Apple for babies: when to start, stewed apple and raw apple safety

Apple is one of the most familiar first foods, and it can go on the menu from around 6 months, once your baby has started solids. The NHS first solid foods guide suggests mashed or soft, cooked sticks of apple among the first foods to try.

What matters most is the form. Raw apple is crisp and hard, and pieces of it turn up on almost every list of foods that young children choke on. Cooked, stewed, puréed or finely grated, it's a safe and easy food. This guide covers why raw apple is risky, how to prepare apple at each stage, a simple stewed apple method, seeds and skin, pouches, and apple juice.

When can babies eat apple?

From around 6 months, once your baby shows the signs of being ready for solids described in starting solids.

The Australia's ASCIA guide to introducing solid foods, from Australia's allergy body, says solids usually start around 6 months and not before 4 months, that iron-rich foods should come first, and that other foods can follow in any order. Australia's Pregnancy, Birth and Baby includes puréed fruit among first foods. The NHS guide to feeding from around 6 months lists apples among fruits to try and says harder fruits need cooking to soften them. The CDC's foods and drinks for 6 to 24 month olds says babies can start foods other than breast milk or formula at about 6 months.

Why is raw apple a choking risk?

Raw apple is hard and crisp. A baby or young toddler can bite or break off a piece but can't yet chew it down, and a firm piece can lodge in the airway. New Zealand's Ministry of Health, in its advice on reducing food-related choking, describes exactly this: raw apple is difficult for young children to bite through and break down enough to swallow safely, and pieces can become stuck.

Every major source we checked names raw apple:

The CDC's choking hazards list includes pieces of hard raw fruit or vegetables, such as raw carrots or apples. The AAP's choking-prevention advice lists raw fruit chunks, such as apple pieces, and says to keep high-risk foods from children until 4 years of age or older. The Royal Children's Hospital Melbourne in Australia names pieces of apple among foods that are easily inhaled, and says children under 3 may not have a full set of teeth and can't chew properly, so any small, firm food is a choking hazard.

The skin adds to the risk. New Zealand's Ministry of Health lists apples among fruits with skin, and says fruit skins are difficult to chew and can completely seal a child's airway.

How do I prepare apple at each stage?

Around 6 months. The CDC's solids guide says to cook hard fruits, such as apples, so you can easily mash or purée them, and to mash or purée food until smooth at first. The NHS suggests soft, cooked sticks of apple about the size of your own finger, big enough for your baby to hold in their fist with a bit sticking out. Test each stick: New Zealand's Ministry of Health describes soft food as food you can easily squash between your thumb and forefinger. For very young children, the NHS guide to preparing food safely also suggests grating firm fruit, so finely grated apple stirred into cereal or yogurt works too.

8–9 months. The NHS guide for 7 to 9 months suggests more mashed, lumpier foods and a variety of finger foods, and says firmer fruit needs cooking first. Pregnancy, Birth and Baby says it's important to introduce lumpy food by 9 months, so stewed apple can be left chunkier.

12 months and beyond. The NHS 10 to 12 months guide suggests chopping fruit up or offering it as finger food. Raw apple still needs changing. New Zealand's Ministry of Health suggests grating, spiralising or slicing raw apple thinly with a mandolin or vegetable peeler for children aged 1 to 6, or cooking it soft and cutting it into strips. It suggests raw apple sticks only for 4 to 6 year olds. The NHS says to cut apples into slices rather than small chunks.

How do I make stewed apple or apple purée?

Stewed apple is quick to make, and spare portions can go in the freezer.

1. Rinse the apples under running water, as the CDC's food-poisoning advice suggests.
2. Peel, quarter and core them, cutting out every seed.
3. Chop and simmer the pieces in a little water until they collapse when pressed with a spoon. Add no sugar; the NHS suggests harder fruits like apple and pear cooked without adding sugar.
4. Mash or blend to the texture your baby is ready for, smooth at first and lumpier later.
5. Cool it right down before serving, as the NHS advises for cooked food, and refrigerate leftovers within 2 hours, as the CDC advises for cut fruit.

The AAP's starting solids page says fresh foods should be cooked with no added salt or seasoning, and that apart from mashed banana, most fruits should be cooked until soft. Stewed apple is naturally sweet, so it's handy for loosening iron-fortified cereal or swirling through plain yogurt.

Is shop-bought apple purée okay?

It can be, now and then. The NHS 7 to 9 months guide says food pouches, pots and jars can be convenient but shouldn't be relied on as an everyday food. It says not to let your baby suck from a pouch, because that can increase the risk of tooth decay, and to squeeze the food onto a spoon instead. The CDC's foods to avoid or limit says children younger than 24 months shouldn't have added sugars, so choose apple purée or apple sauce with no added sugar.

Do apple seeds and skin need to come off?

Seeds and core: yes. The NHS says to always remove hard pips or stones from fruit, and the CDC says to remove seeds and hard pits before cutting fruit into small pieces. The core is tough and fibrous too, so cut it out completely.

If your baby swallows a seed by accident, it's unlikely to matter. The US National Capital Poison Center says apple seeds contain amygdalin, which the body can turn into cyanide, but that swallowing a few apple seeds is generally fine; the concern is chewing or grinding large numbers of seeds. If you're worried, or your child seems unwell, call a poisons information center or your pediatrician's after-hours nurse line.

Skin: take it off for young babies. The NHS says removing the skin from fruit makes it easier to swallow, especially for very young children. Cooking softens the flesh, but peel can stay tough and stringy, so peel before stewing.

Is apple juice okay for babies?

Not in the first year. The AAP's statement on fruit juice says juice shouldn't be given to infants under 12 months and offers no nutritional benefit over whole fruit, which also provides fiber. The CDC says children younger than 12 months shouldn't drink any fruit juice. Pregnancy, Birth and Baby says babies shouldn't be given fruit juice or cordial, and the NHS guide to drinks and cups says babies under 12 months don't need fruit juice and that its natural sugars and acids can cause tooth decay.

There's one exception in US guidance. The AAP's constipation symptom checker suggests pear or apple juice as a remedy for constipation in babies older than 1 month. Australia's Pregnancy, Birth and Baby guide to constipation suggests prune or pear juice from 6 months instead. Talk to your doctor or pediatrician before using juice this way. Whole fruit helps too: the NHS page on constipation and bottle feeding says that once your baby is on solids, apples, pears and prunes are particularly good for constipation. See juice for babies, constipation in babies and pear for babies.

Can babies be allergic to apple?

They can, though apple isn't on ASCIA's list of the most common allergy foods in Australia: cow's milk, egg, peanut, tree nuts, wheat, soy, sesame, fish and shellfish. The Sydney Children's Hospitals Network fact sheet on fruit and vegetable allergy, from Australia, says fruit allergy can develop at any age and that the Rosaceae family, which includes apples and pears, is more likely to cause reactions. Signs include hives or welts, vomiting, tummy pain, and tingling or swelling of the mouth, lips, face or eyes.

Why might raw apple make an older child's mouth itch?

The same fact sheet lists apple among foods linked to birch pollen in pollen food syndrome. Australia's ASCIA's oral allergy syndrome FAQ, from Australia, explains that some raw fruits make the lips, mouth, tongue and throat itch, tingle or swell in people who are allergic to pollen. It says:

• it's most common in people with asthma or hay fever, and pollen allergy usually develops first
• heated, baked, cooked or canned fruit is usually tolerated, because cooking usually destroys the protein
• peeled fruit may help, because the protein is often in the skin
• it rarely causes anaphylaxis

So it's more likely in an older child with hay fever than in a baby eating stewed apple. If your child's mouth itches after raw apple, see your doctor before offering it raw again.

For babies, Australia's ASCIA says allergic reactions usually happen within minutes to two hours, and that a mild rash only around the mouth, with no other signs, may not be an allergic reaction. The method for the common allergy foods is in introducing allergens.

These steps follow the Australia's ASCIA first aid plan for anaphylaxis from Australia, which says to hold young children flat, not upright, to give the adrenaline device if in doubt, and to start CPR if your baby is unresponsive and not breathing normally.

What should I do if my baby chokes on apple?

Keep every meal set up to lower the risk. The CDC says to have your child sit up while eating, watch them at all times, and avoid eating in the car or stroller. Gagging on soft apple is common while babies learn; choking vs gagging explains how to tell the difference, and foods to avoid covers other hard foods.

These steps follow the NHS choking first-aid guide, which also says to get medical help afterwards even if the food came out, because part of it may still be there. Australia's Royal Children's Hospital Melbourne recommends that anyone caring for children does a first aid course and learns infant and child CPR, and the AAP recommends a certified CPR and first aid course.

Can my teething baby chew on apple?

Not raw. The NHS teething tips suggest healthy things to chew on, such as raw fruit and vegetables, for babies 6 months or older who are weaning, name soft fruit like melon to soothe gums, and say to always watch your baby while they eat. The NHS weaning guidance, though, says to avoid hard foods like raw apple, and new teeth can bite off a hard piece. Soft fruit, or cool stewed apple from the fridge, is the safer choice.

When should I get help?

Call 911 now if your baby:

• can't breathe, cough or cry because food is stuck, turns blue or becomes unresponsive
• has sudden swelling of the lips, tongue or throat after eating
• has difficult or noisy breathing, a wheeze or a persistent cough after eating
• becomes pale, floppy or drowsy, collapses, or has a hoarse or weak cry

The NHS urgent-help guide lists swollen lips, tongue or throat with difficulty swallowing, and difficulty breathing, among reasons to call an ambulance.

Get medical help today if your baby:

• has hives or welts beyond the mouth, or swelling of the face or eyes, and is breathing normally
• vomits after eating apple
• needed back blows or chest thrusts, even if they now seem well

Talk to your doctor or pediatrician if:

• your child's mouth itches or tingles after raw apple
• you'd like to offer apple again after any reaction
• your baby still can't manage mashed or lumpy food by around 9 months