New Recommendations for Introducing Complementary Foods for Prevention of Allergies in Children

As a mom of a baby boy who recently started complementary foods, aka: “solids,” these new findings are really exciting! Released in January 2013, the recommendations were written after finding that delayed introduction of solid foods, including the top allergenic foods, as previously recommended (in 2000), did not lead to fewer food allergies among children at risk for developing allergies based on family history. In fact, over the past decade, the incidence and prevalence of food allergy and allergic diseases in general have increased substantially, leading to the re-evaluation of the 2000 recommendations.

Food allergies affect mostly young children, and about 90% of these allergies are caused by 8 foods: cow's milk, eggs, soy, peanuts, tree nuts, wheat, fish, and shellfish. With the exception of peanut allergy, the majority of children outgrow their food allergies.

The Nuts & Bolts of Introducing Complementary Foods (aka: “Solids”) per the 2013 Recommendations

  • The AAP prefers moms exclusively breastfeeding until baby is 6 months old. There are also a couple developmental milestones your baby should achieve before introducing any complementary foods. Baby should be able to sit upright with support and have sufficient head and neck control.
  • In an unselected population of children, feeding solids before 4 months old is associated with a higher incidence of atopic dermatitis, which was also detected 10 years later.
  • No current evidence suggests delaying the introduction of solid foods beyond 6 months of age will prevent allergic disease.
  • In fact, interestingly enough, delaying the introduction of solid foods, especially the highly allergenic foods, may increase the risk of food allergy or eczema.

General Advice for Introducing New Foods to All Children

  • Most pediatric guidelines suggest first introducing single-ingredient foods between 4 and 6 months of age, at a rate not faster than one new food every 3 to 5 days.
  • Complementary foods in the United States are typically rice or oat cereal, yellow/orange vegetable (ie: sweet potatoe, squash, and carrots), fruits (ie: apples, pears, bananas), green vegetables, and then age-appropriate vegetables with meats.
  • It is common for acidic fruits (ie: berries, tomatoes, citrus fruits, and vegetables) to cause, on contact with the skin, a localized skin reaction or rash. However, these do not usually result in a systemic reaction so delayed introduction of such foods is not recommended.
  • The committee doesn't recommend introducing one of the highly allergenic foods as one of the first complementary foods. Once a few typical complementary foods mentioned above are tolerated, highly allergenic foods may be introduced.
  • Offering whole cow's milk as the infant's main drink should be avoided until 1 year old for reasons unrelated to allergic disease, but rather increased renal solute load, and low iron content.
  • It is ok to introduce other cow's milk-based products, such as cheese and yogurt before age 1 year.
  • Whole peanuts and tree nuts, but not peanut/tree nut butters, carry aspiration risk and should be avoided until your baby's primary care physician feels they are safe.

How to Introduce Highly Allergenic Foods

  • Give the initial taste of one of these foods at home, rather than at day care or at a restaurant.
  • For some foods, such as peanuts, most reactions occur in response to what is believed to be the initial ingestion.
  • If there is no apparent reaction, the food can be introduced in gradually increasing amounts.
  • Introduction of other new foods should proceed at a rate of one new food every 3 to 5 days if no reactions occur.

New Recommendations for Eating Allergic Foods During Pregnancy

While pregnant, I heard varying information about whether or not to eat allergenic foods. The thought was, if I ate a lot of peanut butter, my baby would have an increased risk of having a peanut allergy. With the new recommendations, we know this is not true. Avoidance diets during pregnancy and lactation are not recommended at this time, but more research is necessary for peanuts.

Note: These recommendations come from a collaboration between the American Academy of Pediatrics (AAP), the joint guidelines of the European Society for Pediatric Allergology and Clinical Immunology, and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

In Health and Happiness,

Kelly Harrington, MS, RDN

Registered Dietitian Nutritionist for Healthy Goods

For more information, please visit: Fleischer, DM et al. Primary Prevention of Allergenic Disease Through Nutritional Interventions. J of Allergy and Clinical Immunology: In Practice. Vol. 1, Issue 1: 29-36, Jan. 2013.


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