October 9, 2019
Introducing Highly Allergenic Foods to Babies
If you are unclear on current guidelines for introducing allergenic foods to babies, you’re not alone! The American Academy of Pediatrics (AAP) has shifted its recommendations over the years.
Parents who welcomed their bundles of joy in the early 2000s until about 2015 most likely heard that delayed introduction of allergenic foods would help prevent food allergies. That meant no dairy until one year old, no eggs until two years old, and no nuts/fish until three years old. While technically, these initial AAP guidelines were only meant for a subset of children at high risk for food allergies, many parents took these suggestions to heart as the standard for everyone.
The AAP retracted these delayed introduction guidelines in 2008 due to insufficient evidence that this plan actually reduced the incidence of food allergies. However, they did not replace them with new recommendations, leaving parents and doctors without a new approach to follow.
Clarity began to emerge in 2015, when the AAP published a statement endorsing peanut introduction at four to 11 months old. The organization cited mounting evidence that early peanut introduction could decrease the risk of peanut allergies. Infants with severe eczema or an egg allergy have a higher likelihood of developing a peanut allergy and thus were advised to work with a doctor to test for the allergy (if indicated) and safely introduce peanuts under medical supervision. This higher risk group was found to be 70-80% less likely to develop a peanut allergy with early introduction and frequent consumption of peanut products.
In March 2019, the AAP introduced a detailed set of guidelines on introducing allergenic foods (milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soybeans) to children. Based on extensive research, the organization stated that the risk of developing food allergies decreases when allergenic foods are introduced and frequently fed to babies as young as four to six months old.
The peanut allergy high risk group including infants with severe eczema, an egg allergy, or a close relative with food allergies should introduce peanut products between four and six months old. This drastically decreases the risk of developing a peanut allergy. An allergist can explain whether or not skin testing is advised, as well as craft a plan to introduce peanuts under medical supervision if desired. For low-risk infants, the AAP recommends peanut consumption within the first year.
While peanut introduction at a young age is beneficial, never give a baby whole/chopped peanuts or chunky peanut butter. These are choking hazards (whole peanuts are considered a hazard until the age of four or five years old). You can mix a small amount of creamy peanut butter with formula, breastmilk, water, baby cereal, or yogurt. Powdered peanut butter can also be mixed with other foods that are already tolerated. There are baby-friendly snacks that contain peanuts. These work well for infants that do not need everything pureed.
Breastfeeding alone has not been proven to prevent food allergy. The AAP’s guidelines state that pregnant and breastfeeding mothers should not eliminate allergenic foods from their diet. There is no evidence to support the idea that the mother’s diet has any impact on food allergy incidence for her baby.
While breastfeeding maynot prevent food allergies, exclusive breastfeeding for three to four months might make a child less likely to develop eczema before two years of age. Breastfeeding beyond four months (regardless of if it’s exclusive) protects a child against wheezing for two years and can also reduce the incidence of asthma.
Babies with a cow’s milk protein allergy or intolerance typically drink extensively hydrolyzed formula, which minimizes allergic reactions due to how the milk protein is broken down. No studies have shown that the risk of food allergies decreases on this formula, so the AAP clarified that infants on hydrolyzed formula need to eat allergenic foods as early and often as the other groups.
If you find yourself confused or uncertain about your child’s risk of developing a food allergy, don’t hesitate to contact an allergist. They will provide expert guidance and ensure that you feel confident in the allergenic food introduction process.