Food Allergy Guidelines for Kids: An Update

The thinking on how we expose our kids to new foods has recently changed

New Food Allergy Guidelines

We all want what’s best for our kids, including preventing any harm or discomfort. And that includes food allergies. Who wouldn’t want to prevent scary food allergies? But the thinking on how we expose our kids to new foods has recently changed. 

The old idea of avoiding certain foods to prevent allergies has been replaced with new research that has shown small exposures early on can actually prevent food allergies.

 So let’s discuss what your child should be eating to prevent food allergies.

Pregnancy

We start at the very beginning, even before birth. Research shows no need for pregnant women to limit highly allergenic foods in their diets such as c​ow’s milk protein, soy, eggs, wheat, peanuts/tree nuts and fish/shellfish. It has also been found that there aren’t any links between avoiding these foods during pregnancy and the incidence of food allergies in the child.

Newborns: Breastfeeding vs. Formula

After a baby is born, breastfeeding is thought to be the best source of nutrition to prevent allergies. It’s recommended to exclusively breastfeed for the first four to six months. However, if breastfeeding is not an option, a hydrolyzed formula may be an alternative. 

Four to Six Months: Introducing Solids

Previous recommendations warned against introducing foods such as peanuts, eggs, soy, fish, cheese, and yogurt.

However, new recommendations endorse otherwise. When a baby is ready to start eating solid foods (when they can sit with support and have good head and neck control), it’s wise to introduce new foods one at a time. Furthermore, only single ingredient foods, such as sweet potatoes or infant rice cereal, should be given to a baby, waiting three to five days between introducing more new foods, like the following:

  • Peanuts. The American Academy of Pediatrics recommends that “peanut-containing products” be introduced between four and 11 months of age to prevent a peanut allergy. This doesn’t mean handing our 4-month-old a spoonful of peanut butter, rather mixing in a very small amount of peanut powder (such as PB2 powdered peanut butter) into another food that has already found to be acceptable. Solid nuts should still be avoided because the risk of choking.
  • Cow’s Milk. Though it is still recommended to wait to introduce cow’s milk as a liquid until after 12 months, cow’s milk can be introduced in the form of yogurt or cheese. Start in small quantities and increase as your child grows.
  • Eggs. There is no need to wait until after 12 months to introduce eggs. Eggs are a great source of protein and contain many other essential vitamins. Again, start in small quantities and slowly increase as your baby develops.

Introducing Foods One at a Time

It can be tricky to figure out how to introduce new foods safely, so here’s a quick timeline to help you out:

  • Day 1: Feed half to one teaspoon of the new food. Watch for any reactions for four hours. Reactions might include colicky pain, vomiting or frequent spitting up, diarrhea, bloating, or frothy stool. If no reactions occur, give a slightly larger serving of the new food four hours later and continue to watch for reactions. Again, if no reactions occur, give a one to two teaspoon serving of the food to your baby. (In total, you will have given your baby the new food three times during the first day.) Note: Anaphylaxis is rare in infants. Symptoms usually appear within minutes of the exposure and can be life-threatening. Immediate medical attention is necessary.
  • Day 2: Monitor for delayed reactions such as skin irritation like eczema or hives, disturbed sleep patterns, irritability, and other allergy symptoms.
  • Day 3: If no delayed reactions are noticed, more of the same food can be given. Use slightly larger quantities than were given the first day. Use the same feeding timing, using a  four-hour window between three feedings. During the last exposure on this day, your baby can eat as much of the new food as he or she wants. (Again, in total, you will have given your baby the new food three times during the day.)
  • Day 4: This is the second monitoring day. None of the new food is to be eaten. Watch for any signs or symptoms of discomfort or allergic reaction.

If no symptoms are noticed, it is safe to assume that your child is not allergic to this food. If there are any reactions at any stage, stop feeding the food to your child immediately and then wait 24 to 48 hours before introducing any other new foods.

High Risk for Food Allergies

Some individuals are at higher risk than others of developing food allergies. Because food allergies have a genetic component, children with a sibling or a parent who have food allergies are at higher risk than others of developing them. With these children, it is thought that allergenic foods should still be introduced between four and 11 months, but with higher vigilance and more care. These foods should be introduced at home, not in a daycare setting.

Other precautions should also be taken. For instance, when introducing new foods, it is helpful to check for reactions on the skin before feeding the food to the child. First, start by brushing it on the outside of baby’s cheek and waiting 20 minutes to check for redness.This may be wise even before allowing your baby to eat the food. Next, try brushing it on the outer border of your baby’s lip (not in the mouth). Observe for signs of redness or irritation for another 20 minutes before feeding the baby the food.

If your child is at higher risk for food allergies, it is wise to consult your pediatrician or allergist before introducing any solid foods.

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