Offering your infant her first spoonful of solid food is an exciting developmental milestone. While you may not be able to control whether the food will end up in baby’s mouth or splattered on the floor, one thing that you can do is look for expert advice to navigate the confusion surrounding first foods. One particular topic that has become the center of many nutrition-related myths: introducing your infant to highly-allergenic foods.
The Guidelines for the Diagnosis and Management of Food Allergy in the United States, sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), were published in 2010, but they were recently updated in 2017 based on new recommendations for best practices. In order to keep your infant safe (and yourself sane), you will want to stay up-to-date with the most current recommendations for introducing highly-allergenic foods. Let’s see how some common food allergen myths stack up to the current advice.
Myth: You should avoid highly-allergenic foods while breastfeeding
In the past, women were told that they could further reduce their infant’s risk of developing allergies by avoiding certain foods while breastfeeding. Many breastfeeding women began excluding the most highly-allergenic foods from their diet, which are products made with cow’s milk protein, soy, wheat, egg, peanuts and fish.
Today, expert sources like the American Academy of Pediatrics do not recommend avoiding highly-allergenic foods during pregnancy or lactation. They agree that there is no clear evidence to support the theory that avoiding highly-allergenic foods during these times will actually reduce your infant’s chance of developing allergies. And by restricting specific foods from your diet, you could put yourself at risk for vitamin and mineral deficiencies. If you do choose to avoid any specific foods during pregnancy or lactation, be sure to consult a doctor and registered dietitian for the proper nutrition advice.
Myth: It is best to wait until your baby’s first birthday to introduce highly-allergenic foods
Similar to the previous myth, the idea that you should wait until after your baby’s first birthday to introduce highly-allergenic foods is outdated. Emerging medical evidence has found that there is no significant benefit to delaying exposure to highly-allergenic foods past 4 to 6 months of age. In fact, choosing to withhold the introduction of these foods may even increase your infant’s risk of developing an allergy.
It’s okay to start adding age and stage-appropriate, highly-allergenic foods into your infant’s diet once other solid foods have been well-accepted. Examples of appropriate foods include dairy products like cheese, yogurt and cow’s milk protein formula. Regardless of concerns for allergies, infants should never be fed whole cow’s milk before 12 months of age because they can’t digest it well.
More examples of highly-allergenic foods that are okay to serve to infants before their first birthday include eggs, soy, wheat, fish and peanuts/tree nuts in the form of butter or paste (serving pieces of nuts is not appropriate due to choking hazards). If no reaction occurs within minutes to hours of introducing these foods, then you can gradually increase the amount you give your infant every few days.
Myth: Solid foods must be introduced in a specific order
It can be stressful to decide which solid foods to offer your infant first. The good news is that there is not a steadfast recommendation for the correct order of foods to try as the long as the food’s texture is age and stage-appropriate for your infant.
Most infants are ready to try their first taste of solid foods between 4 to 6 months of age. Your infant may be developmentally ready to start solid foods when he or she can easily sit up and control the motion of their head and neck.
Start with single -ingredient infant foods. Examples include:
- Unsweetened, whole milk yogurt
- Iron-rich baby cereals or pureed meats
- Strained or pureed vegetables like squash, carrots or sweet potatoes
- Strained or pureed fruits like apples, pears or bananas
Some healthcare providers may recommend that you serve vegetables before fruits, but there is no strong evidence to suggest that your baby will grow to dislike vegetables if fruit is introduced first. As your baby advances through the age and stage-appropriate food textures, remember that you can also introduce highly-allergenic foods such as whole milk yogurt or cooked eggs.
Experts recommended that you continue to introduce one new solid food every three to five days. Try to avoid mixing any foods together until each food in the combination has been well-tolerated by itself. By gradually introducing new foods independently, it will give you a chance to identify and remove any foods that may cause your baby to have an allergic reaction.
Tips for confidently introducing highly-allergenic foods
Many parents feel nervous before offering highly-allergenic solid foods for the first time. It can be helpful to try first bites of these foods in a safe home environment, rather than in a public place like a day care facility or restaurant.
Extra precautions should be taken when introducing solid foods to infants that have an increased risk for developing allergies. A baby may be considered at-risk if they meet any of the following criteria:
- Have a history of allergic reactions or a known food allergy
- Have persistent eczema despite treatment
- Have a parent or sibling with a known food allergy
If you’re concerned that your baby is at-risk for developing allergies, contact your pediatrician before introducing them to any highly-allergenic foods.
For more information on starting solid foods, check out evidenced-based resources from the International Food Information Council Foundation and the National Association of Pediatric Nurse Practitioners.
This post was written by Alison Webster, Dietetic Intern at Virginia Tech.
Published March 2018