This blog has been contributed to by Dr. Julie Sweeney from @allergymom.md. Dr. Sweeney is a pediatrician and mom of 3 boys with multiple food allergies. You can learn more about her and her work here.
Ever hear about that “rule” that you have to wait 3 days before introducing a new food to your baby?
It’s typically called the “3 day wait rule”.
And we think you should ditch it.
Even though many doctors (and regulatory bodies) are still doling out this advice…we know that, as a team of registered pediatric dietitians, speech language pathologists, a pediatrician, and moms…this “rule” is founded mainly on fear based assumptions about allergies, lack of research, failure to update guidelines, and general old wives tales.
In this blog, I’m going to cover whether or not you need to wait between introducing new foods, why this is an outdated rule, and how many new foods you can introduce at once.
So let’s take you through the ins and outs so you can understand the history, research and guidelines to best prevent picky eating, safely feed your baby, and raise a healthy eater!
To find all the in-depth, research backed info for starting solids in one place, and to get access to my signature Texture Timeline™ that has been tried and tested by thousands of parents, sign up for my Baby Led Feeding online course! Learn all about introducing solid foods the way that you and your baby want to start, and about how to continue to advance your baby in textures from there.
How did the 3 day wait rule originate?
The original idea for this recommendation was to be able to rule out any allergic reactions to different foods your baby was eating.
Let’s directly address the current recommendations from the CDC, AAP and the AAAAI to paint a picture of their stance on and adaptation of this rule.
AAAAI
As per the American Academy of Allergy, Asthma, and Immunology, this cautionary waiting period is to evaluate for adverse reactions during introduction of new food, with a goal of identifying foods that cause an allergic reaction (1).
CDC
Centers for Disease Control and Prevention advises to “let your child try one single-ingredient food at a time at first. This helps you see if your child has any problems with that food, such as food allergies. Wait 3 to 5 days between each new food” (2).
AAP
The American Academy of Pediatrics recommends giving your baby “one new food at a time, and wait at least 2 to 3 days before starting another. After each new food, watch for any allergic reactions such as diarrhea, rash, or vomiting” (3).
However, the most recent research points to exposing baby to a wide variety of foods early on, including highly allergenic foods. Let’s dig into all the nitty gritty details!
Why we think you should ditch the 3-day wait rule
Babies NEED exposure to a variety of foods early on
If we were to wait 3-5 days between introducing each and every new food, your baby would be off to an extremely slow start to experiencing as many new foods as possible within the first year of life. Rather than having the potential to experience over 100 different foods by 1 year of age, waiting 3 days between introducing any new food means babies are only getting 5-7 new foods a month (or 15-21 new foods by 9 months of age).
We need to introduce as many different foods (flavors and textures) as possible during the critical period between 6-9 months of age while baby is developing taste and texture preferences (4). The more exposure a baby has to different foods during this period of time, the more likely they’ll accept these foods long term and more easily learn the skills to eat them.
In addition, following the protocol of a 3 day waiting period can actually have a negative impact by limiting food diversity for your baby early on, which researchers have confirmed to be associated with an increased risk of allergies (5).
In fact, research has shown that introducing a diverse diet in the first year of life has been shown to reduce the risk of atopic dermatitis, asthma, and food allergies until up to 6 years of age (5).
Finally, when 10 months+ hits, and many babies-turning-toddlers start to drop previously liked foods and enter a picky eating phase, you now have a much smaller pool of foods to work with. If you have a broader number of foods introduced and accepted in babyhood, this will give you more to work with on your menu in toddlerhood.
Because of all this, repetition of foods is absolutely not needed in the short term (meaning multiple days in a row)! Waiting 3-5 days between introducing new foods eliminates the ability for your baby to experience more variety.
Allergic reactions don’t take 3 days to show up
As mentioned, the original concept for the recommendation of waiting 3-5 days between new foods was to be able to rule out any allergic reactions to different foods your baby was eating. But we know that a 3-day waiting period doesn’t match the clinical timeframe of most allergic reactions (5).
Research has shown that allergy symptoms resulting from the body’s immune system making antibodies (AKA IgE-mediated food reactions) typically occur immediately or within 2 hours of ingestion of the offending food (5).
Two hours.
A far-cry from 3 days, that’s for sure!
Signs of allergy or anaphylaxis in infants include skin rash (hives), vomiting, scratching/fussiness/crying, and more drooling may reflect difficulty swallowing. Also be on the lookout for swelling of lips, cough, wheeze or high pitched sound and difficulty breathing. Just because they don’t have a rash doesn’t mean it is not an allergic reaction. Call emergency services if you have any doubt about a severe allergic reaction.
When it comes to food protein-induced enterocolitis syndrome (FPIES), the symptoms are quite different. This type of allergy is common among children between the ages of 0-3 years old and causes a “severe gastrointestinal reaction” (vomiting, diarrhea, dehydration) that “generally occurs two to six hours after consuming milk, soy, certain grains and some other solid foods” (1).
This is one example of an allergic reaction that does not involve antibodies (AKA non-IgE-mediated reactions). Typically, with these types of allergic reactions, symptoms can occur 1-4 hours after ingestion of the suspect food (5).
All in all, when you’re looking for symptoms of any type of allergic reaction, you should reliably see these within the first 24 hours. In fact, sometimes reactions are so quick that if you’re an anxious parent and you have a high risk infant, just give the amount on the tip of the spoon, wait 10 minutes and then go ahead and give the rest of the spoonful.
Note: Allergic reactions can be much worse the second time around. So, for the top allergenic foods only, we recommend introducing the same allergen for a second time to rule it out completely and make sure there were no symptoms that may have been missed the first time. Use the weekends or a 2 day stretch when you will be available to feed your baby and observe them for a reaction, rather than letting daycare be responsible for this. You know your baby best!
The chance of being allergic to non-highly allergenic foods is very low
We know with much more certainty that the risk of developing food allergies or reactions to foods that are not on the highly allergenic food list is extremely low. In fact, the repercussions of waiting 3-5 days between introducing new foods can be much worse than the very minimal risk of developing a food allergy to – let’s say – steak or green pepper.
6-7% of children develop a food allergy, and of those allergies, less than 10% come from beef, chicken or other non-highly allergenic foods. And honestly of those, only 0.3% of the entire population have an allergy to beef, for example (6). Compared to more than 90% of food allergies that are caused by the same 10 foods (what we call highly allergenic foods or top allergens).
Within the 6-7% of children who develop a food allergy, the prevalence of having an allergy to each of these foods are (7,8,9):
- Peanut (2.4%)
- Tree nuts (1.6%)
- Eggs (1.0%)
- Cow’s Milk (0.7%)
- Soy (0.1%)
- Wheat (0.3%)
- Sesame (0.1%)
- Mustard (1.1%)
- Fish (1.0%)
- Shellfish (1.4%)
So again, these foods listed above are the foods most likely to cause an allergic reaction, not food like cereal, fruits, vegetables, and meat which are all great foods we recommend introducing early and freely (5).
By waiting multiple days between introducing non-highly allergenic foods, we are unnecessarily preventing baby from experiencing a variety of solid foods during their critical period of 6-9 months of age, which we know is a big part of preventing picky eating down the road.
Overall, the benefits associated with your baby experiencing enough variety during this critical period far outweighs the extremely minimal risk of reaction to a non-allergenic food (like chicken).
The exception to ditching the 3 day wait rule
The only exception that requires waiting between introducing new foods are the highly allergenic foods. You can start serving highly allergenic foods regularly to your baby around 6 months (or sooner if they’re high risk). For these foods only, you do have to wait a 2 day stretch before you pick another highly allergenic food to introduce.
Note: This doesn’t mean you can’t introduce other non-highly allergenic foods during those 2 days.
And remember, as you rule out top allergens, it’s important to keep offering them alongside other foods as well. If there is no reaction, continue to feed the top allergenic foods at least 2-3x a week as you continue to introduce other foods.
Can I give my baby more than one new food every day?
The answer is yes you can and you absolutely should!
There is no need to introduce food in any special order or “ease” babies into solids and flavors by only offering one at a time or just sticking with bland foods and flavors in the beginning.
In fact, offering a new food daily is a great practice to ensure baby is getting exposed to a wide variety of textures and flavors early on (remember they need this variety during their critical period of 6-9 months of age). Keep in mind that spices are an excellent way to add variety and broaden the types of food your baby will accept over time, as well.
Is there a specific order I should introduce new foods?
There’s still a common misconception out there that babies may not be able to handle certain foods early on. But the truth is, there’s no specific order that solid foods need to be introduced to your baby.
Many websites incorrectly claim that vegetables should be offered before fruit, that meat or grains shouldn’t be offered until a couple months into starting solids, or that mixed meals need to be introduced after single ingredient foods. We now know after many years of experience and research, this isn’t true at all!
There’s no set order required for introducing solids. Having to introduce veggies before fruit isn’t a thing. Waiting to introduce grains isn’t a thing. Babies can eat grains and starches, fruits and vegetables, meat, beans and pulses, soy, dairy, and more, from day 1 when they begin eating solid foods. You can mix them all in one meal, or have multiple foods over multiple meals (as long as they aren’t a top allergen).
And for those of you who aren’t sure what to serve and what foods to start out with – I’ve got you covered! I’ve created the perfect baby led feeding meal plan to guide you through the first couple months of starting solids. You’ll get access to over 80 recipes that are perfect for starting solids, and that the whole family can enjoy. This isn’t just a regular meal plan with a list of recipes, you’ll actually be able to follow along with the plan to strategically introduce allergens, advance your baby in textures, and ensure all nutrient needs are being met.
In Summary
- Introduce your baby to as many different foods as possible during the critical period of 6-9 months of age. Introduce different textures of food, flavors, and spices daily.
- There is absolutely NO need for babies to have to wait 3 to 5 days in between the introduction of new solid foods.
- Introduce top allergens to your baby early and often, following the guidelines found here.
Want to learn everything you can about feeding your baby from 6-12 months of age? Join the Baby Led Feeding online course! You’ll get access to all the in-depth, research backed info for starting solids in one place, and get access to my signature Texture Timeline™ that has been tried and tested by thousands of parents. Learn all about introducing solid foods the way that you and your baby want to start, and about how to continue to advance your baby in textures from there.
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References:
- The American College of Allergy, Asthma, & Immunology. Food Allergy. https://acaai.org/allergies/allergic-conditions/food/
- Centers for Disease Control and Prevention. When, What, and How to Introduce Solid Foods. https://www.cdc.gov/nutrition/infantandtoddlernutrition/foods-and-drinks/when-to-introduce-solid-foods.html
- American Academy of Pediatrics. https://www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/When-can-I-start-giving-my-baby-peanut-butter.aspx
- Harris, G., Mason, S. Are There Sensitive Periods for Food Acceptance in Infancy?. Curr Nutr Rep 6, 190–196, 2017. https://doi.org/10.1007/s13668-017-0203-0
- Samady, W., Campbell, E., Aktas, O. N., Jiang, J., Bozen, A., Fierstein, J. L., … & Gupta, R. S. Recommendations on complementary food introduction among pediatric practitioners. JAMA network open, 3(8), e2013070-e2013070, 2020.
- Wilson, J. M., & Platts-Mills, T. A. Red meat allergy in children and adults. Current opinion in allergy and clinical immunology, 19(3), 229, 2019.
- Messina, Mark PhD, MS; Venter, Carina PhD, RD. Recent Surveys on Food Allergy Prevalence. Nutrition Today 55(1):p 22-29, 1/2 2020. | DOI: 10.1097/NT.0000000000000389
- Allergy, Genes and Environment Network. https://allergen.ca/wp-content/uploads/Canadian-food-allergy-prevalence-Jul-2017.pdf
- Sharma, A., Verma, A.K., Gupta, R.K. et al. A Comprehensive Review on Mustard-Induced Allergy and Implications for Human Health.Clinic Rev Allerg Immunol 57, 39–54 (2019). https://doi.org/10.1007/s12016-017-8651-2
