16 | Baby's First Foods: Best Practices for Starting Solids

Do your patients ask you when and how to transition their baby to solid foods? Join Colleen as we navigate this exciting and often confusing journey with our guest, Jessica Penner, a registered dietitian with extensive experience in pediatric nutrition. 

Jessica breaks down the importance of defining what a "solid food" means, debunks the age-old myth of starting with vegetables before fruits and stresses the pivotal role of iron-rich foods for the infant.  Jessica clarifies the difference between gagging and choking and teaches us how to calm parental anxiety around gagging. 

Don't miss my Nutrition Notes segment, where I give you 5 crucial topics you must address with your families when you begin the conversation about starting solids. Today's episode will equip you with the tools to educate your families properly when it comes to starting complementary foods. 

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Transcript

Jessica: 0:00

One way that babies learn is by observing those around them that already have the skills they're working on. And you are your baby's best teacher as their parent, simply by eating with them. Starting Solids is just inviting that baby to be part of that family structure.

Colleen: 0:20

Welcome back to the Exam Room Nutrition Podcast. I'm your host, colleen Sloan. I'm a registered dietitian and pediatric PA. We're jumping back into the pediatric world today and, whether you work in pediatrics or not, a lot of my listeners are parents, so I know this topic will hit home for you. We're tackling a very common question among parents, and so we're gonna equip you with how to answer when your patient might ask you when can I start my baby on solid foods? And I get this question multiple times during a day, being a pediatric PA, and I'm very excited to tackle this topic with our guest today, jessica Penner. Jessica is a registered dietitian, mama to two boys. Jessica has worked in the field of pediatric nutrition since 2011. In 2020, jess and another registered dietitian named Nita came together with a common vision to empower parents to start their babies on solids confidently. You can find them at Happy Healthy Eaters and Jessica, thank you so much for the gift of your time. I greatly appreciate you being here. Welcome to the show.

Jessica: 1:23

Okay, thank you, colleen. I'm so honored to be here with you today Talking about my favorite topic starting solids.

Colleen: 1:31

It's such a good one and it can be so confusing and so challenging. So I'm so thankful that you're here to just ease our minds and give us some really practical tips and things that we can say and ways that we can guide our parents in navigating this first year of feeding. So let's start first by laying the foundation of when does the clinician actually start discussing this? Is it at two months? Is it at four months? Is it at six months? When can we begin the topic of introducing solid foods.

Jessica: 2:02

That's a great question. I would say the sweet spot would be at that four month checkup. Four months is definitely the time to have that discussion because between four to six months is when babies are showing those signs that they're ready to start solids and that, and very importantly, they're developmentally ready.

Colleen: 2:24

Yeah, I'm glad you actually went there because, although we're clinicians, we should be trained in the developmental signs of readiness for solid feeding. But give us a reminder, give us a refresher. Maybe we haven't thought about it since medical school. So give us the information of what to look for for developmental readiness for solid foods For sure, we find that this is definitely a gap in knowledge.

Jessica: 2:46

We always call our parents every time we teach a class and ask okay, has your primary care provider? When have they set to start? Solid and hands down. Every single time the parents say that they've been given an age, whether that's four months, six months each clinician kind of has their opinion on that, but it's always about the age of the baby. And while age is definitely a factor, we don't want to start before four months. That is the minimum age and we don't want to start later than six months. There's really that time period where it's going to be unique to each baby when is the right time for them.

Jessica: 3:31

So if you start too early, then there's some safety components and there's a higher risk of choking. And, as well, we often hear from parents if they started too soon, then their baby has a negative experience with solids, which then it kind of turns into an aversion that's harder to overcome as the baby ages. And then if you start too late, then you might risk some nutritional deficiencies, missing windows of opportunity for self-feeding, those sorts of things. So the signs that you want to look for are that the first one is if the baby is able to sit up mostly independently. So that means if they can sit in their high chair, maybe have a towel that's rolled up around their hips to give them a little support, but that they're not wobbling back and forth, because for safety we want them to be able to be just have that strong core strength so that they can have a good gag reflex and they can focus all their attention on this new skill in their mouth and they're not getting distracted by keeping themselves upright in space. And then the second one is if baby has good head and neck control so that they can move their head back and forth and side to side. And one of the main reasons for this is that's baby's way of communicating with the parents. So if they are spoon feeding, then it's really important to have that responsive relationship with the baby. So if they are hungry and wanting more, they're leaning towards that spoon and when they've had enough they're going to turn their head to the side. And if they don't have that ability to move their head that well, then you're not going to be able to communicate quite as easily with the baby.

Jessica: 5:31

And then the next one is the diminishment of the extrusion reflex. But just as a reminder to the clinicians listening, the extrusion reflex is when an object touches baby's mouth, the lips then their tongue automatically pushes that out, and so that is a safety mechanism built in at birth to prevent baby from choking, because they don't have the oral motor skills to be able to manage anything other than swallowing that liquid diet Right. And so this diminishes somewhere between four to six months, and if you try to start cells before then, it might just end up being a bit of a frustrating experience, because as soon as you put food or a spoon towards the baby's mouth like they're going to be pushing it out, and so it's a little counterproductive. A couple more is that if, when baby is reaching for objects and bringing them to their mouth, that's more of a sign that they're ready for self-feeding. So usually that comes a little later.

Jessica: 6:41

And then lastly and this is kind of a global picture we wouldn't take this one on its own, but if your baby's really interested in the food that you're eating, it's definitely a sign that they're interested and ready for this next step and that they're going to be excited for the solid foods. And for those who are listening, if you want this kind of an easy way to present to your parents. We actually have tier pads that we've printed and we send them out to clinicians, so it's just like a quick little flow chart that you can go through with the parents and say in the next couple of months you're going to be noticing some of these signs, and when you can tell that your baby's ready, then that's the go ahead.

Colleen: 7:30

And that's such a helpful tool and resource. We're definitely going to link that in the description below. So if you do think that might add value to your clinic day, please absolutely make use of that incredibly valuable tool. Jessica, I love that you talked about the infant's body language, so to speak. Right, we kind of forget that they're little human beings and that they can express their desires or that they're full, that they're finished, that they want more. So I love that you brought into the description of the developmental milestones the why behind it, because it's so easy to forget. We all know they need to have, you know, head, neck and trunk strength, but understanding the why and maybe even explaining that to your parents, the why behind head and net control, why that's important I think might be very valuable to your parents. So maybe now let's move into some definitions, now that we know we might have a baby that's ready for solids. But can you define what does it actually mean to start solids and then maybe move into what's the some safe methods to actually do this?

Jessica: 8:32

I love this question that because it's Really interesting talking and working a lot with parents in this space and how important it is To use terms that you're both using them in the same way. So when I've always talked about starting solids, we refer to Complementary feeding, which is, you know, that clinical term that encompasses any Food or beverage other than breast milk or formula. So then when we're talking with parents, sometimes what their idea of solids is is different than ours and they don't include purees in that solids category, so which I found that pretty fascinating. So the signs of readiness, like I said, those could appear anywhere between Four to six months of age.

Jessica: 9:23

But we know that the only safe texture, according to the research and literature that we have available to us before six months, is the puree Texture. So anything that is From the baby led weaning movement, where you're giving baby soft, cooked, mashable foods that are larger, kind, like the size of an adult's finger, that they can pick up and self feed, you don't want to start that before six months. So, again, if you are having a discussion with the parents and are saying, yeah, okay, you know your babies Four and a half months, they're ready for solids and then they're thinking these bigger pieces of food than that wouldn't actually be safe for them. We want to stick to purees only until six months of age, and then at that point they're more developmentally ready to be self-feeding.

Colleen: 10:19

Yeah, a lot of the times they hear solid and we as adults eat solid foods, which are pieces of food that we need to chew and tear apart inside our mouth. But a solid for a baby you can't give them a piece of steak to start out with. So, making sure that everybody has the Right and accurate definition and that we're both talking about the same thing when we recommend Okay, now time to start your baby on solids that you might want to define what you mean by that. All right, so we've got our six-month-old, maybe five-month-old, who's developmentally ready for these solid foods. We have an understanding of what these solid foods.

Colleen: 10:51

Let's dig in and and introduce what is the appropriate order of foods to start with, because I remember when I was in school that we should always start with vegetables because they're not as sweet as fruit and if you introduce fruit before vegetables, your baby is only gonna want sweet foods and they're not gonna eat the vegetables. So debunk any of these myths. Provide us with the evidence-based recommendations so the clinicians who are listening can set these families up for success. Of First thing to try is a recommendation still to start with the rice cereal.

Jessica: 11:24

I'll kind of break this down into two components of answering this question. One is adjusting that myth of veggies before fruit, and then we'll get into Exactly what foods to focus on first. All right, so let's look back to when the baby is in the womb and if baby gets a chance to drink breast milk. Those are actually both time periods where babies are Tasting sweet things. So in the womb they're swallowing amniotic fluid which is slightly sweet, and Breast milk is actually quite sweet, if anyone's tried it, and so baby's already primed to be eating and enjoying sweet foods, and so there's actually nothing to Introducing fruits before veggies because they've literally already been eating sweet things.

Jessica: 12:20

I'm gonna just just summarize a really cool Study that was done that compared Babies that were fed green beans every day for a while and then the other group. The babies were fed green beans, but then at the end of the meal they were given peach puree. So they both did that for X amount of time and then they. They revisited these babies later and Then the peach group they only fed the green beans and then the green bean group. That continued with just the green beans, and what they found was that the group of babies that were fed the peach puree. When they discontinued that peach puree they consumed more green beans than just the green bean only group. So the thought behind this is that that nice, pleasant Peach puree at the end of the meal and coated like a really good memory of both foods for the baby, and Then at the end the baby enjoyed the green beans as well. So that's kind of a little side note.

Colleen: 13:28

That's so interesting. I love that dessert helps us in doing it.

Jessica: 13:32

Yeah, so there's only one study, but I just think it's kind of fascinating. So now back to exactly what foods to start with. So what we know Nutritionally, the main reason for starting solids is that babies need Another source of iron in their diet. Though in the last couple months that babies in the womb, they were gathering up iron from their mama, storing it away, and that storage amount will last them about six months. What they get from either breast milk or formula they're just like little maintenance doses and then at six months those stores are going down and baby needs to get iron from their complimentary foods at that point. So the main thing to really focus on and we try to repeat- this over and over to parents and those high iron foods.

Jessica: 14:28

Babies' needs are extremely high, relative for their size. A seven to 12 month old baby needs 1.4 times more iron than a grown man. It's kind of mind blowing. And we do know that iron deficiency is the top nutrient deficiency in babies and toddler hood and that first couple of years of life is a really critical time period for iron. So good question about the rice cereal. That has historically been why rice cereal was started first was because of the iron.

Jessica: 15:06

So iron fortified cereal was developed shortly after World War II when it was realized that babies really need this iron, and at that time this was a great way to get it into babies. There's lots of different options now. I just love nowadays that parents have so many different tools in their feeding toolbox that they can offer their baby. But I talk about the importance of those high iron foods and right from the get go every meal you feed your baby, just think, okay, where's the iron? And, like we said, iron fortified cereals is simply one of the options.

Jessica: 15:47

So you could do meats, whether that's in a pureed or a handheld form. Something like a sardine is really great. Not only does it have iron, but it also has omega three fatty acids, which are really important for babies during development. So that's also found in other fish. Eggs are a fantastic source of iron and some plant based options they have lentils, chickpeas, nut butters or quinoa green beans and then once your baby is regularly accepting high iron foods, then you can start to add on some produce. So fruits and vegetables, and the bonus with this is that many of the fruits and vegetables are sources of vitamin C, and we know that vitamin C and iron when they're together in the stomach it hasa lot of iron, so it helps the body absorb more of that precious iron. So it just really makes everybody that they take powerful.

Colleen: 16:51

So when first starting solids, should everything be pureed? How do we describe this consistency to parents?

Jessica: 16:58

So I don't know about you, colleen, but when I was in university we were taught just one method of starting babies on solids, and that was kind of what we now call traditional method, which is starting out with that thin, homogenous puree and then slowly changing the texture so that it becomes lumpier and then you get towards a mince texture and then before you know it, they're onto these little like teriopie sized pieces once they're developing that pincirgrass that they can feed.

Jessica: 17:35

That's definitely one option that parents can still use.

Jessica: 17:40

Or you can go more of the route of kind of a millennial mom movement, baby led weaning, which is kind of this idea that babies can self feed from the start and that they don't only tolerate pureed textures but that they can get foods that are cooked soft and they're mushable so that baby, when they pick it up and put it in their mouth, that those gums can break it down and they can swallow it safely.

Jessica: 18:14

They have two different options and they actually aren't mutually exclusive. Sometimes you might see online that baby might get confused if you do purees and handheld foods, and there's just simply no evidence for that. Babies, I think, are much smarter than we give them credit for and these are just different textures, that they get the opportunity to learn how to manage. So in practice we find that parents and babies thrive more on this mixed approach, so that they get the opportunity to self feed with those baby led weaning style foods and then they also maybe get to ingest a little bit more with the purees and you can kind of get a little bit more nutrition in them that way too.

Colleen: 19:09

Now, what do you recommend for portion sizes? Is there a hard and fast rule with this? I know we should be encouraging our parents to pay attention to those hunger and fullness cues, but what would be portion size wise, let's just say, for a seven month old?

Jessica: 19:27

This is a question we get all the time and I know parents are wanting us to give a certain volume amount and unfortunately we are not going to do that because really the ultimate is that babies are all different and they are going to have varying degrees of foods that they need and that can vary from day to day, week to week, baby to baby, and so there's not an exact amount that they need. What we do go through is maybe some red flags. If your baby never once eat anything, you just put this into their mouth and they're always rejecting it or they just can't seem to swallow anything, those are definitely red flags that maybe there are some feeding challenges and an assessment by a feeding specialist would be warranted. But it's very normal for babies to eat like maybe even a tablespoon or two at a meal and be done, and it's really not a lot at the beginning. So one of the questions is do I discontinue nursing sessions or bottles? And really you don't need to do that when you start solids.

Jessica: 20:48

The clinical word we use is complementary feeding, so it's really just complementing what they're already getting and as they get older they're going to need more calories for their bigger body than for growing, and so solid foods is in addition to what they're already getting and again, they're just really learning how to eat, so they're not going to take in a lot right away. It's estimated that between six to nine months it's going to be like 10 to 15% of their calories. They still continue to nurse or bottle feed on demand and then, as babies get older, closer to the one year mark, they tend to naturally start to decrease their liquid intake and you can kind of play around with it like OK, they don't really seem that interested in this bottle feed right now, maybe I'll cut it out, introduce a little snack, see how it goes. And sometimes it just takes some trial and error before figuring out when they're ready for a next meal, dropping bottles, those sorts of things.

Colleen: 22:02

Is there a feeding schedule that you recommend parents follow? Should they be feeding three times a day, setting up breakfast, lunch and dinner already, or is it a little bit less scheduled than that?

Jessica: 22:13

We are definitely big fans of schedules because up until this point, you're feeding your baby on demand. Whenever they're showing those cues that they're hungry, you're going to give them a bottle, you're going to nurse them, and the wonderful thing about solid foods is that now you can introduce those meal and snack schedules and their body is going to start to expect to receive food and eat at different times of the day, like we do. We have our eating windows and our non-eating windows and you're going to start slow just at the beginning. Just one meal a day.

Jessica: 22:53

As your baby gets practiced with that, maybe a month or two in, add another meal and you don't have to overthink the timing too much. Literally, when you are having breakfast, invite your baby to join you. Is that also a really important piece that we find gets missed? Is that modeling piece? One way that babies, humans, learn is by observing those around them that already have the skills they're working on, and you are your baby's best teacher as their parent, simply by eating with them. Starting solid is just inviting that baby to be part of that family structure.

Colleen: 23:35

I love that and I think it also you know a schedule and eating as a family sets the child up for success when they're a little older, to those toddler years when they develop some independence and some selective eating. So if you already have that system and that schedule in line and set up, the child knows when to expect food and that boundary is already set. So I think it's easier for them to follow that.

Jessica: 24:02

Exactly. If you can start it right from the get go, then that expectation is there.

Colleen: 24:09

So you mentioned briefly a little bit about how the liquid intake from breast milk or formula can gradually decrease over time as they're learning to eat more solid foods. But right in the beginning, at that six month mark when we are starting to introduce solid food, is there kind of a rule with giving the formula first, or the liquid first or the solid first? Does it matter?

Jessica: 24:31

That's a very good question and it does matter, but there isn't a one size fits all and this is something that, again, you might need to play around with and find the sweet spot for your baby. So we want the baby to come to the meal with a good appetite, so that they're not overly hungry, but that they're hungry and interested in trying new things. In reality, what most parents find works well is to feed their baby solid foods, maybe about 45 minutes to an hour after their last bottle or nursing session. But there's really no right or wrong and you just go with it, try different things, see what works for your baby and that's that.

Colleen: 25:22

I think that is important to remember that there isn't a one size fits all, because in medicine we can diagnose and treat and we follow guidelines, and sometimes it is really much.

Colleen: 25:32

You're boxed into a one size fits all for this diagnosis. We treat it with this. With nutrition it's different, right, we're dealing with individual little human beings and I love that you reassured us that there's not really a right or wrong way to go about it, as long as they're ensuring adequate nutrition, appropriate nutrients and safety for the baby. Now I wanted to ask you one thing, because I get a lot of pushback from parents, especially either starting solids or if there's, like a nine month old, that maybe they've struggled with solid foods in the last preceding three to four months, they will tell me I haven't started solid foods because the one time I give it to her she gagged and I'm scared to feed her again. They sometimes say that the child choked. So break it down between what the difference between choking and gagging is, because I think that's an important educational piece that we as clinicians need to make the parent aware of the difference between the two and then help us reassure our families that if the child gagged is it still okay that they try it again.

Jessica: 26:34

This understanding of the difference is so critical. So just a quick overview choking is when object food, anything is obstructing the airway and baby can't breathe. And the signs that this is happening is that baby is silent, maybe a pained expression on their face, but one of the defining features is that you know their airways blocked so that those vocal cords they can't get the noise out. So it's very quiet Because gagging is a protective mechanism to prevent choking from occurring. And that's when baby's mouth and body is pushing the food towards the front of the mouth so that it doesn't inadvertently block the airway. And this is often loud and it looks kind of frightening. And I know as a parent myself when I saw this, like your gut reaction is like this is frightening, my baby needs help. But actually this is a protective mechanism and your baby's body is doing exactly what it needs to to keep it safe. So the parent's reaction in this scenario is actually really critical. So even though inside you might be like freaking out a bit, you do want to as much as possible project calmness and say things like can you cop this baby yet? And like even mirror back some of that tongue thrusting. So your baby's like yeah. Okay, mom is doing it, I'm doing it, this is cool.

Jessica: 28:13

Whereas if you like, run in and like I don't know it's happening, then your baby feeds off of that and interprets this as a negative thing. That's happened. And then their brains working a little backwards okay, I gagged, and this was bad. What caused the gagging? Oh, I was eating. Okay, now I don't want to eat solid foods.

Jessica: 28:37

And so sometimes we find that a baby's end up really resisting solid foods and then it's kind of a vicious cycle. Parents are scared because this gagging thing happened and unfortunately it really doesn't help the baby in the end, because we do know that there's a wonderful window of opportunity for babies to learn to manage different textures other than purees, and that window of opportunity closes around nine to 10 months. So they really need to be exposed to that, those lumpier textures or those soft handheld foods, so that they aren't stuck in this pattern of only eating purees for an extended period of time. And one of the best things that parents can do if they're afraid of that gagging is to simply Google videos of babies gagging and just watching like other people's babies go through it, and that can kind of just calm your nervous system and just be like okay, yeah, this is good, this is normal, this is protective and it's okay if this happens to my baby.

Colleen: 29:53

And after a gagging episode, is it okay to, once the baby's calmed down, to try again, or should we wait later on in the day, wait a couple of days, or is it perfectly fine to let them try to eat again?

Jessica: 30:07

Yeah, it's perfectly fine to let them try to eat again. If they're not interested, don't force it, but kind of just play it cool. It's similar to a toddler. If they're walking and maybe they trip and fall. If the parents swoops in right away is like what are you okay? Then baby's like oh yeah, this is bad. And then they cry and maybe they're not interested in walking anymore. But if you're there close by, you're responsive. But oftentimes when they fall they're fine, right, and then they just get up and they keep walking and it's all good. So similar thing with gagging.

Colleen: 30:52

So is there anything else, any other last pieces of advice that maybe we didn't cover, about starting solids that you wanted to leave us with, I guess?

Jessica: 31:01

it's kind of passed on the message to the parents like you got this, it's good, it's fun. I mean there are important milestones and nutrients we want to focus on, but don't be scared, find joy in the process, and it really can be such a rewarding experience to start solids and we're there to support parents along this journey.

Colleen: 31:27

I completely agree with you, because I think it is so fun just watching babies face when they taste a new flavor, when they try something different.

Colleen: 31:36

You know they're messy. They're so cute at this age and everything is new and everything is exciting. So I love that you remind us to find the joy in feeding our infants, because I think that is really important, because they're only in this little cute window, trying new things for very short time, so we should really encourage our parents to enjoy it and to not overburden and overstress it, to keeping it simple and really truly less stress about feeding our babies is really really important. So, jessica, this was so extremely helpful for us. Whether you're in pediatrics or not. Hopefully you can take some of her expert advice and tips about feeding babies and relay that to your patients or your loved ones, and we're going to be linking all of her information for her website, including those tear sheets that are free for providers to use, down below in the description. So, jessica, I would love for you to come back with us and help us tackle those next topics about starting solids.

Jessica: 32:33

Thank you so much for having me today and, yes, I would be delighted to keep talking about this topic.

Colleen: 32:39

All right, guys. Now it's time for my nutrition notes. In this section. I leave you with a nutrition tip and encouraging quote or an interesting case that I think might add value to your day.

Colleen: 32:49

So today I've got five things that you need to say to every parent when you discuss starting solids. These need to be part of the conversation every time, with every four to six month old that you're discussing, because they're common questions that parents either ask or don't ask and then go home and Google later. An important thing to address is making sure that when they start solids, that you tell them that they need to do so with a spoon and although this sounds like common sense, it is a piece of education that you must provide and tell them that they should not put any of the pureed foods into the bottle. The baby needs to learn this new task of using a spoon and managing pieces of food in her mouth, so putting food into the bottle is actually very counterproductive and it can be potentially harmful. The other thing I like to mention to parents is that it's perfectly fine if you want to cook or prepare your own food, but it's also fine if you wanna buy commercial baby food If your parents choose to make their own, I always recommend that they moisten the food with either breast milk, formula or some sort of broth to keep it as a puree consistency. Vegetables are a really easy thing to prepare from home, especially if you're doing a family meal. The vegetables would just be cooked like normal and then you can just use a blender and blend it with breast milk or formula or that broth to create a pea soup consistency. I always let them know if they wanna do a combination of home cooked and commercially bought baby food. That's perfectly fine as well too.

Colleen: 34:14

Tip number three is that making a face or spitting food out is normal. I let my parents know this right off the bat and I'll say hey, when you offer her a new food, it's more likely than not that she's going to either make a face like she doesn't like it or she's gonna spit that food out, and it's perfectly normal. It does not mean that she doesn't like it. Remember this food is a brand new flavor, it's a new texture, it's a new smell and so it's new to the baby. So sometimes it's just surprising. The other reason that babies sometimes spit this out is because mature chewing actually requires a lot of motor skills and sensory awareness, and these are skills that the baby is just developing. It's also perfectly fine to allow the baby to spit the food back out, inspect it with their hands and looking at it with their eyes, and then put it right back into their mouth. This is all part of developing their chewing skills and is perfectly normal, but it's an important point to make so the parents are expecting this to happen and aren't alarmed or concerned or withhold food if the baby does spit it out or make a funny face.

Colleen: 35:16

Tip number four is discussing water. Some parents will ask when and if it's okay to introduce water and if they don't, this is a great time to do so. Water is perfectly fine to give with meals. At around the age of six months, I recommend no more than four to eight ounces in a day, and you can suggest that they give this with meals with a small cup. A fun way to do this is to use a medicine cup that comes with Tylenol or Benadryl. Those are often already lying around the house, or you can buy very small condiment cups or sippy cups. You can also use straw cups or any of the other kind of open cups that the family has. This helps the baby in two areas the baby will develop cup drinking skills, which is very important come age one, when we are recommending that they discontinue the use of the bottle, and it also familiarizes the child with the flavor of water. All right.

Colleen: 36:06

Last, and I think most importantly, is the discussion around how long we must wait before introducing a new food. So the AAP and the CDC recommend waiting three to five days in between each new food. Now this is actually a guideline that is extremely controversial among RDS, speech language pathologists and doctors, because this rule is outdated, based on what we now know about allergies. So, if you think about it, if we're telling our parents to wait before offering any new food three to five days, this is gonna be a very slow start to experiencing a variety of foods within the first year. We also now know that IgE mediated food reaction typically occurs immediately or up to two hours after consumption, not three to five days, and reactions to non-highly allergenic foods are actually very rare. So there's no need for families to wait three to five days in between offering every single new food. They only need to follow this guideline when offering a highly allergenic food.

Colleen: 37:08

So these are the foods you must know and you must educate your parents on these. Foods include shellfish, fish, soy, dairy nuts like peanut butter or tree nuts wheat and eggs. You should instruct your families to wait at least two days in between each of these foods, so these highly allergenic foods must be introduced in isolation from each other. However, they can be introduced alongside other non-highly allergenic foods. So, for example, if your family wants to give the baby eggs for breakfast, it's perfectly fine to give them those scrambled eggs with strawberries and oatmeal, even if the strawberries and oatmeal are brand new foods. Those are non-highly allergenic foods, so it's perfectly fine to introduce those in conjunction.

Colleen: 37:50

So I hope these five tips were helpful to you in having those conversations with your parents regarding introducing solid foods, and I hope you found value in today's content. I just wanted to thank you so much for choosing to listen to my podcast. It's really an honor to be able to teach you these concepts about nutrition and to help you have more impactful nutrition discussions. I'd love to hear from you If you want to reach out to me on Instagram. You can find me at exam room nutrition. And that's all I've got for you today, guys. So let's continue to make our patients healthier. One exam room at a time. I'll see you next time.