Which of the following foods should be AVOIDED or introduced LAST when starting complementary feeding in a 6-month-old infant?

Explanation

## Foods to Avoid or Delay in Early Complementary Feeding **Key Point:** Honey should be avoided in infants under 12 months due to the risk of infant botulism caused by *Clostridium botulinum* spores. ### Why Honey Is Contraindicated 1. **Botulism Risk** - Honey can contain dormant spores of *Clostridium botulinum* - Infant's intestinal flora and gastric acid are not mature enough to prevent spore germination - Results in in vivo toxin production → flaccid paralysis, respiratory compromise 2. **Age-Related Susceptibility** - Risk is highest in infants < 12 months - Older children and adults have sufficient gastric acidity and mature flora to prevent spore germination - After 12 months, honey is safe **High-Yield:** This is a classic NEET PG trap question. Honey is often offered by caregivers for its perceived nutritional benefits, but it is explicitly contraindicated in infants < 1 year. **Mnemonic:** **H**oney = **H**azard in infants < 1 year. **Clinical Pearl:** Infant botulism presents insidiously with constipation (often the first sign), weakness, poor feeding, weak cry, and loss of facial expression. Progression can lead to descending paralysis and respiratory failure requiring mechanical ventilation. ### Recommended First Foods (in contrast) | Food | Why Safe | When to Introduce | |------|----------|-------------------| | Iron-fortified cereals | No botulism risk; easily digestible | 6 months | | Pureed vegetables | Low allergenicity; good micronutrient source | 6 months | | Banana | Easily digestible; low allergen | 6 months | | Honey | **Contains *C. botulinum* spores** | **After 12 months only** | [cite:Park 26e Ch 8; IAP Complementary Feeding Guidelines]