Tofu for babies: when to start, soy allergy and how to serve it

Babies can eat tofu from around 6 months, once they've started solids. It's soft, easy to mash and a useful source of iron, especially in vegetarian families. Australia's ASCIA's guide to introducing solid foods, from Australia's allergy specialists, lists tofu among the iron-rich foods to offer from around 6 months, and soy among the common allergy foods to introduce in the first year (by 12 months).

Because tofu is made from soy, it's worth introducing it the way you'd introduce egg or peanut: on its own, in a small amount, then regularly. This guide covers when to start, silken versus firm tofu, how to serve it at each stage, signs of a soy allergy, soy drinks and soy formula, and getting enough iron on a vegetarian diet.

When can babies eat tofu?

All three countries say from around 6 months, as one of the common allergy foods to include early.

Australia's Pregnancy, Birth and Baby, the Australian Government's parenting service, lists cooked plain tofu among the first iron-containing foods, alongside cooked legumes and soybeans. The NHS guide to feeding from around 6 months lists tofu among the protein foods suitable from around 6 months, and soya among the foods to introduce one at a time in very small amounts.

The NHS guide to food allergies in babies says these foods can be introduced from around 6 months, just like any other foods. The AAP's allergen guide lists soy among the highly allergenic foods babies can start once they've managed a few first foods, and suggests keeping them in the diet routinely.

Silken or firm: which tofu is best for babies?

Both work; they just suit different stages.

• Silken tofu is very soft and smooth. It mashes or blends easily into vegetable purée, porridge or a sauce, which makes it a good first texture.
• Firm tofu holds its shape, so it can be cut into strips your baby can hold, or small soft pieces once they can pick food up between finger and thumb.
• Plain tofu is the one to buy. Flavoured, marinated or smoked tofu often has added sauces, and the NHS salt guide lists soy sauce among the high-salt sauces to limit. It says babies under 1 should have less than 1 g of salt a day.

Both Pregnancy, Birth and Baby and the Victorian Government's Healthy Eating Advisory Service menu guide in Australia describe it as cooked plain tofu, and the NHS guide to preparing food safely suggests steaming, simmering or mashing tofu for very young children. Steaming or simmering is an easy way to warm tofu through before serving.

How do I prepare tofu for my baby at each age?

Start with a texture your baby already manages and move on as their skills grow.

The NHS first solid foods guide says finger food pieces should be big enough for your baby to hold in their fist with a bit sticking out, and that pieces about the size of your own finger work well. Pregnancy, Birth and Baby says most babies can manage finger foods cut into small pieces at about 8 months, and that lumpy food should be introduced by 9 months. By 12 months, most babies can eat a wide variety of family foods.

A few practical points:

1. Drain and pat firm tofu dry, then cut it into strips or cubes and steam, simmer or bake it until heated through.
2. Mash silken tofu with a fork and stir it into a food your baby already eats.
3. Check the texture. A piece should squash easily between your thumb and finger; crisp, fried or chewy edges are harder to manage.
4. Store leftovers safely. The NHS guide to storing and reheating baby food says to cool cooked food ideally within 1 to 2 hours, use it from the fridge within 2 days, and reheat it only once until steaming hot, then let it cool. Keep unopened tofu as the pack directs.

For texture progression in general, see food textures by age.

How do I introduce tofu as an allergen?

Introduce soy the same way as the other common allergy foods.

1. Pick a good time. Offer tofu when your baby is well and you can watch them for the next couple of hours. Australia's ASCIA says allergic reactions usually happen within minutes to two hours.
2. One new allergen per meal. Australia's ASCIA says to introduce only one new common allergy food at a meal, so you know which food caused any reaction.
3. Start small and build up. Australia's ASCIA describes starting egg and peanut with about 1/4 teaspoon mixed into a familiar food and doubling up from there; the same small start works for mashed tofu.
4. Keep it going. Once tolerated, Australia's ASCIA says to include common allergy foods at least once a week, which can reduce the chance of an allergy developing.

If your baby has eczema or a diagnosed food allergy, the NHS suggests talking to your GP or health visitor first. Australia's ASCIA says these babies should still have the common allergy foods in the first year. Introducing allergens has the full plan.

What's worth noting when you introduce tofu?

A quick note each time helps: the type of tofu, how you prepared it, roughly how much your baby ate, the time, and anything you noticed over the next two hours. If there's a reaction, a photo of any rash and the time it started are useful for the doctor. Ticking off the weeks tofu was eaten makes it easier to keep soy in the diet regularly.

If your baby is allergic to soy

Australia's ASCIA's soy allergy dietary guide lists tofu, soy milk, soy yoghurt, soy formula and soy sauce among foods that contain soy, and says most people with soy allergy can still eat soy lecithin, soybean oil and other legumes such as chickpeas and lentils. Australia's ASCIA's food allergy FAQ says most children allergic to soy will outgrow it. Get specialist advice before trying soy again, and keep introducing the other allergy foods.

What does a soy allergy reaction look like?

Australia's ASCIA's anaphylaxis FAQ separates mild to moderate signs from anaphylaxis, the most severe type of allergic reaction.

Australia's ASCIA classes lip swelling as a mild to moderate sign, while the NHS urgent-help guide lists swollen lips among the reasons to call an ambulance, so this guide treats sudden lip swelling as an emergency. Redness only around the mouth, with no other signs, is not usually an allergic reaction, according to Australia's ASCIA.

For anaphylaxis signs, follow the Australia's ASCIA first aid plan for anaphylaxis: hold your baby flat, give an adrenaline device if one has been prescribed (if in doubt, give it), call 999, and start CPR if your baby is unresponsive and not breathing normally.

For hives, face or eye swelling, or vomiting with normal breathing, stop giving tofu, stay with your baby, watch closely for signs of anaphylaxis and get medical help today.

Can babies have soy milk or soy formula?

Not as a drink or main milk before 12 months, unless a doctor advises soy formula. Breast milk or infant formula should be your baby's main milk for the first year.

• Soy drinks. The NHS guide to types of formula says never to give a baby under 1 drinks known as "milks", such as soya, rice, oat or almond drinks. NSW Health's guide to starting family foods in Australia says plant-based milks don't provide enough nutrition for babies under 12 months.
• After 12 months. The NHS drinks guide says unsweetened, calcium-fortified soya drinks can be given from age 1 as part of a balanced diet, and the AAP's drinks guide says soy milk is nutritionally equivalent to cow's milk. NSW Health says to discuss calcium-enriched soy drinks with a dietitian first. Moving to cow's milk covers the switch.
• Soy formula. The NHS says soya formula is suitable from 6 months but only under medical supervision, and only if a health visitor or GP has recommended or prescribed it. It notes concerns about phytoestrogens in soya and says soya formula is more likely than cows' milk to harm a baby's teeth.

Advice on soy formula for cow's milk allergy differs. Australia's ASCIA's cow's milk allergy FAQ says soy protein formula is tolerated by most babies with cow's milk allergy, is unsuitable for babies allergic to soy, and is usually only recommended for babies over 6 months. The AAP's guide to choosing a formula says there are few circumstances in which soy formula should be chosen instead of cow's milk formula, and that up to half of babies with milk allergy are also sensitive to soy protein. Australia's ASCIA also says soy formula isn't recommended for preventing allergy. Either way, the choice is one to make with your doctor.

How do vegetarian babies get enough iron from tofu?

Tofu contains non-haem iron, the plant kind. The Royal Children's Hospital Melbourne iron fact sheet, from Australia, lists tofu and tempeh among non-haem iron sources, which are not absorbed as easily as the haem iron in meat, poultry and fish. It gives 11 mg a day as the Australian recommended intake for babies aged 7 to 12 months, reached over time, and lists vegetarian and vegan diets as a risk for low iron.

1. Pair tofu with vitamin C. The CDC's iron page says pairing non-haem iron with foods high in vitamin C helps your baby absorb it. The Royal Children's Hospital suggests berries, citrus, kiwi fruit, pepper, broccoli and tomato.
2. Add other iron foods. Iron-fortified infant cereal, lentils, chickpeas and beans all help. The Victorian Government menu guide says iron-fortified foods are especially important for babies on a plant-based diet.
3. Keep calcium and vitamin B12 in mind. The NHS guide to the vegan diet lists calcium-set tofu as a source of calcium and says vegans may need a vitamin B12 supplement. NSW Health suggests seeing a dietitian for advice on iron and vitamin B12 if your baby will eat a vegan diet.

Pregnancy, Birth and Baby says vegetarian and vegan babies can thrive if their food has enough energy and nutrients, and recommends talking to an Accredited Practising Dietitian before starting. Iron-rich first foods has more ideas.

What if my baby gags or chokes on tofu?

Tofu is soft, but firm pieces, crisp fried edges and small round shapes can still be a problem. The NHS says firm foods and small round foods can be more risky, and suggests cutting food into narrow batons. The CDC's choking hazards list includes whole beans, so mash or squash edamame and other soybeans. Keep your baby sitting upright and stay with them while they eat.

The NHS guide to choking and gagging says gagging is a normal reflex as babies learn to chew and swallow, and it's loud. Choking is quiet: your baby can't cough, cry or breathe properly. Choking vs gagging explains the difference.

If your baby is choking and can't breathe, cough or cry, shout for help and call 999. The NHS first-aid steps for a choking baby are up to 5 back blows, then up to 5 chest thrusts, repeated until help arrives. If your baby becomes unresponsive, start CPR and follow the call-taker's instructions. Get medical help afterwards, even if the food came out. The Royal Children's Hospital Melbourne in Australia recommends that anyone caring for children does a first-aid course.

When should I get help?

Call 999 now if your baby:

• has difficult or noisy breathing, a wheeze or a persistent cough
• has sudden swelling of the lips, tongue or throat
• has a hoarse voice or cry, or becomes pale, floppy or drowsy, or collapses
• is choking and can't breathe, cough or cry
• has had no wet nappy or wee for 12 hours

Get medical help today if your baby:

• has hives or welts beyond the mouth area, or swelling of the face or eyes, with normal breathing (stop the food and watch closely for anaphylaxis signs)
• vomits after eating tofu or another soy food
• needed back blows or chest thrusts, even if they now seem well
• has diarrhoea or vomiting with fewer wet nappies than usual (see signs of dehydration)

Talk to your GP or health visitor if:

• your baby has eczema or a diagnosed food allergy and you haven't started soy yet
• you're thinking about soy formula, or a plant drink as your toddler's main milk
• your family eats a vegetarian or vegan diet and you'd like help planning your baby's iron (call NHS 111 after hours)