Early and Often: New Recommendations To Prevent Food Allergies In Babies

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Delicious first spoonfuls

As a pediatrician, I know both the boundless excitement, and the simultaneous worry, that comes when starting to feed a baby solids. It’s exciting to transition from a liquid diet to a solid one, but the glory in feeding and nourishing our babies often comes coupled with a fear of the unknown about how it will go, and a specific worry about food allergies. New data can help. Parenthood is a constant tussle between moments of joy as our children grow, and moments of fear that we’ll do something wrong or unintended. Feeding our babies is no exception. When it comes to feeding:

  • “When should I start to give my baby solids?”
  • “Which foods should I feed them first?
  • “When should I introduce peanuts or egg or shrimp and other potential allergic foods?”

When starting solids, the worry around allergies often causes the most anxiety. In fact the numbers can invoke a sense of unease as rates of some food allergies have been doubling every 10 years. The rise in food allergies is an ultimate rise in suffering, but I’m encouraged that new research can help us reverse the trend. Latest guidelines and research can help us get ahead of food allergies by introducing foods early and often. Research, detailed below, has shown that the old advice around waiting on certain foods like egg or peanut may in fact increase the risk of an allergy developing, not deter it. For children who have not shown signs of an allergy, and do not have severe eczema (skin rash often associated with allergies), I always tell the parents in my practice that “early and often” is the science-based new golden rule when starting a variety of new foods around 4 to 6 months of age.

When To Start? Start at around 4 to 6 months of age after your baby shows interest in food, can keep her head up and can sit up for a feeding. Never force food into your baby’s lips but rather offer foods you think they’ll love when they open their mouth for it at meal time.

Which Foods? Which Foods? The simple answer is any food! There is no perfect first food so choose something you love and introduce it, like avocado or peach or banana. Then add new foods without haste. Keep at it and keep re-presenting foods to babies each day; over time most babies will eat most of what you offer.

When To Introduce Potential Allergens? The last few years have been productive in our understanding of better ways to reduce risks for food allergies. We’ve seen a shift in the way we look at food allergies, with physician groups and health organizations encouraging the importance of early, consistent inclusion of potential allergens for infants and toddlers. Going back to 2013, The American Academy of Allergy, Asthma & Immunology recommended that babies begin eating foods from all commonly allergenic food categories around 4 to 6 months of age, and the science and recent studies have only continued to support this finding. Perhaps most notable are two landmark studies demonstrating the importance of allergen inclusion:

In 2015, the Learning Early About Peanut (LEAP) Study published in the New England Journal of Medicine showed peanut inclusion in the diet reduced the risk of an allergy by 80% if fed early and consistently for the first 5 years of life.

In 2016, the Enquiring About Tolerance (EAT) Study published in the New England Journal of Medicine showed introducing a diverse set of potential allergens (wheat, dairy, egg, peanut, fish and sesame) in infants’ diets was safe. The risk of any food allergy was reduced by two-thirds for infants consistently fed these allergens.

The one point in particular I’d like to reinforce is the incorporation of foods from all commonly allergenic food categories. We want babies to eat lots of diverse foods every single day!

With the recent surge of peanut introduction products hitting the market and support coming from FDA Commissioner Scott Gottlieb’s recent statement announcing a qualified health claim for peanut-containing products, most news reports and conversations have focused on peanut allergies and how to prevent them. I know first-hand how pervasive peanut allergy can be for my patients and I am respectful of what parents who have kids with a peanut allergy go through. I’ve learned so much from families who live in a world where they are nervous about food being dangerous. However, it’s also imperative to remember the importance of dietary diversity, because, 77 percent of people with a food allergy are allergic to something other than peanuts. We want to support habits for babies who can eat all foods.

As a parent, I know how difficult dietary diversity can be in real life. Incorporating what’s commonly referred to as the “Big 8” allergens (peanuts, tree nuts, dairy, soy, wheat, egg, fish, shellfish) into an infant’s diet regularly takes a great deal of patience and coordination, but it’s certainly worthwhile. Get your baby lots of foods, every single day. Start at 4 to 6 months introducing one food at a time but there’s no reason to go slowly. Consider foods with nuts and peanuts, egg, and fish and shellfish. There are more and more options on the market to make this easy for families. Remember, data shows early inclusion of multiple different foods help set your child up for the ability to eat everything.

I’m excited and hopeful about the science we have that shows early inclusion of multiple foods early in life may change the game in growing a happy immune system ready for more diverse foods. And as a pediatrician, but also a mom, I believe I have an obligation to give parents a simple way to get their little ones accustomed to foods, before they become allergens. We get to wed our own joy for food with our feeding with our babies, right from the beginning. This is where we all win.

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