Introducing Baby to Solid Foods With Allergy Awareness

If I wait longer to introduce my baby to solid foods, will she be less likely to develop a food allergy?

The American Academy of Pediatrics recommends introducing babies to solid foods between 4 and 6 months of age, when babies start to show signs that they are ready for solid foods. These signs include reaching for your food when you’re eating, the ability to sit upright with only light support, head and neck control, and the loss of the tongue-thrust mechanism that pushes anything out of your baby’s mouth. Introduction of the most allergenic foods used to be delayed, but the medical and scientific research community now encourages early and regular exposure. Pediatrician Natalie Digate Muth explains, “Highly allergic foods should be introduced early, between 4 and 11 months, and repeated at least three times per week. Early introduction helps to lower the risk of peanut allergy, specifically, in particular for kids who are at high risk for developing a peanut allergy.” Delaying introduction of allergens may actually increase risk of developing food allergies.

Are some foods more likely to spur an allergic reaction than others?

Eight foods are responsible for 90 percent of food allergies: milk, wheat, eggs, soy, peanuts, tree nuts, seafood, and fish. Berries, seeds, corn, and other foods can also be problematic. Some allergies fade as children mature. Wheat, milk, and egg allergies are the most commonly left behind by growing kids, while shellfish, fish, and peanut allergies tend to be lifelong. While there is no cure for food allergies, scientists continue to study ways to lessen symptoms which helps children and adults tolerate problematic foods.

Is a food allergy different from intolerance?

A food allergy is a defensive reaction by the immune system to a specific protein in food, which can lead to respiratory or gastrointestinal problems. Being tested by a doctor or allergist is the best way to distinguish the symptoms and uncover the specific cause.

On the other hand, intolerance to a specific food is a metabolic response, which is not related to the immune system. Most often the response is to an enzyme in a food that the body cannot process. Lactose and gluten intolerances are two examples.

Does breastfeeding prevent food allergies?

“It is recommended that breastfeeding moms eat allergenic foods so that the baby will indirectly be exposed to them, making it less likely to develop an allergy later,” says Dr. Muth. Exclusive breastfeeding to age six months is encouraged whenever possible. As your baby starts to eat solid food, she'll still benefit from the nutrients and calories of breast milk for quite a while. Hold off on offering your baby cow's milk until 12 months, regardless of when you stop breastfeeding, because the infant gut cannot digest it well. (It is okay to offer your baby yogurt and cheese, and use some milk in cooking for your baby.) If you stop breastfeeding prior to your baby's first birthday, you'll need to give her formula.

Does the order in which I introduce solids affect the likelihood of an allergy surfacing?

Jill Castle, MS, RD, LDN advises starting with nutrient-dense foods that are a good source of omega-3 fatty acids, zinc, and iron, including cooked pureed meat and fish. You can also offer some of the least-allergenic foods at first, such as oatmeal, root vegetables, avocados, bananas, and sweet potatoes, to ensure that your baby is getting a wide variety of nutrients, textures, and flavors. Soon after, offer the top allergens including egg and peanut. Research suggests that early, regular exposure to these foods may reduce the risk of developing allergies to them. Be sure that the food is presented in developmentally appropriate forms: pureed, blended in with other foods, or as a safe finger food. Don’t serve whole nuts or gobs of nut butter, for example, which are a choking hazard for babies. “Be observant, responsive, and connected,” advises Castle, “and you will be able to gauge readiness for the next step.”

Should I stop breastfeeding or formula-feeding when I introduce my baby to solids?

No. Breast milk and formula have the essential nutrients and caloric requirements a baby needs for his first 12 months. They are much more nutritionally and calorically dense than any amount of solid food your baby will initially be able to ingest. Solids are a supplement to breast milk or formula. As your baby adapts, you will slowly decrease the amount of breast milk or formula in his meals and increase solid foods.

I did not eliminate any foods from my own diet while breastfeeding, and my baby has not shown any allergy symptoms. Doesn't that mean he isn't allergic to any solid foods?

Not necessarily. Some food allergies do not surface until the child ingests the whole food directly. You might have eaten peanut butter sandwiches throughout pregnancy and breastfeeding, only to discover your baby has a peanut allergy when he starts eating them. Despite the uncertainty, it's unnecessary for moms to eliminate allergenic foods from their own diets in anticipation of an allergy, unless determined necessary by a doctor. If your baby shows symptoms of a food allergy when you introduce solids, eliminate that food from your own diet until you have confirmed the source of the symptoms.

Does family history impact the likelihood of our baby having a food allergy?

Children of parents with allergies are 70 percent more likely to have a food allergy. Parents with asthma, eczema, or other allergic diseases are also more likely to have children with allergies. That said, many children with food allergies have no genetic disposition to them. If you, your spouse, or your baby's sibling has an allergy, talk to your doctor about the best way to introduce solids in order to prevent or anticipate the onset of food allergies. New research and guidelines suggest that offering allergenic food earlier to babies who are at higher risk from family history may help prevent them from developing food allergies.

Should I introduce high-allergen foods to my child while at the doctor's office, in case she has a bad reaction?

You wouldn't be the first to do it that way! Introducing foods to babies is anxiety-inducing indeed, and many parents have approached exposing children to high-risk foods this way. If your family history points to the likelihood of an allergy, your doctor might suggest a Food Challenge, an allergy test during which a child is given a high-risk food to eat in a doctor's office in order to monitor any reaction. Otherwise, slow introduction and awareness should be sufficient to safely expose your child to new foods at home.

My baby is spitting up more after eating solids. Does this mean she is allergic to something she's eating?

Babies usually spit up because their esophagus muscles aren't strong enough yet to close completely after swallowing. This improves as their digestive systems develop. Spit-up is quite common and unlikely to be a symptom of an allergy. If your baby is upset, obviously uncomfortable, or exhibiting other signs of distress, make careful notes about what foods might have triggered her reaction and talk to your doctor about the possibility of an intolerance or allergy.

What are the symptoms of an allergic reaction to food?

Allergy symptoms can range from mild to severe. Milder symptoms include eczema and gastrointestinal discomfort.

The most severe reaction is an anaphylactic reaction, which triggers a release of histamine and other chemicals that could lead to life-threatening symptoms. Some signs include hives, swelling of mouth or lips, shortness of breath, wheezing, or intense vomiting or diarrhea. It can also include impaired breathing, weak pulse, and unconsciousness. This requires immediate medical attention.

Food Allergy Research & Education (FARE) is an excellent source for information on identifying and coping with allergies.

Does honey cause allergic reactions in babies?

While honey is not classified as an allergen, it should not be given to babies under 12 months old because it might contain clostridium botulinum, the bacterium that causes botulism, a serious illness that can lead to long-term side effects or death. The underdeveloped digestive systems of babies younger than 12 months are unable to attack botulism toxins, leaving them susceptible to illness.

What should I do if I think my baby might be having a reaction to the food she ate?

If your baby is exhibiting severe symptoms such as respiratory distress, intense diarrhea, vomiting, or hives, get medical help immediately. An over-the-counter children's antihistamine might help calm milder symptoms until you can talk with your baby's physician. Just be sure to follow proper dosing recommendation for the antihistamine and never give it to a baby under 3 months old without consulting your pediatrician first. It often takes several hours for an allergic reaction to food to surface, so keep notes about everything your baby is eating. You and your doctor or allergist can evaluate the food history and any known genetic ties to come to a conclusion about possible triggers.