A Pediatric Allergist’s Guide to Diet Diversity and Allergen Introduction in the First Year of Life
Starting solids is an exciting milestone! Early nutrition and diet diversity play an important role in your little one’s development. Gone are the days when starting solids meant starting rice cereal. The latest USDA Dietary Guidelines recommend feeding babies a diverse diet that includes introducing common food allergens once a baby starts solid foods. Studies show that diet diversity may help reduce the risk of food allergies while positively impacting neural development and gut health. And, the first few years of a child’s life lay the foundation for healthy habits and healthy eating. There are so many benefits of an early, diverse diet - let’s dive into a pediatric allergist’s take on early allergen introduction and diet diversity!
Our friend and board-certified pediatric allergist Dr. Alice Hoyt, founder of the Hoyt Institute of Food Allergy, host of the “Food Allergy and Your Kiddo” podcast, and Mission MightyMe advisor, shares tips for introducing nutritionally diverse foods and common allergens in the starting-solids phase so you can feed more confidently from infancy through toddlerhood.
What is Diet Diversity?
Technically, diet diversity is an assessment of how many food groups a child is eating on a daily basis (health organizations like the World Health Organization (WHO) want to see at least 5 out of 8 in each day). But what parents are likely seeing on social media, reading, and hearing about is feeding a variety of nutrient-dense, flavor-rich foods early, in order to expose little ones to a range of offerings that optimize their nutrition while also helping to avoid the dreaded “picky eating” stages of toddlerhood and childhood.
But Why is Diet Diversity Important?
As children grow big and strong, their nutritional requirements evolve to meet the demands of their little bodies. Adding a diverse range of foods and food forms to their diets not only helps support their development but cultivates a healthier microbiome and may even help to prevent food allergies.
When Should I Start Introducing New Foods to My Baby?
The transition from exclusive breast/formula-feeding to a diet of breastmilk/formula plus the introduction and incorporation of common, age-appropriate foods typically occurs between 4-6 months of age. One of the big Q’s parents frequently ask is “how do I know when my baby is ready for solids?”
Look for these signs that your child is developmentally ready:
- Being able to control the head and neck
- Sitting up with or without support
- Showing an interest in food and reaching for it
- Bringing objects to the mouth
- Losing the tongue thrust reflex that pushes food out of the mouth
What Food Groups Should Parents Offer?
As to what foods parents should offer first, the American Academy of Pediatrics says that for most children, you do not need to give foods in a certain order. Remember, you don’t have to start with rice cereal! It’s totally fine to start with pureed veggies or fruits. The USDA also recommends incorporating foods rich in zinc and iron like meats, beans, and fortified infant cereals. Remember, this a first for your little one (and often mom/dad!), so ease into this new experience and aim to provide a variety of foods from different food groups.
As defined by the WHO3, diet diversity is present when the diet contains five or more of the following food groups:
- Breast milk
- Grains, roots and tubers
- Legumes and nuts*
- Dairy products (cheese, yogurts)
- Flesh foods (meat, poultry, fish)
- Vitamin A-rich fruits and vegetables
- Other fruits and vegetables
You may notice a lot of these groups include common allergens. Early and consistent allergen exposure is recommended by leading health organizations. The top 9 allergens (peanut, tree nuts, egg, cow’s milk, wheat, soy, finned fish, crustacean shellfish, and sesame) also happen to be some of the most nutrient-dense foods you can serve your little one–win, win! The key is that once you introduce your baby to a new allergen, incorporate it as a regular part of the diet, rather than just trying it once.
*In regard to peanuts, there have been several studies in the last decade that have shown the protective benefit of early exposure. Two such studies are the LEAP and EAT Studies, led by world-renowned pediatric allergist and Mission MightyMe co-founder, Dr. Gideon Lack. Essentially, the LEAP Study proved that most kiddos who are at risk of peanut allergy can actually have that allergy prevented by introducing peanut into their diets in the first year of life and keeping peanut in their diets until 5 years of age. The EAT Study showed protective benefits in lower-risk kiddos when sufficient quantities of allergens were consumed.
Even newer studies, have found that to maximize peanut allergy prevention in the general population, all infants should start eating age-appropriate peanut products by 6 months of life; and infants with eczema, especially severe eczema, should start from 4 months of age.
What parents need to know is: the earlier, the better (starting as early as 4 months of age)!
How Should I Introduce ‘Diet-Diverse’ Foods to My Child?
Always check with your pediatrician with any questions about whether your child is ready to start solids and begin trying common food allergens. Current American Academy of Pediatrics Guidelines do recommend that high-risk infants (those with severe eczema and/or existing egg allergy) be evaluated by a physician before trying peanut foods, but most other infants can start when they’re ready for solid foods. Once you get the greenlight, remember these tips:
Let your child try one, single-ingredient food at a time at first. This helps parents see if their child has any problems with that food, such as an allergy. The old guidance said to wait 3-5 days in between introducing each new food, but this really wasn’t based on any evidence and can be overly cumbersome for parents. I recommend trying foods at your own pace, which could mean more than one at a time or one per day or whatever you feel your baby would like! My exception to this is introducing common allergens: introduce common allergens, such as peanut and egg products, one at a time. This is because most food allergies will present with symptoms within a few minutes to a few hours. Before long, your little one will be on their way to eating all types and textures of new foods!
At first, it’s easier for infants to eat foods that are mashed, pureed, or strained, and very smooth in texture. It can also take time for children to adjust to new textures – this may look like coughing, gagging, or spitting up. When you see these responses, hold off on that texture for now and try again in a few days. As their oral skills develop, thicker and semi-solid foods can be introduced. Here are some tips for preparing foods:
- Mix cereals, puffs, and mashed, cooked grains with breast milk, formula, or bottled water to make the food smooth and easy for your baby to swallow
- Mash or puree vegetables, fruits, meat products, and other foods
- Remove all skin and bones from poultry, meat, and fish before offering
- Cut soft foods into small pieces or thin slices; likewise, cut cylindrical foods (sausage, string cheese, etc.) lengthwise then again into thin, short strips for easier consumption when your little one is ready for these
- Baby-led weaning is another great approach to feeding your baby
- When in doubt, ask your pediatrician!
It’s best to introduce potentially allergenic foods when other foods are introduced. Allergists recommend “early, often, ongoing”. My rules of thumb are:
- Start at 4-6 months of age, depending on your baby’s risk factors
- Include nut proteins in the diet about 3 days per week (that’s about 2 teaspoons of peanut butter 3 times per week, or 1 bag of MightyMe Peanut Butter Puffs per week)
- Keep nuts in the diet regularly, at least through age 5, always in age-appropriate forms
You will drive yourself crazy trying to craft multi-course meals for your little one every day of the week. Just aim to keep a variety of foods and other common allergens in your child’s diet regularly as a normal part of your family’s overall routine. There are also a number of packaged baby food options available that supply convenient, diverse nutritional offerings (e.g. pouches, baby food jars, delivery services, etc.) if you decide that’s right for your family.
If you’re looking for simple, nutritious and diet-diverse foods and are ready to regularly include peanuts and tree nuts in your little one’s diet, check out Mission MightyMe Nut Butter Puffs!