loudly, leave him to it as this may be enough to dislodge the object.
  • If this is not helping, or he starts to go silent (but still conscious), try back blows. Sit down, lay him face down on your thighs, supporting his head with your hand. Try and get his head lower than his bottom. With the heel of your other hand, give 5 sharp back blows between the shoulder blades, checking him in between each.
  • If this has dislodged the object, turn him over and lay him face up across your thighs, supporting his head with your hand and his head slightly lower than his tummy.
  • Place two fingers on his breastbone and apply 5 sharp chest thrusts, assessing him in between each.
  • Repeat if this has been unsuccessful but only if he is still conscious.

If he falls unconscious immediately call for help and commence CPR. [57]

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How do you avoid choking?

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  • Always ensure he is sitting up right at a 90-degree angle, and never in a recline position (stroller, couch, leaning back when sitting on your lap).
  • Always supervise him when he is eating, preferably in front of him so you can watch his face.
  • Beware of foods that can be choking hazards. These include grapes, peas, chickpeas, cut-up apple, cherries, whole nuts and seeds, popcorn, hard vegetables, chunks of peanut butter, large pieces of meat. 
  • Cut up problematic foods (e.g. grapes, peas, cherries) and ensure all food offered as finger food is smooshable. That is, if you were to place it between your thumb and forefinger you can easily squash it.
  • Ensure you/they do not put too much food in at once. Watch for the chipmunk! Some babies are masters at storing food in their cheeks!
  • Know the difference between choking and gagging. [56]

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What are the most common food allergies?

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There are many foods that can stimulate an allergic response. The most common are:

  • Peanuts
  • Egg
  • Fish
  • Tree nuts
  • Shellfish
  • Soy
  • Milk
  • Wheat

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When is it safe to introduce potentially allergenic foods?

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Although it can feel daunting to introduce potentially allergenic foods, research now shows us that leaving it for too long can actually exacerbate the problem. Evidence affirms that the early introduction of potential allergens, even in high-risk infants, can actually help protect against the development of an allergy.1 In light of this, most guidelines around the world advise to introduce all potential allergens in the first year of life, but not before 4 months. [34, 36, 37, 55, 77] 

However, if someone in your baby’s immediate family (mother, father, sibling) is known to have a severe allergy to any of the food groups, please consult with your pediatrician first.

The American Academy of Pediatrics (AAP) New Guidelines for Infant Food Allergy Prevention:

What Families Need to Know 

  1. The AAP guidelines recommend early “purposeful” introduction of allergens to help reduce your baby’s food allergy risk. 

  2. Introduce foods like peanut, egg, and milk when baby is 4 to 11 months old, regardless of baby’s risk for food allergies. 

  3. Families with infants at high risk for peanut allergies (due to family allergy history and/or severe eczema) should introduce peanuts into their baby’s diet at 4 to 6 months. 

  4. Breastfeeding alone is not enough to prevent food allergies, although it may help prevent eczema. 

  5. Feeding your baby hydrolyzed formula will not reduce your baby’s food allergy risk.

How to Introduce Allergenic Foods

  • Only introduce one new ‘allergenic food’ at a time so that if a reaction does occur, the problem of food can be more easily identified. 
  • Try the food at a convenient time, earlier in the day if possible (in case there is an allergic reaction).
  • Ensure the child is otherwise well.  

Rub a small amount of smooth peanut butter (a good-quality peanut butter without added salt or sugar) on the inside of the infant’s lip (not on their skin). 

  • If there is no allergic reaction after a few minutes, increase to 1⁄4 teaspoon and observe for 30 minutes. 
  • If there is no allergic reaction, give 1⁄2 teaspoon and observe for a further 2 hours. If there is going to be an allergic reaction it will occur with 2 hours of exposure. If there is no allergic reaction, parents should continue to include peanuts in their infant’s diet in gradually increasing amounts at least weekly. Regular exposure helps to build immunity and decrease the chances of allergies.
  • If there is an allergic reaction at any step, stop feeding peanuts to the infant, and seek medical advice.

Repeat the steps above but with a well-cooked egg. You can mix a small amount (1⁄4 teaspoon) of mashed hard-boiled egg with a liquid such as breast milk or formula, or into the baby’s usual food (such as vegetable puree). There is no need to separate the white and yolk.

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What does an allergic reaction look like?

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In general, if there is going to be an allergic reaction to a certain food, it will most likely occur when he is eating, or shortly after. Very occasionally it doesn’t show up for several hours so it is important to keep a close eye on him for potential signs, especially when introducing the common allergens. It is always a good idea to have a chat with your health professional before you introduce the most common allergens (peanuts, egg, fish, dairy). They may advise to have some medication on hand in case it is required.

Signs of a mild to moderate allergic reaction

  • Swelling of lips, face, eyes
  • Hives (reddish, swollen, itchy areas on the skin)
  • Eczema flare (a persistent dry, itchy rash)
  • Tingling mouth
  • Redness of the skin, particularly around the mouth or eyes
  • Itchy mouth or ear canal
  • Odd taste in mouth
  • Nasal congestion, runny nose, sneezing, cough
  • Abdominal pain, vomiting, distress
  • Diarrhea

Signs of severe allergic reaction (anaphylaxis)

  • Difficult/noisy breathing
  • Swelling of the tongue
  • Swelling/tightness in the throat
  • Wheeze/cough
  • Pale and floppy
  • Loss of consciousness

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Can an allergic reaction happen after subsequent exposures to a food baby has previously had no reaction to?

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Yes. Allergic reactions do not always occur on the first exposure to the new food. Monitor him if it is a common allergen (e.g. peanuts, egg, dairy) for at least 6 exposures. Once introduced, it is a good idea to keep exposing him to that food on a regular basis (once a week is good) as this helps to build up his immune system to that particular food.

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What is the difference between a food allergy and a food intolerance?

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A food allergy stimulates an immune response and can result in these symptoms [46] within 2 hours of exposure. A food intolerance, on the other hand , results in a range of mainly digestive symptoms, including abdominal bloating, wind, diarrhea, nausea, and indigestion. However, a food intolerance can also result in eczema flare-ups and/or asthma. Sometimes these symptoms can mimic other medical conditions and it’s advised you follow up with your pediatrician.

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Disclaimer: The information provided is the opinion of Good Feeding, it has not been evaluated by healthcare professionals, and is for educational purposes only.  Before starting any new foods or feeding practices, please consult your baby's healthcare professional.