Baby First Foods Schedule and the ‘3-5’ Day Rule

Maria E. Rivera, MD, MPH

Is your baby ready for first foods? Alright! Have you noticed there are mixed messages on what exactly to do? Unfortunately, mixed messages come from differences in the expert guidelines! This annoyed me, so I looked at the evidence. In this post I take on why you have to wait 3 to 5 days between foods to introduce another one. And, what does that mean for your baby first foods schedule?

What are the actual expert guidelines?

First let’s look at the American Academy of Asthma, Allergy, and Immunology (AAAAI). They recommend a parent introduce single-ingredient infant foods between four to six months. Parents can introduce food this way every 3 to 5 days as appropriate for the infant’s developmental readiness.

In its last guideline the American Academy of Pediatrics (AAP) recommended that parents introduce single-ingredient complementary foods one at a time for a several day trial. However, this guideline was last updated in 2000. Notably I found no recommendation to wait on the main AAP feeding site currently.

Why is this wait period recommended? 

Basically, the idea is – if you go slowly it allows caregivers to figure out what food is the offender if a child has an allergic reaction. Therefore, this approach is used as a way to help parents know what foods to avoid. 

Is this baby first foods schedule a recommendation backed by science?

Nope. No studies are cited in either the AAP or AAAAI guidelines and we couldn’t find any evidence looking in to this waiting rule at all!

But it makes sense, doesn’t it?

It does and it doesn’t. Let’s take an example with potatoes.

Why does this make sense? The majority of food allergies do get diagnosed when a child is less than two.  If the only thing you feed your child for 4 days in a row is potatoes and they break out in hives, the most likely culprit is potatoes.

Why it doesn’t make sense? Food allergies can happen at any time. Babies can have a reaction the first time they have potatoes or the 58th time. Also, if your baby has a reaction to those potatoes or anything else, you most likely will end up at a doctor’s office and need to get testing done anyway. 

Ok… but doesn’t it take several days for some reactions to appear?

There are several kinds of food reactions. A food allergy happens when your immune system has a response to a food. Typically, this means that your body makes antibodies against the food. Then, your body goes into overdrive when you expose yourself to this allergen. These food allergies can cause anaphylaxis and most occur within minutes or hours of exposure. Food allergies are series because they can stop a child from breathing. If you see hives, coughing, trouble breathing, or vomiting you should call 911 or go to the ER immediately. Remember to administer an epi pen if you have one!

Other food reactions that are not caused by antibodies may take longer to appear. However, there is no guarantee that they will happen within the three days of waiting and can happen later.

Is there harm in waiting and just do 1 food at a time?

Again, there is no evidence or even studies looking specifically on these waiting “rules” for your baby first foods schedule. However, we are learning more and more about how a diverse diet in the beginning is good later on. For example, kids are more likely to eat a variety of foods later on. Exposure to many different foods can help prevent food allergies!

So, if your child is not ready to start solids until they are 6 months old and the goal is to have a varied diet with several textures by age 1 you don’t have that much time. If you wait three days between each new food, that means at most the number of foods that you can introduce is around 61 foods. If you wait 5 days, you can only introduce about 37. This might be enough diversity, but we just don’t know. 

Furthermore, the LEAP trial completely changed what we tell parents about introducing allergens, especially in kids at high risk of peanut allergies. Pediatricians now recommend introducing them early. If you want to read more about why that guideline changed and other food allergy tips for baby, watch this.

So, what is the bottom line?

In conclusion, the bottom line for baby first foods schedule is that there is actually no evidence to suggest you should wait.  I feel that in this case parents can choose what feels right to them. In the end we want to prevent allergies and build healthy confident eaters, and that means introducing a large variety of foods at an early age! 

One last piece of advice: At your 4-month well child visit with your pediatrician, talk to her about introducing solids. Ask her what to look out for as signs your child may be having a food allergic reaction. This way you can feel prepared to identify one. We take on readiness cues, if you want to read more with Fooblie.

Want more help in creating a baby first foods schedule?

Our Fooblie Coaches are ready to help you out! Talk to a coach to get some guidance on first foods. You’re not alone!