Guidelines for Preventing Food Allergies in Children
Your baby is six months old. You've introduced her to solid foods, and she's healthy and happy, sitting up, and about to start crawling. Should you feed her a little scrambled egg? A few years ago the answer would have been no. But today, the answer is go ahead.
The best way to prevent food allergies, according to a new report by the American Academy of Allergy, Asthma, and Immunology (AAAAI), is to expose babies to more foods early, rather than delaying them. The recommendations, based on several studies and expert opinions, are a complete reversal of the guidelines of a decade ago. Here’s what parents need to know.
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What Are Food Allergies?
No one understands why, but food allergies in children are an increasing occurrence. Some theories: children are exposed to allergens at a later time, they come across less bacteria in everyday life, and parents have more awareness. The foods that cause 90 percent of allergic reactions in the United States are milk, eggs, peanuts, tree nuts, shellfish, fish, soy, and wheat.
“A food allergy occurs when the body responds to proteins in foods that it mistakenly thinks are harmful,” says Katie Marks-Cogan, M.D., co-founder and Chief Allergist of Ready, Set, Food. Whether or not a baby will develop food allergies is partly determined by genes, but other dietary and lifestyle factors may also come into play. Babies with eczema, for example, have a higher likelihood of developing food allergies, says Dr. Marks-Cogan.
Why Did the Food Allergy Guidelines Change?
The American Academy of Pediatrics published guidelines in 2000 recommending that infants not consume milk until they were 1 year old, eggs until age 2, and peanuts, tree nuts, fish, or shellfish until their third birthdays. There was no evidence that delaying those foods prevented eczema and food allergies, so in 2008 those guidelines were changed.
But it was unclear when and how to begin giving those foods to young children. As a result, many parents were confused about how to protect their children and remained cautious. Mothers-to-be cut certain foods out of their diets and left them out as they began nursing. But this prevented kids from getting much-needed nutrients, which is partly why organizations have released new guidelines in recent years.
What Are the New Food Allergy Guidelines?
According to the new guidelines, basic foods like rice or oat cereal, fruits, and vegetables should be introduced when babies are between four and six months of age. Parents can gradually introduce babies to allergenic foods soon afterwards. Why? “Avoidance of food allergens early on in infancy when the immune system is developing can play a role in forming allergies,” explains Dr. Marks-Cogan. In other words, introducing foods early can actually prevent food allergy in infants and children.
Two studies found that there was a higher rate of wheat allergy in 5-year-olds who had not been fed wheat until after they were 6 months old. Another found that delaying wheat in the diet until the age of 6 months did not protect against wheat allergy.
Infants who ate eggs at 4 to 6 months appeared to have a lower risk of egg allergy than infants who first ate eggs later in life. And according to yet another study, children whose parents avoided feeding them peanut butter had a ten-fold higher rate of peanut allergy than those whose parents offered it.
Are These Guidelines Safe?
“We know that feeding infants allergenic foods is inherently safe,” assures Dr. Marks-Cogan. “Allergic reactions are milder in children than in adults. That's why we believe that less than 1 year of age is the safest time to be introducing allergenic foods.” That said, you can still follow these safety measures when starting solids:
- Start solids around 4 to 6 months, depending on your baby’s readiness. Introduce new foods one at a time, three to five days apart, to watch for allergic reactions. Symptoms include itchy eyes or mouth, swelling of the tongue and throat, hives, vomiting, diarrhea, abdominal cramps, difficulty breathing, and in extreme cases, anaphylaxis.
- The AAAAI recommends that allergenic foods like eggs and cow's milk be given for the first time at home, rather than at day care or in a restaurant. They can be introduced after an infant has successfully tolerated a few of the basic complementary foods.
- Peanuts and peanut butter are choking hazards in infants and young children, so rely on peanut butter mixed with warm water or purees instead. Also, a child who has a sibling with peanut allergy does not necessarily need to be tested before eating peanuts because their risk is only slightly higher than the general population.
- Follow your doctor's advice for starting solids if your little one was diagnosed with asthma, eczema, or a food allergy.
Video courtesy of National Jewish Health
Additional reporting by Nicole Harris.