What Are the Potential Benefits and Risks of Premasticated Foods?

Patient Presentation
A 3-month-old female came to clinic to recheck her weight. She had been seen at 2.5 months and had a weight at the 3rd percentile, length at 15% and head circumference at the 25%. Because of a recent formula shortage her mother had been feeding her almond milk for the past month, which she said she liked more than formula. She also had been prechewing a variety of foods such as macaroni and cheese, chicken, pizza, and some different fruits which she said she ate well without choking. She also said she gave her some of whatever she was eating. She denied any emesis, diarrhea, or rashes. The past medical history showed a term infant born without complications at the 25% for growth parameters. The parents were both of average size and weight.

The pertinent physical exam showed an interactive female with a normal examination but was small without a lot of subcutaneous fat.

The diagnosis of a healthy but small infant with concern for inadequate nutrition was made. The mother was counseled that almond milk did not provide all the necessary nutrition for the infant and help was given to obtain formula. She also was counseled about introduction of complementary foods and the choking hazard risks, dental caries and other potential problems. The patient’s clinical course at followup the following month, the mother had switched her to formula but was still giving her premasticated foods. The infant’s weight had increased to the 5th percentile, with length and head circumference at the 25%.

Premastication is the prechewing of foods or medicines by another person before feeding to an infant. It is also used to pretaste or temperature test foods. It was a common practice for millennia, especially before modern food technology, as a way to transition an infant from a solely liquid based diet to a mixed diet mainly of solid food. Rates of premastication vary, with less developed countries having an increased incidence/prevalence (up to 50%) but it is not uncommon in developed countries (in the US 14% is reported).

Saliva is also used to clean other people, treat cuts/itches or insect bites as well. Placement of an avulsed tooth in the patient’s or another person’s mouth is also one of the preferred ways to transport avulsed teeth before treatment.

Learning Point
Premastication has potential benefits and risks which include:

  • Potential benefits
    • Makes a wider variety of foods available and more affordable
    • May help with immunotolerance and immunosensitization potentially decreasing allergy
    • Can be an important cultural practice
    • Saliva
      • Has bactericidal effects which could be transferred to infant
      • Has digestive enzymes to help break down food
    • Protective effect against
      • Respiratory syncytial virus
  • Potential risks for
    • Choking hazard
    • Group A Streptococcus
    • Streptococcus mutans and dental caries
    • Helicobacter pylori
    • Cytomegalovirus
    • Epstein-Barr virus
    • Hepatitis B
    • Human herpes virus 8
    • Human immunodeficiency virus (HIV) – appears to need blood exposure not just saliva

Questions for Further Discussion
1. How common is premastication in your practice?
2. What anticipatory guidance do you offer for infants with first teeth?
3. When are complimentary foods usually introduced and how do you know if the infant is ready for them?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: Growth Disorders and Child Nutrition.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Centers for Disease Control and Prevention (CDC). Premastication of food by caregivers of HIV-exposed children–nine U.S. sites, 2009-2010. MMWR Morb Mortal Wkly Rep. 2011;60(9):273-275.

Maritz ER, Kidd M, Cotton MF. Premasticating food for weaning African infants: a possible vehicle for transmission of HIV. Pediatrics. 2011;128(3):e579-590. doi:10.1542/peds.2010-3109

Pelto GH, Zhang Y, Habicht JP. Premastication: the second arm of infant and young child feeding for health and survival? Matern Child Nutr. 2010;6(1):4-18. doi:10.1111/j.1740-8709.2009.00200.x

Zhao A, Zheng W, Xue Y, et al. Prevalence of premastication among children aged 6-36 months and its association with health: A cross-sectional study in eight cities of China. Matern Child Nutr. 2018;14(1). doi:10.1111/mcn.12448

Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa