For many years the issue of complementary feeding has been a real chaos when making recommendations because each center, and each professional, explained it in its own way and in the end it seems that there were as many recommendations as professionals. Some said they had to start at 4 months, others than at six; some said that first it was necessary to give fruit, others that first cereals and others that did not matter; some said that what gave more allergy had to wait and others that was not necessary; and so, as I say, each family did a different thing and as it occurred to them to ask other families the debate was served.
Now we know that there is no need to wait with virtually no food, precisely because The longer it takes to offer the greater the risk of allergy, and that is why there are many six-month-old babies who are already eating peaches or strawberries, legumes, fish or even eggs. Foods that until now were not given until 12 or even 18 months.
Now, there is still an important doubt: How many days must pass between one food and another at the beginning of the complementary feeding?
All at once a week between meals
About ten years ago, when I started working in pediatrics we gave some recommendations in which there was no limitation between some foods and others. We delivered a sheet where it was said that at six months they could start eating vegetables, fruits, cereals, meat ... and each mother and father did and undid as he saw fit.
Then, we began to consider that this could be dangerous, and some, like me, went over to the recommendations that were then given by official bodies, with guides who talked about separate food at least seven days. Thus, every week a food was added to the diet of each baby to be clear that it was well tolerated and there was no allergic reaction.
From the week between meals to one per day
The problem of giving food every 7 days is that the child is growing and his diet is very poor. If the first week we give potato, the second bean, the third pear, the fourth chicken and the fifth orange, for example, we will be talking about a baby older than 7 months who only eats 5 foods, and that if he accepts them well and more or less likes them.
Another problem added is that allergy to these foods is very rare, so we have thousands of babies with poorly diversified diets just in case one reacts a food at a specific time. That is why in many cases, many professionals started talking about waiting one day between one food and another, especially if there was no history of allergy in the family and if the food was not very allergenic.
So, four or five years ago it became very popular the recommendation to offer one food per day, never for dinner (in case there was any type of reaction during the night), counting on those 24 hours to observe possible reactions: edema, respiratory problems, diarrhea, vomiting, skin reactions, etc.
Above all it was done like this to have a little control IgE mediated allergic reactions, which are the most scary because they are the ones that put the life of a baby more at risk, and that usually appear after eating the food that causes allergy.
The bad thing about waiting for one day is that allergic reactions often do not happen after the first exposure to food, but rather sometimes it is after the second or third, and then the question arises: has it been so because of what I have given it new today or for what I have been giving it repeatedly for three days?
But in the end it does not matter much because you have to run to the hospital and there they will ask you what you have given a while before. And even if one of the foods has never tasted it, those that have been proven will be possible culprits, so tests should also be done to determine which of the foods consumed before the reaction is the cause.
Moreover, I know cases of allergic reaction on the sixth or seventh day, others of bestial reaction on the first day (never having tried it and becoming fatal with the first exposure), and cases of reaction in foods that were already considered tolerated because the child did months I ate it without problems.
From food per day to three to five days
And so we come to the current recommendation of the guide "Recommendations for early childhood feeding", referring to the most up-to-date evidence, because it is from last year, where it is said that Ideally, let's wait three to five days, which is also the recommendation of Pediatric Nutrition Handbook of the American Academy of Pediatrics.
These three days would be a good way to control a little better the possible reactions in the first three days, which are the most "key", and it would mean not having to wait so long between meals to make the children's diet so poor as mentioned the food per week.
What an eye, the best way to control allergens would be to give a food every ten days, for example. Or every two weeks. We would have very clear that it tolerates it well and in case of allergy we would have very clear the causative food. But it makes no sense, if what we want is for the child to learn to eat, taste flavors, textures, smells, flavors, etc.
Is there no evidence?
How many days are they then? Seven? One? Three? Five? What do the studies say? Any. The studies they don't say anything. They say that a food can cause allergic reaction on the first day, although it is more likely to happen from the second day. They say it can happen on the fifth day too. They say that the amount of IgE that a child secretes does not determine how serious the reaction is, because a few days with little can get fatal, and other days with much take it better. And even different people, with a similar amount of IgE may be on the verge of anaphylactic shock and another in the process of overcoming their allergy.
Come on the three to five days are a consensus for waiting for a reasonable time. So, personally, in the absence of evidence, and considering that allergies to certain foods are very rare, I still have the 24-hour rule, varying it in two cases: if the food that is going to be given to the boy is potentially allergenic (egg, milk, fish, peach, strawberry, kiwi ...) and yes there is a history of allergy in the parents
That is to say, I (personally I, I repeat), I see much more logical to offer a different food every day, from those that do not usually give allergy: potato, carrot, beans, meat, bread, pasta (without eggs), rice, pear, etc., and when arriving at one of those most allergenic foods, so wait three to five days with the same food Until we go to the next one.
This would make even more sense if the father or mother is allergic to something. I do not mean that if one is allergic to the egg, the child will have a higher risk of egg allergy, but if this is the case, the child has a higher risk of being allergic to anything: allergy to a particular food is not inherited; the predisposition to have allergy to something is inherited.
Thus, if, as I say, the parents are allergic, it would be advisable to be more careful on the days in which a more allergenic food is going to be offered, being able to take advantage of the more conservative version of the "three to five days": spend five days with that food to make sure the tolerance is correct.
So as you see, if we throw a little common sense so that children can soon have a varied, stimulating, fun and diversified diet in which they eat many things and can enjoy before so many foods so rich and nutritious, the option of waiting one day between meals may be valid, if then we are more cautious with foods that can give more allergy. What an eye, there is no reason to wait for that later (7 years ago an article was published that served as the basis for everything we explain now). As I just said, it is known that The longer it takes to offer them, the more likely they are to cause allergy.
Photos | iStock
In Babies and more | Complementary feeding: complete guide, Baby feeding from 6 months: complementing breastfeeding, Decalogue of tips to start complementary feeding
