Katie Ferraro (1s):

So we want our babies to eat fish because it's a potentially allergenic food that we should introduce early and often, but there's other things to consider when selecting fish, right? Low sodium choice and a highly nutritious choice that's lower in mercury. There's also environmental considerations. Hey there, I'm Katie Ferraro, Registered Dietitian, college nutrition professor, and mama of seven specializing in baby led weaning. Here on the Baby-Led Weaning Made Easy podcast I help you strip out all of the noise and nonsense about feeding, leaving you with the competence and knowledge you need to give your baby a safe start to solid foods using baby led weaning.

Katie Ferraro (44s):

Welcome back to another episode of the baby led weaning made easy podcast today. We're talking about fish, how to introduce your baby to this potentially allergenic food, because fish is one of the big eight allergenic foods. Those are the eight foods that account for about 90% of food allergy. And we know that for a lot of the allergenic foods, we introduce them early and often to our babies. It can help prevent food allergy. The American academy of pediatrics reminds us. There's no evidence that says that waiting to introduce these foods like eggs and dairy and soy and peanuts or fish. So if you wait longer down the road, there's no benefit to doing that.

Katie Ferraro (1m 26s):

So we take that advice and say, all right, the alternative is we want to introduce it early and often as a way to help prevent food allergy. But how do we do that safely? Right? Because fish can be problematic with concerns about bones, obviously making sure that it's prepared safely. So it doesn't cause foodborne illness there's concerns about mercury. So I want to start our episode off today with a baby led weaning tip of the day. As I do every episode, I want you guys to know that the benefits of feeding your baby fish far outweigh any risks. Now hang tight because at the end of the episode today, I am going to talk a little bit about risk. There are some higher mercury fish that we don't want our babies to be eating, but I don't want you to be scared off of fish.

Katie Ferraro (2m 9s):

Fish is your friend. All right. And we're going to talk about how and why. So, as I mentioned, fish, it's one of the big eight allergenic foods. Those are the eight foods that account for about 90% of food allergy and seafood. Okay. When we think about the category of seafood, right? Fish and shellfish are in there. Fish is one of the big eight allergenic foods and shellfish is a different, big eight allergenic food. Okay. So two of the eight allergenic foods are seafoods today. We're not talking about shellfish. I'll do that in a separate episode today. We're just going to be talking about fish. So we're referring to fin fish here. Now, according to fare food, allergy research and education, great resources at foodallergy.org.

Katie Ferraro (2m 50s):

Finned fish is one of the most common food allergens. That's why it's one of the big eight. And the allergy for fish is usually lifelong. So this is not like when we were about wheat. For example, in episode 29, go back and listen to that. If you don't know how to introduce your baby to wheat, wheat is one that most children will outgrow by age 12. If your baby is allergic to fish, it's going to be more likely to be a lifelong allergy. And fish is not one of the most common pediatric food allergies by any stretch of the imagination, about 40% of people who have fish allergy, they have their first allergic reaction as adults, but babies still can be allergic. So again, fin fish allergy, it's separate from shellfish allergy.

Katie Ferraro (3m 30s):

Having one doesn't necessarily mean that you'll have the other, but of course, babies who do have one type of food allergy are at higher risk or more elevated risk for having a different food allergy. So when it comes to the type of fin fish that people are allergic to things like salmon, tuna, and halibut are the most common kinds of fish people are allergic to. And I'm going to talk today about my favorite types of fish for baby led weaning. Because depending upon where you are geographically listening to this, either in the world or in north America, your access to different fish may vary. So I want to give you guys a couple of options so that you do find a fish that works for your baby. So fish can be found obviously in the flesh of fish, right?

Katie Ferraro (4m 11s):

And so, but it also can be in different ingredients. So one that you might not be aware of worcester sauce. So if you ever look at vegan recipes, for example, they never have worcester sauce in them because there's fish in there and vegans don't eat animal products and fish ingredients would not be compatible with a vegan diet. Now, even vegetarian and vegan families, vegetarian means lots of different things. Some families do eat fish on a vegetarian diet. Some if they're vegan, they eat no animal products, including fish, but many vegetarian families will sometimes relax their approaches to the inclusion of certain types of animal foods during baby led weaning because they want to expose their babies to these proteins, to help them prevent the food allergy down the road. So maybe you're not inclined to be eating fish regularly, but you might consider offering it to you, your baby, because you do want your baby to be exposed to that protein.

Katie Ferraro (4m 60s):

So worcester sauce can have fish in it, and it's also in certain cuisines, like certain types of African cuisine, Chinese Indonesian, Thai Vietnamese. Even if you get fish free dishes, especially if you're purchasing it from a restaurant there's a high risk of cross contact. So it is important to educate yourself if your baby does have an allergy to fish food, allergy.org fair is a wonderful resource to start there. And I'll link that up in the show notes to some more resources that I'll talk about today. If you go to BLW podcast.com/ 31, you can find all of the resources from this episode. So let's get started talking a little bit about the introduction of fish to your babies. When do we do it? How much? And then what types of fish? So starting with when, as I mentioned, the AAP states that there's no evidence that waiting to introduce is beneficial.

Katie Ferraro (5m 47s):

Okay? So we take that to basically mean starting at the period when it's safe for babies to eat, which is six months of age or older, it's okay to introduce your baby to fish. Now how much, how much fish should our baby be eating? Remember, baby portions are small. There's no set number of grams of fish, protein that you want to feed X or Y number of times over Z number of days to make sure your baby is adequately exposed. Okay. The guidance about introduction of allergenic foods, it's purposely vague early and often. So we don't start solid foods before six months of age because that's not safe. But at around the six month mark, you can start introducing. I usually do one new allergenic food per week.

Katie Ferraro (6m 28s):

I usually do that on Friday. So if you guys follow my five step feeding framework, as we're working towards feeding our babies a hundred different foods before they turn one, we do five new foods a week on Monday. I do fruit Tuesday. I do vegetable Wednesday. I do starch Thursday, do a protein food. And then on Friday I do a challenge category food. The challenge category consists of the big eight allergenic foods, fish being one of them. Plus some trickier textures and more complex flavor profiles. Every Friday, I do a new challenge category food. So starting in the first week of baby led weaning, I'll do an allergenic food. I usually start with milk or eggs or peanut because those are the three most common pediatric food allergies.

Katie Ferraro (7m 10s):

But in week four, you could do wheat go to episode 29, to learn more about how to offer wheat to your baby in week five on Friday, you could introduce fish. Now you do not have to wait three to five days between introducing low risk foods, but you should wait a number of days when you're introducing the allergenic foods. So that's why I do it on Friday. I might feed the baby fish. You know, if you're feeding two times a day, I would offer that fish twice a day on Friday, maybe a different one on Saturday, once or twice, Sunday, once or twice, no other new foods in between. You can introduce familiar foods your baby's already done well with, but keep an eye to see if there's any potential allergic reaction with fish and then go back to introducing new foods starting on Monday.

Katie Ferraro (7m 54s):

So how much should we offer? I usually do a few strips, maybe an ounce or so. Okay. There's no actual recommended portion size for babies. If you look at the EPA and the FDA guidance, it says for children that a serving is one ounce starting at age two, but obviously you guys are feeding your babies at six months of age, right? So we're doing this for babies and there's no recommended portion, but I generally say around an ounce. Okay. And if you're not sure how much that is, you could get a food scale. But if you don't have one that the Palm of your hand, as an adult, we generally say, that's about three ounces. Now everyone has different sized hands. I get it. But so we're talking about pretty small portions, a couple of strips of fish.

Katie Ferraro (8m 34s):

Now, what sort of fish do you want to feed your baby? You can do canned fish, or you can do fresh fish. Now it depends where you are in the world, but there are certain food cultures that are more inclined or prone to be eating canned fish and others that you might've been like, gosh, I have never had a canned fish product in my life. So let's talk a little bit about canned fish first because they're surprisingly versatile and they worked very well for baby led weaning. Especially if you don't like cooking fresh fish, I don't mind it. It's something, I guess my husband does more than me, but yeah, I've always liked with baby led weaning, being able to just pop open a can of fish and some of my favorites, okay. Are things like anchovies? Okay. You might turn your nose up at the idea of anchovies, but anchovies are a fatty fish.

Katie Ferraro (9m 16s):

And I always say, if you're choosing between trying to pick a type of fish, there's lots of types of fish. Your baby can eat. But I prefer to do the ones that are fattier fish for a number of reasons. First fat equates to moisture. Okay. And the more moist the food is, especially protein foods. The less likely your baby is going to be to choke on it. So you could feed, okay, or like a dry kind of bland white fish. And you're welcome to do that, but you want to prepare it in a way where there's a lot of sauce or a lot of moisture, because a fish like a tilapia, which is essentially almost fat free, just protein can be really dry and compose a choking hazard. So something like anchovies, which are really fatty, they're going to give them extra moisture, which is going to be easier for your baby to swallow less likely to choke.

Katie Ferraro (9m 60s):

Now anchovies also as a fatty fish have omega three fatty acids. These are essential fatty acids. I've heard fish referred to sometimes as brain food, essential fatty acids play a role in your baby's still developing brain health. So we want to, for foods that are natural sources of essential fatty acids, the dish is a good one. Now you might think, well, canned foods, those are high in sodium. I'm going to do an episode dedicated justice sodium in the future very soon. But my general rule of thumb is if you're looking at canned or processed foods, we more often than not, don't feed Babies processed foods, but anchovies like unless you're catching them yourself, they're going to be processed. And so sometimes we feed foods that are processed.

Katie Ferraro (10m 42s):

And so I generally look for foods that are a hundred milligrams of sodium or less per serving. Okay. And that's just a rule of thumb. There's no actual guidance in the United States for sodium intake for babies, less than one. But we generally say minimize sodium as much as possible. But in some cases, you know, fish, we have to decide what our goal here is. If our goal is to introduce the baby to the fish, protein and anchovies are an easy way for you to do it. It might be a little bit of a higher sodium food than other new foods you've been doing. But more often than not, you're offering wholesome foods, don't have added salt. Don't freak out about a little bit of salt in the anchovies. Cause the goal here is get your baby exposed to the protein, right?

Katie Ferraro (11m 21s):

Allergy prevention mechanism there. So you can do anchovies. I like salmon is another great one. You can also, you can buy canned salmon again, look for lower sodium options when possible. But if you're not inclined to cooking fresh salmon, look for the canned one. One good thing about the can when there's different varieties and parents ask sometimes when, when I open up the can of Salmon, I can see bones. Generally I say with fish, obviously remove the visible bones. If you're doing fresh fish, cause that could be a choking hazard, but feel how the bones feel in a can of canned salmon. They almost dissolve in your fingers. If they dissolve in your fingers, your baby's going to because they're so soft right there. You're eating another species, calcified bone, but when it's processed and canned, oftentimes it becomes so soft that it just dissolves.

Katie Ferraro (12m 6s):

That's perfectly safe for babies to have. Sometimes in different brands will actually be harder bits of bone. You do want to pick those out. Okay? So you make the call. If it doesn't seem safe, remove it, but also know that some canned bones are so soft that they're actually okay for babies to eat. Now, when I talk about canned fish, you guys probably think of tuna, right? And tuna is a great option for babies with a couple of caveats here. Again, you want to look for lower sodium versions. Now, if you're in a traditional grocery store in the United States, the brands that you come across are StarKist chicken of the sea is another one. They do make very low sodium or low sodium versions of those tunas. It just depends on what your particular store carries.

Katie Ferraro (12m 49s):

Now, if you're planning out your baby's foods and you know, Hey, next week, I'm going to do tuna. You may have time to order it online. And so sometimes of course it costs a little bit more per can like canned tuna is a very affordable source of protein. If you're buying in the grocery store, usually around about a dollar, a can for a six ounce can or five ounce can rather, but if you go online, it might be more like three or $4 a can for the lower sodium version. But I would say that's a good place to spend your money because you're going to get a number of different portions, right? If you buy a five or six ounce, can, that's five or six portions of that fish for your baby, spend the money to get the lower sodium one, if you can, but just look for the lowest sodium version. One, StarKist makes a very low sodium tuna at 35 milligrams per two ounce serving, right?

Katie Ferraro (13m 34s):

And remember the portion sizes are for adult servings. They tend to be bigger. Manufacturers can pick their own portion sizes though in the United States. So just remember your baby's going to eat a smaller portion of that because it's a baby and not an adult. chicken of the sea. That's a brand that makes it, they have a light tuna packed in water. 90 milligrams of sodium per two ounce serving general rule of thumb is you want to look for less than a hundred milligrams of sodium. You can go online, the brand wild planet. They have no added salt tunas. Those are more expensive than more like $4 a can. And if you add some of the more specialty grocery stores, you can sometimes find wild planet actually on the shelves or you can of course order it online. So canned, don't discount, canned fish.

Katie Ferraro (14m 15s):

It's actually a pretty cool way to serve your baby in already soft, already cooked. Sometimes you can find lower sodium version of these fish. Now what about fresh fish? Okay. You do want to watch out for bones. Okay. At the end, I'm going to mention a little bit regarding mercury, but the EPA and FDA have guidance about what sort of fish we don't want. Pregnant and breastfeeding moms and babies and young children to eat. So the types of fish that I'm going to recommend, I just want you to know they're all on the best choice list, meaning that they're lower in mercury. So it's not really a concern. And again, remember the tip from the top of that episode, the benefits of feeding your baby fish far outweigh any of the potential risks. But some of my favorite types of fish salmon is I think the easiest one, right.

Katie Ferraro (14m 59s):

Salmon is a high-fat fish. It's so easy to cook. You can just put it in the oven. I usually do it about 350 or 375. I'll pour olive oil all over the top of it for added fat and moisture kind of rub it around, put it on a pan. Don't even cover it, just put it in the oven, bake it for 15 or 20 minutes. Depends on how big your piece of fish is. Of course. And then you just want to make sure when you hit it with the fork, that it's, you can kind of separate the flesh, look inside of there and make sure it's not translucent. See that it's cooked all the way through, or you can also use a meat thermometer, which is always a good idea and look for the internal cooking temperature of fish. Okay? And so if you use your meat thermometer for fish, you want to cook to 145 degrees Fahrenheit, or until that fleshes, opaque and separates easily with a fork, you don't want to overdo it because if you cook fish too far and it gets really dry, then again, it doesn't taste good, but also could be a choking hazard.

Katie Ferraro (15m 54s):

So I love salmon as probably the easiest type of fish. Plus it's a high fat fish, but some other high-fat fish that I, like I mentioned, anchovies sardines are another good one. Herring trout. If it's freshwater trout, again, depends where you are geographically as to whether or not you can get access. But I feel like most people can get access to canned anchovies or canned sardines. You can sometimes get fresh anchovies or fresh sardines if you're doing fresh fish. I think salmon is one of the best ones, but halibut's another good one. These are lower in fat, but still find for babies to have catfish Cod Mahi Mahi tilapia. There's a whole list of fish that I will link up, which are fine for babies to eat. I'll put that in the show notes for this episode.

Katie Ferraro (16m 35s):

If you want to come back and check it out, BLW podcast.com/ 31, but if you're not sure what fish to do, I say go salmon. If you're doing fresh because it's so easy to cook and everyone else in the family can like it and enjoys it. When you take it out of the oven, sometimes just squeeze some lemon on top of that, you can make a dill sauce with yogurt. If your baby's already been exposed to the milk, protein and yogurt, adding moisture, adding sauces, adding dippers, especially to protein foods to make sure they're not dry. On top of the fact that salmon already has a lot of fat. It's a great way to offer your baby fish safely. If you want to go the canned route, look for lower sodium versions of tuna, as well as anchovies and sardines. Now, things you want to avoid fish sticks.

Katie Ferraro (17m 16s):

Okay. I know fish sticks are easy, but I don't like fish sticks for babies for two reasons. First and foremost, the breading on the fish sticks can be very crunchy and very dry and dry crunchy bread products can be a choking hazard for, especially for early eaters. If you're doing fish at six or seven months of age, steer clear of fish sticks, as your baby gets more proficient at self-feeding, you can do more of the dry bread products, but on top of the potential choking hazard for early eaters, I don't like fish sticks because commercial fish sticks tend to be very high in sodium. Again, we want to minimize the amount of sodium that the baby is eating. So steer clear of fish sticks. If you can. Now I do want to address a little bit about mercury.

Katie Ferraro (17m 57s):

I'm going to put at the end of the episode, because I want you to know the benefits of feeding your baby fish from a nutrition standpoint, from the Allergan introduction standpoint. But I would be remiss if I didn't touch briefly on mercury concerns. So the FDA and the EPA, so in the United States, the food and drug administration and the environmental protection agency, they've issued joint advice regarding eating fish for pregnant and breastfeeding moms for babies. It's not really for babies. It's for children two and older, but you can kind of take this all with a grain of salt that it does apply to the infant population. So you wait until your baby's six months of age, between six months and 12 months of age. You're introducing all these different foods, including the allergenic foods and fish should be one of them. So they have a chart.

Katie Ferraro (18m 38s):

Now I'm going to link to this chart inside of the show notes for this episode, that makes it really easy to choose what types of fish are safe to feed. And we want you to choose a variety of fish that are low in mercury. So in this chart, there's best choices. So all of the fish that I've listed so far from the best choices, meaning you can eat those two to three times a week safely get the beneficial benefits from that good choices is a separate part of the list. Like a little bit higher risk for mercury. You only eat those one time a week and then higher in mercury choices to avoid. And so the choices to avoid our fish that we don't want to eat when pregnant, breastfeeding or feeding small children, because they have the highest mercury levels. These tend to be the bigger fish, right?

Katie Ferraro (19m 19s):

Cause they're higher up on the food chain. They eat all of the smaller fish. They bioaccumulate and absorb all of their potential mercury. And then the bigger fish are potentially more hazardous from the standpoint of having higher mercury levels. Mercury as a heavy metal is certainly something we don't want to be overexposed to from a developmental and health standpoint. So the choices to avoid this is from that chart. We don't feed our babies the following fish king macrel, we avoid Marlin don't feed orange roughy, shark, swordfish, tilefish Gulf of Mexico and big eye tuna. Now sometimes parents get confused about tuna. They're like, wait a minute. You just told me to. And I was okay, so here's the deal with tuna.

Katie Ferraro (20m 3s):

Okay. When you go to the store, let's say you're in a regular grocery store and you're looking at tuna there's albacore, and then there's chunk light. The albacore is like fancier, right? It's like the white one. It's usually priced a little bit higher white, meaning that the fish is actually white. When you open the canopy, the pink one, which is chunk light, it's usually cheaper. Okay. It's kind of Pinker when you open it up. The chunk light is historically lower in mercury than albacore. When you can choose the chunk light, then of course choose a lower sodium version of it if you can't. But for tuna in the good choices, if you look at that chart, it will tell you that albacore white and Yellowfin tuna are good choices. Meaning you could feed your baby one serving of that a week and you would be fine, but you to stay away from the big eye tuna.

Katie Ferraro (20m 49s):

So don't feed your baby big eye tuna. Okay. And again, just check out this chart that I'll link to in the show notes, it kind of summarizes it all for you. But I do want you to know that fish is perfectly safe to feed your baby. So if you want to find that chart, go to BLW podcast.com/ 31. And I've also linked to another great resource there too, which is seafood watch.org. Some of you guys might be familiar. This is the website from the Monterey bay aquarium. And it provides recommendations that help you choose seafood, that's fished or farmed in ways that have less impact on the environment because I'm not choosing fish and seafood products can be hard because you're like, okay, I have to think about mercury. I think about nutrition and I have to think about the environmental impact.

Katie Ferraro (21m 31s):

So again, if you go to seafood, watch.org, their recommendations are largely environmental. That may be of importance to you. And you want to select foods that are safe for your baby to eat nutritious for your baby to eat and also environmentally sustainable choices. They also tell you on seafood watch.org. Like this is a good one, or this is one to avoid the EPA and the FDA guidance that fish chart, their recommendations are based more on mercury. So again, we're kind of weighing a number of different things here, but I hope the takeaway message that you're leaving with today is that the benefits of feeding your baby fish far outweigh any of the potential risks. My favorite fish for baby led weaning our salmon, anchovies and sardines. Nothing better than watching a baby eat sardines.

Katie Ferraro (22m 12s):

It's fabulous. I am actually right now in the middle of a, we have a course Dawn and I miss Dawn SLP, who some of you guys may know is a pediatric swallowing expert. We co-teach on the hundred first foods program in a digital program. And that's open right now for a limited amount of time. So if you go to 101st foods.com, you can check out our program. We go through 20 different protein foods, including a number of different seafood options. So that's both fish and shellfish, but also showing you how to prepare many different types of protein foods safely. Cause I know like most of us can do, like I can do avocado. I can do banana. I can do sweet potato. Like those are the, some of the easy starter foods, but sometimes parents get a little bit tripped up when we move into the more complex and the more the combination foods and some of these trickier allergenic foods.

Katie Ferraro (23m 4s):

So if you want to check out the a hundred first foods digital program, you can either go to the show notes for this episode or 101st foods.com has more information about that program. It's only open for a limited amount of time, but a lot of parents like that program because it's really detailed information on how to feed a wide variety of foods safely, including fish. So I hope you guys enjoyed this episode all about how to introduce your baby to the potentially allergenic food fish. See you later. Bye now!