Introducing solids for infants with cows’ milk protein allergy

Starting your infant on solid foods is an exciting time as they are introduced to new flavours and textures. These early experiences with food are important as they can have a strong effect on your child’s health and attitudes to food later in life.¹ The skills infants learn at this time, as well as the variety of tastes and textures they are exposed to, form the foundation of future eating behaviours.² 

Why do parents of infants with cows’ milk protein allergy find introducing solids so difficult? 

Introduction of solids can be challenging for any parent, but it can be even more daunting for parents of infants with cows’ milk protein allergy (CMPA). Many foods that are traditionally introduced early on, for example, yoghurt, cheese and custard, contain cows’ milk protein. As your child progresses onto different textures, pre-prepared foods like certain baked goods, cereals and breads may also contain cows’ milk protein. Parents of children with CMPA have the added challenge of needing to learn how to read the food labels to be able to choose the ones that are appropriate for their child. 

Another concern of many parents of children with CMPA is when to introduce other foods that are known to be allergenic such as egg, soy, wheat and nuts.³   

Fortunately, there is help available through your doctor and dietitian. They can help to make the transition to solids a smooth and stress-free transition. 

How can a dietitian help? 

Accredited Practising Dietitians are experts in food and nutrition. They can advise parents on how to confidently navigate the introduction of solids for an infant with food allergies with helpful guidance and suggestions on appropriate non-dairy alternatives. 

When to introduce solids? 

Australian guidelines recommend that for infants with food allergies, the introduction of solids should happen at around six months of age (not before four months) while continuing breast milk and/or infant formula.³ The point at which to commence solids within this timeframe depends on when your infant is developmentally ready. An Accredited Practising Dietitian can help you identify the signs of readiness for solid food. 

Signs of developmental readiness may include^1,2: 

• Showing interest in food 
• Increased appetite 
• Sitting upright with limited support 
• Progressing from sucking to biting and swallowing when feeding 

Suitable textures 

The introduction of new textures into your child’s diet helps them learn the skills that are needed for eating.  The texture and consistency of foods offered to your infant at each age should be right for their developmental stage¹: 

• From 4-6 months of age, foods offered should be pureed, progressing to mashed, then to minced and chopped foods 
• By 8 months of age, most infants can manage ‘finger foods’. This stage helps to develop hand-eye co-ordination 
• By 12 months of age, infants should be consuming a wide range of nutritious foods. Generally, they can eat the same foods as the rest of the family 

Suitable Flavours 

Offering a wide variety of flavours will help to maximise your child’s willingness to accept new foods.  Australian Infant Feeding guidelines recommend that the first foods that are introduced should contain iron, for example, iron-enriched infant cereal, pureed legumes, meat, chicken or fish.¹ This can then be followed by pureed fruits and vegetables. The order in which new foods and flavours are introduced is up to the family, as long as iron-rich foods are introduced first.¹ For infants with allergies, like CMPA, new foods can be added every 2-3 days so that any possible adverse reactions can be identified.³ In the first 12 months of life, foods that are included in the diet should be without added honey, salt or sugar.¹ 

Are there any foods that should be avoided when introducing solids to infants with CMPA? 

There is no need to delay the introduction of other foods that commonly cause allergies, even for infants with CMPA.³ These foods include cooked eggs, wheat products and peanut butter. Foods should be introduced when your infant is developmentally ready for that texture.  The types of foods that are introduced should be in line with what your family usually eats. There is even some evidence that including certain foods that commonly cause allergies early on may be protective against developing an allergy to that food in the future.³ 

Some infants with CMPA, however, will still develop allergies to other foods. If this happens it is important to stop that food and seek advice from your doctor. 

In order to safely introduce new foods into the diet of your infant with CMPA, it is recommended that³: 

• New foods are introduced one at a time and start with single ingredients 
• Introduce new foods 2-3 days apart to allow time for any adverse reaction to be observed 
• Discuss clear steps with your doctor to follow in case of an allergic reaction to a food, particularly what to do if your child’s breathing is affected. 
• Try to introduce new foods earlier during the day, so that you can observe any possible reactions and get advice if necessary. 

For some allergy-free recipe ideas go to our recipe page.

Starting your infant on solid foods is can be an exciting time as they are introduced to new flavours and textures 

This article is not intended to be a substitute for medical advice. Always consult your doctor.