the new thinking on allergens
breaking down new guidelines with dr. alan greene
Many parents may still be surprised to hear that introducing a diverse array of food in a baby’s diet early on is not only safe, but may help prevent certain allergies. I always get the question, “But what about highly allergic foods such as eggs, peanuts, milk, or fish?” Prior to 2008, the guidelines were that in allergic families, whole cow milk should be delayed until 12 months of age, eggs until two years, and nuts, peanuts, and fish until age three. The new American Academy of Pediatric (AAP) guidelines state that there is no convincing evidence that delaying these foods beyond six months prevents allergies. It’s always safe to consult your doctor first, but I firmly recommend that, as long as they are healthy, you do not delay foods in an effort to prevent allergies in your children. Early on, babies’ immune systems are trying to learn what is normal and what to react against later. There is no good evidence that delaying any food beyond six months decreases allergy risk—and there is some evidence that the opposite may be true. I do recommend avoiding highly allergic foods when kids are on antibiotics or have a tummy illness, if there is a strong history of an allergy in your family, or if your baby is already showing signs of an allergic reaction. And do avoid foods that might cause choking or carry infections (such as raw or undercooked fish, meat, or eggs). There is also no need to wait three to five days between foods. Introducing new foods rapidly, and feeding mixtures of foods, leads to more adventurous, happy eaters. As long as babies are tolerating the foods well, full steam ahead! This doesn’t increase allergy risk. It does make it a little more work to detect the culprit if a child develops a food allergy—but over 90% of children never will.¹ ² If a child shows signs of an allergic reaction, removing the possible culprits from the diet is wise—these guidelines are about preventing, not treating allergies. I am a fan of introducing a wide variety of healthy foods to babies between six and 12 months old, but I prefer organic foods for babies in the first year when possible.
1Kristen D. Jackson, M.P.H.; LaJeana D. Howie, M.P.H., C.H.E.S.; Lara J. Akinbami, M.D.: NCHS Data Brief, No. 121, May 2013, Trends in Allergic Conditions Among Children: United States, 1997–2011
2Ruchi S. Gupta, Elizabeth E. Springston, Manoj R. Warrier, Bridget Smith, Rajesh Kumar, Jacqueline Pongracic and Jane L. Holl: The Prevalence, Severity, and Distribution of Childhood Food Allergy in the United States; Pediatrics; originally published online June 20, 2011; DOI: 10.1542/peds.2011-0204