By Dr. Kerry McGee

Wouldn’t you think feeding a baby might be straightforward?   All these rules --- vegetables before fruit, green before yellow, Stage One before Two, one food a week, nothing spicy, nothing salty, nothing from the sea—and, for gosh sakes, nothing that ever came anywhere near a peanut.   Seriously?  Is this the way nature intended?

   There are well-intentioned reasons behind our traditions.  And we still talk about them, in part because many new parents want a clear-cut action plan when it comes to starting solids  Most of us in this business know these rules by heart.

   So, imagine my surprise when I learned that many of the traditional Somali families I worked with in Columbus were starting their (healthy, growing) 4-month-old infants on pre-chewed goat meat.

   Goat meat? What about the box of Kleenex-like rice cereal flakes (yum!) and the little jar of watery squished peas?  Those Somali moms (and, especially, the associated grandmoms) thought I was crazy.  It must have sounded as foreign to them as the goat meat sounded to me.

   Really.  Do we actually think that the way we teach parents to feed babies is the way babies are fed around the world?  Of course not.  We follow the guidelines of the American Academy of Pediatrics because we want to avoid risk, but we also understand that newborn people have been fed in all kinds of different ways throughout history.  And, while there are clearly lots of wrong ways to feed an infant, there are certainly also lots of right ways. 

   As it happens, the AAP Committee on Nutrition has also been rethinking some things recently.

For the youngest ones, it’s still pretty easy:  breastfeeding is usually best.  In fact, for babies from allergic families, exclusive breastfeeding probably is protective against allergic diseases.  And, for moms who can’t breastfeed, using a hydrolyzed formula may help prevent later food allergy in high-risk babies.

   For the older babies (those starting spoon food at 4-6 months), it gets complicated.  We’ve been telling moms to avoid the scary allergy foods (nut, egg, fish, and sometimes even wheat) until later…until after first, second or third birthday, depending on whom you ask.  The AAP used to support this idea, at least in babies from allergic families.

   Now, there is new evidence suggesting that waiting to start these foods is probably not helpful.  In fact, some of the research shows that avoiding these food in early infancy might actually make that baby more likely to be allergic to them in later.

   In a Clinical Report published in the January 2008 issue of Pediatrics, the AAP Committee on Nutrition and Section on Allergy and Immunology conclude that, once a baby is 6 months old, there is no dietary way to reduce the risk of allergic disease.

   Of course, peanuts and peanut butter are choking hazards.   And for kids who already have known allergies, avoiding these foods is important.  But, there is no reason why the average non-allergic 10-month-old can’t gum up bits of a peanut butter cookie (as an occasional treat, of course).

   And the goat meat?  At the AAP Conference in October, Dr. Greer of the AAP Committee on Nutrition announced that they are working on a new set of guidelines for starting solids, which will likely include some pretty radical changes.  I found a blurb about it in the September issue of AAP News.  “Throw Out the Rice Cereal” was the title and it included this bit:

  “Consider that a 5-month-old baby exclusively breast fed is most likely to be deficient in iron and zinc. ‘If you look at the needs of the baby, what he probably needs is red meat and is probably the last thing he is introduced to,’ Dr. Greer notes.  “None of that is based on any data,” he says in that same article.  ‘We should focus on the biology, not the tradition of complementary feeding.’”

   Huh!  Fortunately, those wise Somali moms probably didn’t listen to a word I said.