Introducing Foods and Managing Your Child’s Diet

Are you ready to start weaning?

In this section nutritionist, Charlotte Stirling-Reed, explains the national guidelines for weaning, the different approaches you can take and provides advice for high-risk babies.

Is my baby ready to start weaning?

In the UK and in line with advice from the World Health Organisation, it is recommended that we start introducing solid foods to babies at “around six months” of age.

Before this, babies are less likely to be ready for solid foods as they need time for their digestive system and their immune system to develop. Additionally, breast or formula milk contains more or less everything that a baby needs until they are around six months of age.

Of course, there are circumstances where some babies may need solid foods a little before they get to six months, and certainly babies do all reach milestones at different times too.

If you feel your baby is ready before six months of age, it is a good idea to have a chat with your GP or health visitor first and look out for the signs of readiness below.

Signs that may suggest your baby is ready for their first solid foods include:

1. Your baby can stay in a sitting position and hold their head and neck steady
2. Your baby can coordinate their eyes, hands, mouth and so they can look at, pick up and put foods in their mouth
3. Your baby can swallow foods and doesn’t push more food out with their tongue than they swallow.

Many parents often point out other signs of readiness in their babies, such as a real interest in watching their parents eat, chewing toys and their fists and waking more during the night. However, these can just be typical developmental milestones that babies reach at around this age and don’t necessarily mean a baby is ready for solids. Try to look out for the main three signs above and ensure they are happening regularly and all together rather than just on one occasion.

Advice for babies in the high-risk category

When it comes to babies who are higher risk of allergies, research suggests that they may benefit from early weaning, including the early introduction of eggs and ground peanuts with the support of a paediatric allergy specialist/dietitian.

If your baby is in the high-risk category and you want to attempt early introduction, it is still important to make sure your baby is developmentally ready for solid foods, so make sure those signs of readiness are ticked off before you offer your baby their first foods.

What time of the day shall I start introducing solid foods to my baby?

The best time of day to start introducing your baby to solid foods will vary from family to family. Only start introducing solids (especially food considered more allergenic) to your baby when they are well. Try to pick a time of day that is calm, free of distraction and when you’re not in any kind of a rush. You also want your baby to be happy, not too tired or over-hungry.

Start with just one meal a day initially and try and build a routine around this mealtime, so that you offer solids at a similar time each day going forward. This will allow your baby time to get used to a new routine, to build up an appetite for solids and, lastly, to know when to expect solids instead of milk.

Once your baby has accepted their first meal and seems to be getting small amounts into their tummy and enjoying the process, you can think about adding a second meal in and then again, a third. Go at your baby’s pace – nice and gradually.

One point to note is that when it comes to introducing allergens it’s good to try and pick a time earlier in the day – breakfast or lunch at the latest – so you have plenty of time before bedtime to spot any potential reactions. When it comes to introducing allergens it’s best to offer them in small amounts and as the only new food that day, doing so will make it easier to identify any problem foods.

How to make it an enjoyable experience for you and your baby

It’s not unusual for parents to feel anxious when it comes to weaning their babies. Where do I start? What about finger foods? How do I prevent my baby from choking? Combine those normal parental worries with a baby at higher risk of developing food allergies, and the process of weaning can seem quite frightening.

It doesn’t have to be so scary and actually, making foods and mealtimes fun can make a really big difference to how well your little one takes to solids and the process of eating.

There are so many ways to make the weaning experience fun for BOTH you and your baby. First through, try to boost your confidence by doing a little reading around the topic; know the basics and try to get together a few helpful pieces of equipment to get you on your way (this support pack should help you do that!).

When you’re ready to start your weaning journey, try out some of these tips below to keep those mealtimes fun and enjoyable for you and your baby:

Eat together: Sit together and eat with your little one as much as possible – they will learn so much and enjoy it so much more if you’re part of the mealtime with them.

Find a routine: Get into a routine around mealtimes so that your little one knows when to expect solid foods and can get ready for them.

Create a relaxing environment: Try putting some calming music on in the background before you pop baby in the highchair so you’re instantly establishing a calm and relaxed environment.

Offer variety: Try to offer plenty of variety on baby’s plate after those first tastes, this helps expose baby to a variety of colours, tastes and textures and helps keep the weaning journey exciting.

Let them explore: Avoid putting lots of pressure on them to ‘eat up’ and instead allow them to play with and explore the foods in front of them. All of this helps to build familiarity with food, which has been shown in research to increase acceptance.

Make mealtime quality time: Take away distractions at mealtimes and focus on it being a time for just you and your baby – they will really appreciate the quality time and attention you have to offer them, and they’ll soon learn to associate mealtimes with quality family time too.

Stay calm: Try to stay relaxed and calm at mealtimes, even if you don’t feel it’s going well. The more baby sees you relaxed and happy, the more they will emulate that themselves.

Make it fun: Try introducing funky plates, cutlery and tablecloths for your baby to keep their interest in mealtimes and don’t be afraid to take them alfresco in the summer and get them involved in mini picnics with family and friends.

When choosing plates and cutlery, if your baby has a food allergy, check what the cutlery is made of, for example, some bamboo products are made from maize fibres.

Introducing allergenic foods

Once your baby is eating some fruits and vegetables, you can start to introduce foods considered to be more ‘allergenic’ like egg and peanut. If you decide not to introduce these foods early, try and aim to introduce egg and peanut to your baby by 12 months of and if no reactions occur, continue to give them to your baby regularly as part of their usual diet.

When introducing a new food, always choose a day when your baby is well. Introduce one new food at a time (one per day) so that if an immediate reaction occurs, the problem food can be more easily identified. Foods that cause delayed reactions are harder to identify, so continue to give the foods you introduce regularly and if symptoms occur, keep a food and symptoms diary to try and work out what could be causing the problem. You can find a great template to use in this pack. Some foods, such as strawberries and tomatoes, often cause redness, however this is very unlikely to be an allergy.

If your baby shows no signs of an allergy, continue to give this regularly as a part of a varied diet. It is important to introduce foods that you and your family eat regularly and that you want to eat on a regular basis. For example, if the family eat lots of almond, hazelnuts and peanuts, focus on introducing those rather than Brazil nuts which the family may never eat. If your family never eat sesame, focus on introducing other allergenic foods that you use more often in your cooking, such as fish or celery. Do not continue to feed your baby something they are allergic to.

Whilst taking small steps to introduce the food might make you feel more at ease, smearing food on your baby’s skin will not help to identify possible food allergies. This is because your baby’s skin is very sensitive and skin irritation and redness on contact does not necessarily mean they have a food allergy. Many foods (e.g. citrus, tomato and strawberries) can irritate the skin and cause a red rash (especially around the mouth). This is not an allergy, and you do not need to avoid the food.

What if I follow all the advice and still suspect an allergy?

If you think your child is having an allergic reaction, then stop giving them the food and do not reintroduce before speaking to your healthcare professional.

Tips for introducing allergenic foods

• Egg white and yolk: Choose fresh, in date, British Lion stamped eggs. You can offer your baby scrambled, soft- or hardboiled egg, or perhaps in the form of an omelette. You can also mash egg into other puréed foods like fruit, vegetables, yoghurt or baby rice. Aim for at least one egg over the course of a week. Current guidance is to only use British Lion stamped eggs as these have been laid by chickens vaccinated against salmonella to reduce risk of food poisoning.
• Wheat: Weetabix or similar breakfast cereals, well cooked pasta shapes, toast fingers, couscous.
• Fish and seafood: Puréed, flaked or mashed cooked fish such as cod, haddock, salmon or trout or seafood such as prawns or crab.
• Seeds: Hummus (houmous) (which contains sesame paste, tahini) or crushed seeds added to foods like yoghurt or puréed fruit.
• Cow’s milk: Yoghurt, fromage frais with no added sugar. Add fresh whole milk to meals like mash potato or sauces.
• Tree nut: Use smooth nut butters or grind whole nuts (e.g. almond and cashew) to a fine powder and mix with fruits, vegetables, yoghurt or baby cereals.
• Peanut: Use smooth peanut butter or grind whole peanuts to a fine powder and mix with fruits, vegetables, yoghurt or baby cereals. You could also add to your baby’s milk. Aim for a total of two-level teaspoons per week.

IMPORTANT: Never give whole nuts, coarsely chopped nuts or chunks of nut/peanut butter to children under five years of age as these are a choking risk.

Understanding food labelling

When weaning a food allergic baby, it is important to understand exactly what allergens they are eating to track symptoms and reduce risk of a reaction.

The top 14 allergens

The below 14 food groups currently have to be listed (by law) on packaging and labelling in the UK.

1. Celery
2. Cereals containing gluten
3. Crustaceans
4. Eggs
5. Fish
6. Lupin
7. Milk
8. Molluscs
9. Mustard
10. Peanuts
11. Sesame seeds
12. Soya
13. Sulphites
14. Tree nuts

What you should expect to see

Pre-packed food

This refers to food products which are packaged before being sold. Prepacked food products should have a full ingredients list with the top 14 allergens emphasised, for example in bold font. The top 14 allergens are required to be emphasised on the label, even if they appear ‘hidden’ under a different name (e.g. whey protein (from milk)).

Non-prepacked (loose) food

This refers to food products which are sold loose (e.g. bread at a bakery) as well as prepared meals in a restaurant or café. Food businesses are required to provide allergen information on the top 14 allergens, but the way they provide this is up to the individual business. They may provide allergen information in a written form (e.g. on the menu) or they may communicate the information verbally.

If allergen information is not provided in written format, food businesses should signpost customers to where they can obtain this information. For example, there may be a statement on the menu directing customers with allergy to ask staff for allergen information.

Prepacked food for direct sale (PPDS)

These food products are packed on the same premises from which they are being sold (for example, a sandwich packaged and sold in a café). Currently the allergen information can be provided in the same way as non-prepacked (loose) food products. However, from 1st October 2021 these products are required by law to have full ingredients listed with allergens emphasised.

It is important to remember that food labelling laws differ in other countries. You should always check ingredients carefully on food which has been imported or when buying food abroad.

For more information on the requirements of food business in relation to allergen information, please visit the Food Standards Agency website.

Reporting labelling errors/malpractice

If you feel that a food manufacturer or catering outlet has not met their legal obligation to provide accurate allergen information, you should report this to your local trading standards.

Allergy Alerts

Sometimes food products are withdrawn or recalled from sale due to a risk to consumers. This could be down to incorrect or missing allergen labelling, or any other food allergy risk (such as cross contamination). You can sign up to receive alerts of these recalls free of charge via our Allergy UK website or Helpline to stay updated and informed.

Precautionary labelling

Precautionary labelling indicates a risk of unintentional presence of an allergen due to cross contamination or manufacturing techniques. The wording is sometimes phrased as ‘Not suitable for those with x allergy’, ‘May contain x’ or ’Made in a factory that also handles x’.

There is currently no legal requirement for manufacturers to use precautionary labelling. In general, snacks and dry foods such as cereals, cereal bars, chocolate, biscuits and nuts are at greater risk of cross contamination with allergens. It is up to you whether you avoid products with may contain labelling, and this is something you can discuss with a healthcare professional when drawing up an allergy management plan.

Vegan and allergen-free labelling

People living with milk, fish, crustacean, mollusc and/or egg food allergies should not assume that products labelled as ‘vegan’ are suitable for them. This is due to the risk of unintentional cross-contamination with allergens. If a product does not specifically say it is ‘allergen free’ you should not assume that it is. For more information, see the full FDF Guidance on ‘Allergen’-Free & Vegan Claims. (February 2020).

Our top tips

1. Check food labels every time you purchase a product, even if you’ve purchased it before as ingredients can change.
2. When buying loose food always check that the food business has precautions against cross-contamination.
3. Claims on a product such as ‘improved recipe’ may indicate a change of ingredients.
4. If you have any doubts over the allergen content of a food, do not take the risk.

Keeping on top of nutrition

When you remove a food or multiple foods from your child’s diet it is important to make sure their nutritional requirements are met.

In this section dietitian, Kate Roberts, outlines the ways we can make sure a child’s nutritional needs are met when excluding foods due to allergy.

How do I keep on top of my child’s nutritional needs when removing food groups due to allergies?

Excluding different foods create different challenges:

Cow’s Milk: Cow’s milk is a very common food allergen, and often dairy products are relied upon to provide essential nutrients. Here are the main nutrients that cow’s milk provides and how to replace them:

• Protein: an essential nutrient for providing the building blocks for growth and repair, dairy products are an excellent source of protein, for example a matchbox size piece of cheddar cheese contains 8g protein. Soya and pea alternatives contain enough protein but the other plant-based alternatives such as oat, coconut and the nut milks have negligible amounts.
• Fat: Not often considered but cow’s milk in the form of cheese and yoghurt is a valuable source of fat in the diet for your baby. Although adults do not need large amount of fat in their diet, it is useful for children to have to help with their fast weight gain and to slow down gastric transit. There are plenty of substitute products including soya, oat and coconut versions of cheese, yoghurt, custard, crème fraiche and cream. Just be aware that these products do not always contain calcium and are usually very low in protein.
• Calcium: If your child is still breastfeeding or having sufficient volumes of a hypoallergenic formula, they will most likely be getting enough calcium. Breastfeeding mums need to have 1250mg of calcium daily which is difficult to get through food alone. It is wise to start a calcium supplement containing at least 800mg of calcium or request one from your GP.
• Vitamin D: All breastfed infants should be offered a daily vitamin D supplement containing 10mcg of vitamin D. Formula fed babies will need to have a supplement when the volume of formula drops below six00ml or 20oz per day.
• Iodine: Iodine is a mineral needed for the production of thyroid hormones, these are important in many processes in the body, especially in the development of your baby’s brain. Dairy products are one of the most common sources of iodine in the UK, eggs and white fish are also good sources. Many plant-based milks are not enriched with iodine, therefore if the one you use isn’t, ensure your child is eating eggs regularly if they are able to and is having a couple of portions of white fish per week. If either of these are not possible you may need to consider a supplement. Breastfeeding women provide iodine for their babies but need a higher amount per day (200mcg).

Eggs: Egg is another common food allergen. They are good sources of protein, vitamin A, vitamin D, calcium, iron and iodine. If you have removed eggs from your baby’s diet you are able to replace these nutrients easily with meat, fish and dairy products.

Wheat: Wheat in itself is not necessary for a healthy diet; however, it is a good source of carbohydrate and is often the basis of baking. There are many alternative sources of carbohydrate available including: rye, spelt, barley, corn, rice and quinoa. See below for more tips on baking.

Peanuts and tree nuts: These are a good source of fats and protein. These nutrients can be replaced with meat, fish, eggs, dairy products and seeds. People following a plant-based diet will need to increase their intake of pulses, seeds and vegetable oils if they rely on peanuts or tree nuts.

Cooking with allergies

Tips and cheats for replacing allergenic ingredients when cooking:

• Oat alternatives to milk are an excellent replacement in savoury and sweet recipes as they don’t have a strong taste and are suitable for the whole family. You can use them in mashed potato, white sauces, custard, rice pudding, cakes etc. You can also get higher fat versions which add a creaminess if desired. Almond milk alternatives are also quite mild tasting.
• There are a huge range of dairy-free spreads available depending on your budget and taste. They can usually be used in cooking and baking, however, check the label as some cannot.
• Once you have dairy free milk and spread then you can make most things dairy free – you can bake or convert recipes quite easily.
• White sauces are easy to make with a plant-based milk and cornflour.
• Custard is simple as original custard powder is cow’s milk free and can be made with a plant-based milk.
• Substitute butter for a dairy-free spread or oil in baking and remember, cocoa powder is dairy free.
• Check the food labels on food you already get and regular items before getting everything from free-from sections. A lot of food is already allergen free but not marketed as such.
• Look for vegan products and recipes which will not contain cow’s milk or eggs. Do check labels though as they may contain traces of allergens.
• There are many replacements for egg including:
  • 1 tbsp of chia or linseed mixed with 2 tbsp of water and left for 5 minutes to gel
  • 1 tbsp of puréed fruit or ½ mashed banana
  • 1 tbsp of chickpea flour with 2 tbsp water
  • 1 teaspoon of baking powder (raising agent)
• If baking without wheat, wheat free flours are widely available, and xantham gum is an excellent addition to replace the gluten in wheat and is widely available.

Traditional weaning methods vs baby led weaning

For healthy term babies, the Department of Health recommends exclusive breastfeeding until around six months and introducing solid foods when your baby is developmentally ready at around six months. Recent research has found that babies who are at a higher risk of food allergy may benefit from earlier introduction of solid food.

Traditionally parents provide first foods, usually fruit and vegetables in a puréed form. This is particularly important if started weaning before the age of six months because babies don’t tend to be developmentally ready to cope with solid food before six months. The texture of the food is then made progressively lumpier until baby is having normal family meals at around 12 months.

What textures and when?

• Six months or younger: smooth purées
• Seven – nine months: mashed foods with some lumps
• Nine -12 months: mashed, chopped and minced family meals

Baby led weaning is a method which promotes babies being involved in family meals, being offered the same foods and having control over what they eat as well as how much they ingest. (Rapley, 2011).

Babies feed themselves and are not fed by a spoon and foods are not modified by puréeing or mashing in the traditional way. If you chose to approach weaning through the baby led method, you must wait until your baby is six months old before you start.

The benefits of baby led weaning include:

• Reduced fussy eating
• Better appetite regulation
• Decreased risks of obesity in later life
• Fewer mealtime battles

Baby led weaning is not without its risks, the main concerns include choking, faltering growth and iron deficiency. These can be avoided by offering an iron rich source of food at each mealtime, an energy rich source of food that is easy to eat, and by avoiding offering foods that are disc shaped or a choking risk. Foods should be about the size of an adult finger and not easy to break off (such as raw apple).

You should not feel pressured to fall into either method, weaning should be a relaxed and enjoyable process, and you will quickly find out your baby’s preferences. Often a mixture of both methods is the best as you can experience the benefits of both.