Episode 12: Starting Solids Part 1: 4–6 Months, Preparation and What Babies Really Need

Starting Solids: What to Know Before You Begin

In this foundational episode of Nutrition for the Early Years, I walk you through the stage before starting solids—because introducing food is about more than just the first bite.

If your baby is approaching the 4–6 month window, or you want to feel more confident before starting solids, this episode is for you. I break down what readiness actually looks like, how nutrition needs begin to change in infancy, and how I think through common questions like rice cereal, allergen introduction, water, cups, and baby-led weaning versus purées.

This is one of those episodes you may want to save and come back to.

In this episode, I cover:

• Developmental readiness for solids
• Why tummy time matters for feeding skills
• What the tongue extrusion reflex is and why it matters
• Iron needs in infants, especially for breastfed babies
• Why solids do not reliably help babies sleep
• When and how to start practicing with cups and water
• The role of cereal today
• Baby-led weaning versus purées—and why many families do both
• Early introduction of peanut and egg
• What the LEAP trial changed about infant feeding
• First food ideas and what a simple baby plate can look like

Key takeaways

Starting solids isn’t just about age—it’s about readiness, skill development, and understanding your baby’s changing nutritional needs.

In this episode, I explain why head and trunk control matter, why oral play and table exposure can start before true feeding, and why introducing solids too early doesn’t necessarily add benefit. I also share how I approach common infant feeding questions in real-life pediatric practice, including how I think about iron, allergen exposure, and balancing purées with baby-led weaning.

My goal is for you to walk away feeling more confident about:

• how to tell if your baby is ready
• what nutrients matter most in this stage
• how to begin allergen introduction thoughtfully
• how to keep the process simple, low-pressure, and developmentally supportive

A few reminders from this episode

• Babies should be sitting with good support and head control before starting solids in a meaningful way.
• Milk remains the nutritional cornerstone through the first year.
• Breastfed babies need more intentional iron support through complementary foods... for them, feeding before 1 is more than just fun!
• Solids are not a sleep solution.
• Water at this stage is for skill-building, not hydration replacement.
• Rice cereal isn’t “bad,” but grain variety matters.
• Baby-led weaning and purées can absolutely coexist.
• Early peanut and egg exposure reduce allergy risk in many infants.
• First foods don’t have to be complicated.

My first food philosophy

Simple, single ingredients that are super squishable or oversized.

Mentioned in this episode

• The LEAP study on early peanut introduction
• Research on baby-led weaning and choking risk
• Infant CPR and choking resources

Listener note

Every baby is different. My hope is that this episode helps you feel informed and empowered as you start solids. Use this information as a springboard for a conversation with your pediatrician, especially if your baby was born prematurely, has significant eczema, or has other factors that may increase allergy risk.

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Transcript

SPEAKER_00 0:00

Here's something that I think a lot of families think, okay, they've heard the phrase food before when it's just for fun. And I agree it can be, but there's more to that. Okay, so we need to put a pause and talk about the actual nutrition part here. Welcome to the Nutrition for the Early Years podcast with Dr. Liz, your guilt-free guidance for feeding your family. This podcast is for folks who are craving better nutrition for their kids, but are tired of the whiplash of nutrition claims and diet culture influence. You're reading labels, paying attention to ingredients, but you still doubt yourself. And for good reason. Food goes deep, and often we fear making costly mistakes that as parents we hope to prevent. If you're ready to explore the ins and outs of your child's actual nutrition needs and nourish the whole child from the inside out, hang with me, Dr. Liz Daniels. I'm a board-certified pediatrician plus registered dietitian, and we're gonna dig deep into real deal nutrition science, honest talk about barriers to health, and real stories that I help address. So let's dig in. Hey everybody, thank you so much for joining me today on Nutrition for the Early Years. You guys, today is an episode that I think you'll need to come back to.

unknown 1:18

Okay.

SPEAKER_00 1:19

If you have a baby and they're getting close to being ready for solids, or you're gonna be having another baby, or you know a friend who's having a baby, or say you're a healthcare worker and you're learning how to take care of kids and you want to give some great advice for families who are starting solids. This is like a foundational episode for you. Today we are going to get into the stage before we actually start solids. So normally I'm having conversations like this at my four-month wall visits with my families, and I love these conversations. Like I think infant feeding is one of the most fun experiences because it's a new way of bonding. You maybe got to breastfeed and it was awesome, or maybe you didn't. And like being able to feed your baby, there's just something really sacred about it. It is so fun and beautiful. It can be stressful, but I think it's really one of my favorite memories of having my own babies. And I can't wait for the day sometime when we get to have grandchildren or being able to share this with others. I really enjoyed doing this with my niece. It's just, it's so much fun. So, my hope is that after today, you're done listening to this podcast and you feel like I can do this and it's gonna be awesome. Like, that's my goal. Okay, so we have a lot to talk about, and this is a long podcast. So apologies ahead of time. But again, it is chock full of super good stuff. In my conversations, sometimes even like I'll have a baby who's having trouble sleeping, or having family that's asking them, like, are you gonna talk to your doctor? Because I think they're ready. And I'll hear things like, oh, just put cereal in the bottle so they sleep, or skip the purees so that they're not picky, or baby lid meaning is great, but they're gonna choke, or like, how do you prevent an allergy? And what can I do before to help prevent food allergies? There's a lot of curiosity around this topic. And I think, you know, in the last decade, there's of course a lot of influencers, some with some great knowledge and some who have just a lot of maybe experience. And it can get kind of confusing, but you know what? I just want to share like, even in my own group of amazing pediatricians, there's gonna be a little different conversation from each one of us because some of these things are what I call the gray. Meaning there is evidence for things I'm gonna talk about and I'm gonna share my citations with you. And then there's stuff that in my experience, both as a pediatrician, dietitian, mom, all of that that influences how I guide my families. So some of this is opinion and there is definitely data behind it. And you know what? If we learn that I'm wrong and we need to update things, then we'll update it. But for right now, for the purposes of today, hold tight because we're gonna talk about some things and it might surprise you. So, number one, we are gonna cover developmental readiness. We're gonna talk about nutritional needs at four to six months. There will be a subsequent episode on six to nine months and then nine to 12 months for feeding because those are actually quite different stages. We're also gonna talk about milk intake, like breast milk versus formula intake, how much they need, um, nutrients like iron, zinc, vitamin D. We're gonna talk about rice cereal. We're gonna talk about allergen introduction and the leap trial and where are we at now and what do I recommend. We're gonna talk about water and some cups. We're gonna talk about puries versus baby lid weaning, and we're gonna talk about how to prepare your baby for eating right now, even if they're not ready. Okay. Here we go. All right. So the first thing I like to look at, again, pretending we're at a four-month well visit, is our developmental milestones. And actually, I love to encourage tummy time from day one. Day one. Like on a flat surface, day one. I think it's really, really valuable. I am not advocating for sleeping on our belly. I'm talking about tummy time, which you can start very early. And the later we start tummy time, the slower this process, everything else is a chain reaction that follows after it. So the slower we'll have achievement of some of those developmental goals. So I tend to encourage tummy time from day one. And yes, we're talking about solids here, but it starts with really good tummy time because being on our bellies for a good amount of time really enables good head control, holding the posterior chain of muscles along the perispinals, really giving the neck good range of motion. I like to see that we're turning our heads from side to side at one month. At two months, we're getting a little more extension on the back, and that by the time we're four months, we are doing a really good job holding ourselves up in a Superman position, like on our belly. Our arms can go straight out. We can kind of wiggle them around, and you'll see them sort of like it's a pre-crawling movement where they sort of look like they're they're flat on their belly, but their arms and their legs are kind of twisting in different directions. Rolling isn't something that I get really hung up on here, but I'm really looking to see that on their belly are they really good and strong because we really want them to be a pretty good sitter before we're starting to introduce solids. So this is where if you're not already doing tummy time, dive in, go for it, have fun. Maybe they're still in this preferred position where they really like to sit on your lap facing outward. So they tend to be in this like little C shape where their head sort of droops forward and they're they're not quite holding up their back really nice and straight. Yet that's not quite ready for solids. We want to make sure that when they're seated and their hips are supported, that they can look straight up at you. That's a really good position for making sure airway is gonna be safe for solids. And this is also gonna come with some oral skills. So I'm looking for a baby at this stage to start bringing objects to their mouth. They're probably drooling a ton, that's gonna have happened way sooner, but they're really bringing a lot of toys to their mouth. They may be even trying to reach for food on your plate. They're curious about that process. And if you bring something to their mouth, there's a reflex that tends to still be intact at four months and usually is faded by six months, and it's called the tongue extrusion reflex. And this reflex means that essentially it's there for the baby when they need to latch onto something. So you put something in their mouth and they naturally push their tongue outward to grab hold of a bottle nipple, curl around the nipple, and use that for sucking. And then the sucking reflex takes in. So it's a coordinated movement. And this reflex, the tongue extrusion reflex, should be fading, starting in about four months, and really should be gone by six months. Now, I'll often hear families say, Well, we tried solids, but they just spit it out. And that's a sign that their tongue thrust is still intact, and we need to give that some more time. You can practice with toys like teething toys and toys that they can draw to their mouth and play with getting different textures in there. I love the silicone toys that have different textures on them, really, really great. I love when babies are offered at the table, say they want to be at the table with you because they have FOMO and you offer them a baby spoon, even though they're not actually getting anything on it. Like that's a great skill just for them to play. Like it's a it's a nice fun toy. You can even have these in the bathtub, right? Like these are things that you can bring them out and and have them engaged, and they're still starting to support that oral skill development without having food on it yet. Now, if a baby is super not interested in food, that's pretty hard. We need to start encouraging that at about four months, like bringing them to the table with you. Like I mentioned, a lot of babies already want to do that because they want to be held and you need to eat. So those kind of happen in tandem. But if you're like making your meals, your baby's in the bouncer seat or taking a nap while you're having dinner, it might be time to start thinking about bringing them up and getting them in that same space so they can watch you. This is a lovely thing. I love it when babies can watch you eat. They watch you make sounds, you can be really dramatic. This is so good. And you can make all kinds of silly things. You can even blow bubbles in your water, you can try to be silly with it. But keeping that fun and getting them to giggle when you're at the table is the first start of bonding over food. And it is so easy to do. You can do it without even thinking about it, and it helps support their relationship with food as they grow. If you're at a four to six month stage and your baby's in a point where they're still sitting very forward-flexed, really don't want to hold their head up, they're not quite ready. So we should put a pause on that. Now, you can, just to reiterate, do lots of tummy time, really let them play with mouth toys, bring them to the table when you're there and help encourage that. You can put them in the high chair, just make sure that you're looking at the positioning. This is a little bit more visual, so it's hard to discuss over podcast, but there are different settings you can have your high chair at that, you know, can bring them to the table even when they're not quite ready to be eating or they're not able to hold themselves up super well, but they can still engage in the process. And I think that that is a great thing to do. So don't be afraid to break out the high chair early. Here's something that I think a lot of families think, okay, they've heard the phrase food before when it's just for fun. And I agree it can be, but there's more to that. Okay, so we need to put a pause and talk about the actual nutrition part here. Between four to six months old, babies are needing a lot of calories, but it's really coming from milk. So their primary nutrition is still gonna be milk until their birthday. Like that's a cornerstone. But the reason we care about this is because at about four to six months, baby's iron needs go from being 0.27 milligrams a day, like a quarter of a milligram all the way up to 11 milligrams from seven to 12 months. So they're starting to ramp up. And in the last month of pregnancy, so rewind a bit, last month of pregnancy, the baby's getting a bunch of iron from mama. So if your baby was preterm, they maybe didn't give this opportunity. And that would mean that their iron needs may be a little higher simply because that last month of pregnancy enables this transfer of iron and the baby's liver gets kind of stocked up. And they use that sort of stock of iron storage to help support growth and hematopoiesis, which is making red blood cells and making all kinds of important structures. You need that iron throughout the first four months of life. You use that and it becomes sort of emptied by the time you're four to six months, which is why we need to start getting it in our diet. In breastfed babies, they are not getting very much iron. It's very bioavailable. So it's a beautiful iron. So go breastfeeding. But it's simply often not enough for growth. So if you're exclusively breastfeeding your baby and you're planning to make it to a year, I'm gonna speak to you for just a minute and I'm gonna tell you your route for introducing solids should probably look a little bit more focused than a baby who is on formula. And I say that because formula actually meets the iron needs for babies, and so in entirety, all the way through their first year of life. So at a year, when I'm looking and screening for iron deficiency anemia, I'm really probably not going to be seeing that in a formula-fed baby. It's really rare for me to see that. Now, that said, they need iron rich foods too. So it's not to exclude them. I just simply like to really hammer home that, like, if you're in that category and I was, I breastfed my babies, and then I did baby lead weaning before it was cool because I was rogue and I loved food and I was like, we're gonna do this and it's gonna be fun. And it was great. But in full disclosure, I definitely had an anemic one-year-old. So learning from that experience, I shifted in my subsequent children, and it shifts how I talk about this with you. From a nutrition standpoint, the breast milk is gonna contain typically, we're looking 24 to 32 ounces a day at four to six months. And that's gonna actually continue through their birthday. You actually don't want to wean that volume at all. Okay. That stays true. The difference here is that they need a little bit from solid foods. Your gut maturity, if you happen to listen to some of the earlier podcasts, you might have caught that gut maturity is not intact when we're born. Like we don't have all of our digestive enzymes yet. We don't have all of the gut flora to help with digestion. It's not fully formed and not really ready for solid foods at four months of life for most babies. We have much more of those enzymes by six months of life and definitely by a year. But if you're starting to feed the gut prematurely, there's really not a lot of benefit. There was some concern for risk, increased risk for obesity with early introduction, like prior to four months. So this is why I don't recommend a rice cereal to help your baby fall asleep at night. More on that in a second. But I don't recommend lots of food, four to six months. We're gonna talk about what I recommend in just a second, but I just like to share your primary nutrition is gonna be from your milk until they're a year, but we do need to add on some important and valuable nutrition beginning at four to six months. And then especially from six to nine months, there's a big gap for some kids. And we're going to dive deep into how to meet those needs in a way that's not super stressful. It could be really simple. Okay, so we've talked about iron, zinc, and vitamin D are also things that we need for growth. And in that four to six month stage, again, if you're breastfeeding, this is where some kids will recommend vitamin D supplementation, either for you at high doses, like six to seven thousand IU a day, or for your baby at 400 IU, those will come in drops often. And that can just continue. Here's the thing I hear, and no knock on the grandmas because I love them dearly. But there's a lot of myth that solids will help your baby sleep. And I'll often hear from a family okay, Aunt Janie really suggested that we do a bottle right before bed with rice cereal to help a baby sleep. It works every time for all of her five children. And I'm gonna call BS on that, okay? So bologna sandwich for your kids in the car, because that's what that means. Um it really isn't the case. Sleep is neurologic. Sleep is built on associations, not just hunger. Okay. And especially at four to six months, we actually have the capability to make it through the night. That doesn't mean that all babies do. It just means that hunger isn't really what's driving them to wake up, especially if it's the same exact time every single night. And you put a boob in their mouth or you give them a bottle and they go right back to sleep. That is a sleep association. That is not a hunger cue. And that is one other reason why I don't recommend early introduction, because if it's not fixing a problem, like if we're not trying to treat reflux, if we're not trying to navigate something really specifically for that baby, then it's not adding value. Okay, so you can let that myth go. Solids will not help your baby sleep. I'm sorry, but you're welcome. Okay. Here's the other thing sleep is really key. I do think that when babies are getting hungrier earlier in the day and they're eating like at every two, two and a half hours, to me that's a sign that they're like trying to get those calories in throughout the day. And that is what allows them to sleep longer at night sometimes because they've already met those calorie needs. You know what I mean? So so I guess what I'm trying to communicate is that like following your baby's cues of when they're hungry and when they're ready for food is really going to be so, so essential. But trying to push it with offering more may not work for you. Okay. And it, and I this is where I kind of say, I don't buy the dream feed thing for every baby because it really is a neurologic thing. The next question is, well, what about water and cups? I actually think that this is really fun. Babies start to do this on their own in the bathtub. Like as soon as they can sit with support or they're in like a little seat in the bathtub, they'll start pouring cups and pouring water on themselves and kind of getting a little bit there. So you can already do your cup time there. So sometimes I'll tell families, don't even worry about water. Like just play in the bathtub. You can offer a cup at the table if you want to. It's just, it's gonna be a mess. But really, like just a little bit at an open cup or a straw cup is totally reasonable to do. At like six months, we're gonna start training and practicing. More on that in the next part of the series, but it's a skill that we're working to build. We're not actually replacing hydration. Okay. So again, their volume needs are gonna be met through the milk, but it is a great idea to start practicing because water is a thin liquid. It's actually harder to get and navigate that skill than a lot of other things. So we need a lot of time. And I still recommend kind of introducing water at about six months for play. We're looking at an ounce, okay? And then we kind of build on there. So if you're in that age group and you want to start playing around with it or putting it at the table, that's great. I tend to love like little cups for this. So sometimes families will have like little silicone cups. Those are great. You can also actually think there's some toys that work well, like little bath toys work well for some of this. Again, depending on what you, what product you have in your home, it doesn't have to be really fancy. One quick thing about the cup, I just like to encourage is this is a skill that takes a lot of practice. So if it's stressing you out, you can pause on that. But what we're looking to get them to do is sort of get their lips over the edge of the cup and sort of practice that first. And you can mimic that and practice that. Babies have a slow processing time. So do it a bunch, sing with it, and then you can offer that to them. And you'd be surprised how how fun that could be. I want to talk about rice cereal because I get this question often like, all right, do we do rice cereal? Do we not? Is it worthless? Okay. I love this. Let's think back a little bit because history is fun. Rice cereal was really introduced, I believe Gerber was the first product to put it out. And it was really for iron fortification. And it was a brilliant move because bear in mind at the time, a lot of formulas didn't actually have a lot of iron in them. They were not all iron fortified. That's relatively new. And so, in an effort to address iron deficiency anemia, which we've already talked a little bit about, and babies are at really high risk for that. Iron deficiency is important because it can lead to cognitive delay and neurodevelopmental issues. And so we want to make sure that we're supplying plenty of iron in our baby's diet. So, rice cereal was pretty easy to manufacture and add iron to it. It was shelf stable and it works really well. I used it for my kids. We now know too that rice can accumulate a little bit more arsenic than some other grains that are out there. So I do, and the AAP recommends that there's grain variety in this. So do we need to avoid rice completely? No, no. In fact, I love rice for babies. I think rice is a great food, especially worldwide. I mean, come on, everybody uses rice. But I do think the texture is important. I do think that the kind of rice is important. And I like to offer it as rice, not necessarily the rice cereal. In other words, we're not getting a lot from it when it is just whole grain rice. Now, I tend to lean more towards the iron fortified cereals for my breastfed babies because it's a great additive to thickening if you are making your own food, if you are wanting to incorporate that into their breakfast. Oats are great, quinoa's great, barley, mixed grains, all really great because they each have a little different profile. Um, so I tend to encourage a rotation. And you know what? You can make this yourself. You can put oats in a little blender and you can blend it up and get like a powder with it, and you can add breast milk or formula to that. Like you can make your own if you really want to. However, the iron fortified ones that are over on the counter are gonna have more iron than what is gonna be in your homemade versions. So if you're gonna use it, I tend to just say get the product that's already there because it really is safe. And now, from a safety profile, most of the products that are now on the market actually have mineral levels that they report out. So you can actually. See that. There's much more transparency. And I think that's really cool. It can be a really great addition to a baby's diet if they are exclusively breastfed or at risk for iron deficiency anemia, like my premi babies, or if it's something that you just are you're making about your food and you want to use that. I used it for my children at times. It wasn't my primary source, but it certainly is an option. It's not totally dead. Okay. Now let's talk about baby-led weaning versus puree's. So you got this baby who is sitting up pretty well. They're holding their head up beautifully. Their tongue thrust is starting to fade. They are excited and interested in the table, and you can't eat a meal without them pulling that tray or that food towards them. So this is what I want to say about this. I love baby-led weaning. Okay. Like I really do. I also really like puree's. And I am in the pro whatever you need to do camp. What I mean, and really where I would land is typically a combo. Most of my families that I'm seeing do a little bit of both. And there's a really good reason for this. So in a 2026 review, which I'll put in the show notes, baby lead weaning was they looked at choking risk. And this is not the first one. There's been multiple studies that looked at choking risk. And actually, it was pretty interesting. It did not increase risk for choking. And I think if it's done well, it doesn't necessarily increase risk for iron deficiency or any other nutritional gaps. But I do think that they're, if you're going to do baby lead weaning exclusively, I would recommend really spending time to nerd out and make sure that you are able to get exposure to enough of the nutrients that your baby needs because some babies really are slower in developing some of those oral skills, and that can cause a gap. So this is a one-on-one, each person makes their own call on this kind of thing. But as a general rule, I love baby lead weaning. Interestingly, there is some observational studies that show that babies who have kind of gone through baby lead weaning tend to have lower food fussiness, a little bit greater satiety responsiveness, meaning they listen to their body a little bit better and the families seem to know what that looks like. They tend to have lower free sugar intake and about 73% more veggies that are offered at six to 10 months, which is pretty interesting. That said, I still think that there is a place for puree's for most babies. I mean, let's be real. There's real life. You're going to go out to eat at a restaurant and maybe need to offer a pouch with it or puree foods or grandma's house, or, you know, maybe your kid's going to be fed at daycare and you don't feel comfortable with the daycare providers watching how they're doing on it, you know, or you want to be the one to supervise those exposures. That's okay. I think that's where most of my families tend to live is this sort of, we're going to add puree's there, but we really want to give them oral skill practice. And I think that's beautiful. It can be done really, really well. So I like that feature. This is all about what I like families to know is baby leg weaning really is about that skill development. And it is a great way for you to see what your baby's really capable of. Because if you don't offer it to them and watch them, then you don't really know. And I think that parents are actually much more, once you get over the initial fears, you're much more equipped to manage choking behaviors or gagging behaviors because you know what your baby can do. And that is really empowering. So I like that. Side note here, in terms of like purees, when people offer purees, I do want families to know that it takes time. So typically when we're introducing spoon feeding skills, like with puree's, it can take a good month, six weeks for babies to get really good at consolidating that spoon feeding. And this is why I like practicing at that early stage when you're not actually introducing the food, like four to six months, you're not introducing the food yet, but you can start playing with spoons. You can model that, you can practice some of that. You can put them in the high chair with the spoon to play with, and they can tap things around with it. Or even if you wanted to put a little bit of like, you know, yogurt out there, let them play around with it and draw and paint with it, that's totally fine. Those are fun things to do. Now, it really does matter that by the time, no matter what's going on, that at least by eight to nine months, we are exposing to more textures. So, again, more on that in another episode. But I do think it's really a fun way to blend both. If you are needing resources for choking and you want to get that down, I am happy to put that also in the show notes. A great resource for how to handle infant highly maneuver if you if you need it. Going on. Hope you're sticking with me. So I want to just paint the picture here a little bit. Like you're at the table, you've been having your baby come to the table for meals from time to time. They seem interested and you're ready. Like you're like, okay, is it go time? Let's go. You put them in their seat. You want to make sure that their feet are supported and that they're able to sort of be in a good seated position, nice and upright. We don't want them leaning back really far. We don't want them leaning forward really far. So kind of 90-degree position from their waist up. I love to offer them spoons, different ones. I think this is fun to have different types of spoons and different like mashing tools. Forks are great, but the spoons that have sort of the open grid in them are also really handy. A lot of families like to use the mesh trainers. I am comfortable with a lot of those things. It's all about practice and they're all different tools. So I think it's great to offer them. And then again, model it is really, really helpful. You should be modeling how to eat with a spoon. And then you can give them a preloaded spoon and see what they do with it. It's really fun. This is also a great opportunity to you can even video it and share it with family and friends, and then look back on it and realize, oh gosh, in a month from now, like you'll see so much more progress with your baby. And that's really empowering too. Just know that this is really messy. I think most parents get that, right? But like if you don't have a dog and it's summertime, bring your high tra outside and eat outside. Cause like it's messy. You can hose down the deck. Like it is definitely wild, especially the more autonomy a baby gets, the wilder they get. And it can be really helpful. If they're consistently throwing food down, they're not interested. If they're just flinging it around because their hands are going wild and it's like kind of soupy, that's okay. But it should be a lot of fun. I also love food as a toy. So, like large sticks of celery or a mango pit, things that are really big. So I'm gonna talk a little bit about how I like to offer that. So now they're ready and you're having fun and it's a big mess. What should we do first? This is where I'm gonna tell you what I do. And you are welcome to talk to your pediatrician. They may agree or have a little different take on it. This is a little bit of the full disclosure. I read the literature and then I practice. Okay. I pretty much across the board recommend sitting well or not, I recommend allergenic exposure to peanuts and eggs at four to six months. I do this because of the leap study. Let's talk about this. In 2015, there was a study called Learning Early About Peanut Allergy. And it was a huge multi-centered study. It was amazingly well done. And they were able to demonstrate that early introduction of peanuts to high-risk infants, which I'll define, reduced their risk for allergy by over 80%. You guys, this is like a landmark study, and one of the most, in my opinion, canonical studies that we have in the world of infant feeding. Like it is landmark. It is a big deal. And I remember when it came out and I was like really excited for this. I had already done it with my own kids. Well, before the study was out, because I was like, I think it was an accident at first. And then I actually started looking into other cultures and I was like, oh, well, I'm gonna be fine. And then the study came out and I felt so much better. I didn't recommend it to anybody until the study came out. But high risk means you have severe eczema or you already have a known egg allergy. Well, how are you gonna know you have an egg allergy until you try it? So this is my beef with this. Okay. In this particular study, these were babies who had a family history, had risk stratification, and they knew that they were gonna be at higher risk for potentially developing a peanut allergy. And they introduced early and frequent, and these um rates for peanut allergy were dramatically decreased, and then it held out. Like they even took these kids off of peanuts and like avoided peanuts for a long time. And then by five, they were still tolerant to it, which is super cool. So I think this study is really, really neat. What they did was offer two teaspoons of peanut butter per session, which is like kind of a lot, or 21 pieces of bamba puffs, which is like a little protein puff. And then this then led to the recommendation, which now currently they'll say uh if you're high risk, then we want you to introduce at four to six months. If you're not high risk, then introduce at six months with the rest of your foods. And I take a little bit different lean on this simply because our high risk category is something that as pediatricians, we decide. Like if you're a patient in my office, we're gonna decide if you have severe eczema or not. And we actually don't know if you have an egg allergy or not, but your family history and other risk factors can play into this, right? And so the thing here that's interesting is actually we also now know, too, that your risk for peanut allergy may be a little higher simply from the eczema component more than your family history. Your family history does weigh in, and I mean, in immediate family, so not a cousin, like a mom or dad or sibling, if one of them have a peanut allergy, your risk is a little bit higher for having a peanut allergy. But it's not as high, and I see this play out in my practice as a kid who has no family history but has severe eczema. I'm gonna be more worried about that kid than my kid who has a family history. The way I do this, and what's recommended is to start, if you're able to, to start that exposure. And we need mucosal exposure. So we need that, the contents to go on the inside of the mouth. And it doesn't actually have to be totally consumed. It's ideal if it is, but babies still often have that tongue extrusion reflex. So I give it a pass if we still get it in the mouth. And then once it's exposed, we want to continue that exposure. That can be done through a lot of ways, whether it's peanut butter powder, whether it's you've mixed peanut butter with some puree banana, or you have thinned it out with some hot water and cooled it down a little bit or peanut puffs, like those are all options. But I just want to mention, by the way, two grams of peanut is like kind of a watt of volume to get down. Like it can actually be quite a bit. And in my family's where they're gonna have an allergy, they'll see it well before that even happens. So, for what it's worth, we do want an exposure. And if it's gonna be an exposure that is going to lead to reaction, generally speaking, the first exposure, nothing happens. Sometimes the second exposure, you will get hives on the face that then spread to the other parts of the body and can include some vomiting or some diarrhea. If that happens, you definitely we encourage our families to call our office to take video or picture. And, you know, then we're gonna encourage some anahistamine. We monitor them, sometimes we bring them in the office. Very rarely do these kids truly present with anaphylaxis, and I mean very rarely. So routinely, I'm not recommending that families try out these allergenic foods in my parking lot or the ER parking lot. I think people do that and then go to the ER when they have a contact dermatitis or they get like a little rash on their face. But I think in general, like it's it's really well tolerated. So this is safe, and I wouldn't recommend this if I felt like it was gonna put your baby at risk, right? This is an individual discussion. So as you listen to this podcast, take this information and talk to your pediatrician. This is empowerment for you to have the conversation to see what risk category am I in and would I be safe to do this at four months? And I think the key here is like, I'm not looking for feeding readiness or gut maturity with this particular exposure. I am looking for can the immune system be presented with this and tolerate it well? That's the question. And then the nutrition part of it and really getting frequency and volume comes down the road. But this is the first question because it also informs our whole conversation at six months. Because if you were to have a reaction, then I'm gonna have a very different approach for the other allergenic foods, right? So it's really information for me, information for you. And let me tell you, when my parents come in after having tried it at six months, they are so excited and so ready to go and they feel so proud of both what they can do and their baby can do. And that's what I want for you because this should be so fun. Okay. Eggs can be done in a similar way. I don't like scramble because they are harder to get in the mouth and they can end up all over the face. And some kids who are like gingers or really sensitive skin can kind of have a little facial response. When we have a rash that's like really true, it's gonna be start on the face, but then it spreads to other parts of the body. So that's kind of how you know it's real and trustworthy. I like to make an egg patty or a strip of an egg and use it kind of like a wand and wand it on the inside of the cheek. And then we kind of go from there. Again, this doesn't require that the baby be totally engaged in the process. A lot of times they are excited about it, and that's really, really fun. But you can still try this if your baby's not quite ready. And I think about that specifically in babies who were like preemies because their motor skills might likely be delayed. But we can still do this investigation. Again, this is a conversation with your pediatrician, but I'm just letting you know, like, I am pretty forward about this because I find that it's really empowering. Babies do great, and I know I'm reducing risk for allergens. Um, and that's huge. So some kids do need to go to the allergist. That's a conversation with your pediatrician. And this is individual, but for the most part, if you don't, you're safe to try. This is really a home thing and it is very accessible. I know this podcast has gone long. And I just want to get into a little bit more with you and share a couple more things that I think are really, really fun. So, four to six months, you're playing, you're getting there, you're ready, and you're like, okay, we passed the peanut and egg test. No, okay, like here we go. Let's think. What do you love to eat? It can be a lot of different things. I think a lot of family favorites are sweet potatoes and avocado. Those are great first foods. But my take home here is it really can be darn near anything except for honey. Honey's a hard stop. And I don't love high volumes of canned fish in the first year of life if we don't know our source. Okay. But I like simple single ingredients that are super squishable or oversized. I'm gonna say that again. It's my phrase. I haven't heard it from anyone else, so I'm not copying you, but you're welcome to copy me. Just give me credit. Simple, single ingredients that are super squishable or oversized. What do I mean? Okay. I mean you can give them avocado and you can smash it on the back of your fork or their little spoon. And if it's squishable, really ripe, that's great. If it's not super ripe, it's not a great option yet. Okay, it needs to be soft and squishable. Sweet potatoes, super squishable. Microwave it up. You can fork it out a little bit and nice and squishable, offer that. Or if you want it to be kind of like think a sweet potato fried where it's nice and long. You want it to be wide. We don't want it super, super narrow and little, but big enough that they can get their hands around it. And that is an option. You could also do that raw, but like really large. Like think of it like this is a toy, but it's food, right? Our goal is that oral motor skill. And we're not really looking to get nutrition from it necessarily. We're looking to give the tongue some different manipulative skills, to give the lips some opportunity to go open and close around it, to really work on that tongue extrusion reflex some more. That's the goal for those really big oversized. Like a half of a tomato is another great example.

unknown 38:57

Love that.

SPEAKER_00 38:58

So, again, simple, single ingredients that are super squishable or oversized. Last night, my husband made beef and broccoli. If I had had a baby, I would have had him cut a big piece of that beef, and he cut it into pretty smaller pieces for us, but I would have had him cut a large piece that he could cook, and I would have offered the broccoli. And I would have heated up the broccoli a little bit more so that it was really squishable. And I would have offered that to my baby. Just squish it on the back of a spoon and let them play with it. Or they could pick it up with a steak, especially nice big piece that's wider than your two fingers together, and grab that with both of their hands, put it in their mouth, gnaw on it, chew around it, and and that's a really great skill as well. So that's what I would have offered if I had had a baby. Now, there is a little bit of rule of thumb. At six months, we are starting to look for some nutrition from our complementary foods. And so I'm gonna give you a framework for building a plate, think of it like a whole day's worth of nutrition, and you can break this down. So, what I mean here, I like to think of how much a baby needs. In like six months, they really only need about 100 to 200 calories beyond the milk. Okay. So your first month of trying solids and you're wanting to build this framework. For reference, a go-go squeeze yogurt pouch is 50 calories. Like a lot of the fruit pouches, also 50 calories. Oh, excuse me. The yogurt squeeze, I think, is 100. You're not looking for a lot of volume. So I tend to build a plate in a two to one ratio, fruits and veggies, two tablespoons, one of a protein, and one of a grain. Okay. So for example, let's take tacos, pretty common. Ground beef, which you can get really nice and fine for babies. That's going to be your protein, one tablespoon of that. Your grain might be uh rice if you have if you have that, one tablespoon of that. And your fruit and veggie, you can have a large tomato wedge that they play with. Plus, you could offer them some black beans that are smashed on the back of a spoon. A tablespoon of each of those. Interestingly, beans count as a vegetable for babies. Or you could do mango puree. So you had a mango salsa and you wanted to add some there, you wanted some fruit in there too. So if you're building a plate in a full 24 hours, a six-month-old really only needs about four tablespoons of fruit, four tablespoons of vegetable, two tablespoons of protein, and two of grain. In a full day. Okay. So what this looks like is if you made a single plate and portion this out, you don't have to, but there are like serving-size trays and stuff like that that you can use. But tablespoons really work well. So if you're building this for daycare, things like that, you can just offer them two different containers. One is your fruit and veg mix, and one is your protein or grain mix. And you do a tablespoon of fruit, tablespoon of veg, a half a tablespoon of protein, and a half a tablespoon of grain for your lunch. And then a dinner, same thing. You can repeat that. It really can be simplified. Like here's another example: a tablespoon of scrambled egg and two tablespoons of sweet potato. That can be a meal. And then the next meal, you can offer them a tablespoon of yogurt. And they're probably gonna want more. But a tablespoon of yogurt and a tablespoon of mashed banana or green peas, and you can add those. Like there's lots of different combinations here. But what I want to simplify for you is when you're introducing your first foods, it can be in the puree form that's already pre-packaged and ready to go. Those are definitely a safe option. But if you are like me and you wanted to make your own food, you can take pretty much anything that you're offering for dinner and build a plate for a baby. Just remember, really small servings. Like if you're gonna offer something, just do a tablespoon on their plate, see how it goes. It is ideal to offer different varieties of things. So we want to add a lot to that. And I there was an old rule for a long time of, you know, the same food for three days to make sure there's no reaction. I don't live by that, and I don't think there's any good evidence for it. So I tend to recommend diversity is great. And so I just tend to offer a lot of variety in the beginning, and I don't really hold back because if there was evidence to tell me that that was really the safest option, I would do that. I, on the contrary, find that a diverse diet is actually a better way to go. It provides more texture, it provides more exposure, more opportunity, more gut flora development. And I think it's a really fun way to live. So I tend to go in that camp. Closing together, we've talked about a lot of things. We talked about readiness, we've talked about some math and the actual nutrition your baby needs in this stage, talked a little bit about a couple. And water, rice cereal, baby lead weaning versus puree's allergen introduction, and what a sample plate could look like for you. So I hope this has been fun. I hope it's been really informative and can serve as a foundational resource for you as you're starting to introduce solids. It's so beautiful and so fun. Take a lot of pictures, enjoy the process. Don't be afraid of going out to eat. Just avoid the honey, no marinades. I'm gonna say that again. And if you need that resource, again, the choking resource is gonna be in the show notes, along with the leap trial and the baby led meaning resource. I think there's a lot of great resources out there. I'm not the only one. So explore, have fun. But if you have questions, reach out. I'm happy to help you. If this is helpful for you and if you find this kind of content really resonating, please share it with a friend. I would really love that. And if you could leave a reading review, it really does help this podcast grow to reach more families who are looking for real nutrition evidence for their babies and toddlers that can be supportive without the noise. Thanks so much for listening. I'll see you guys next week.