In the beginning, babies “eat” only formula and/or breastmilk. At approximately four months, usually rice cereal is started. This is the blandest least irritating food. Some parents will introduce rice cereal in the bottle earlier to reduce nighttime feedings with mixed results. Eggs and nuts are among the foods with the most chance to cause an allergic reaction.
Turning Conventional Wisdom on its Head
In the past, pediatricians advised parents to delay foods that have a high likelihood of producing an allergic reaction such as eggs and nuts. Another food commonly associated with allergic reactions is milk and the introduction into the baby’s diet was usually not started until the child was one-year-old. Eggs were approved for children 24-months-old, with nuts and fish introduced at 36 months.
In 2008, the American Academy of Pediatrics issued a statement saying there is no compelling reason to delay the introduction of known allergens in babies’ diets as study data does not support the delay, showing no increase in reactions with children whose diet includes milk, egg or nuts at an earlier age. Unfortunately, the announcement did not provide new age guidelines so it was anybody’s guess as to when to introduce these foods.
The Body of Evidence
The thinking behind the AAP’s announcement is that adding potential allergens early on may actually prevent allergies not protect from them, but the results of this early introduction had very little support and lacked studies at the time. Then as anecdotal evidence began to trickle in that supported this position some pediatricians began to revise their own guidelines; others were not yet convinced due to the lack of randomized controlled trials.
Then in January of 2013 the American Academy of Asthma, Allergy and Immunology provided new guidelines for introducing potential allergens. The new guidelines, like the previous recommendations, provided no studies but based the new guidelines on observational research and suggested the delay in introducing known allergens could actually cause allergies, yet earlier introduction seem to prevent allergic reactions and eczema.
Out With the Old, In with the New
The new guidelines radically move up the introduction of cow’s milk, nuts, and eggs to just 4 months, the same time frame as introducing other solids. Recommendations are to keep to the normal schedule of giving solids beginning with rice cereal, oatmeal, bananas, carrots and other non-allergenic foods, adding another food every three to five days to pinpoint any reaction.
Once these foods are consistently tolerated begin to add cow’s milk and other potential allergens every three to five days, preferably at home in a controlled atmosphere rather than in daycare. Interestingly, mom’s abstinence from these foods while pregnant or lactating did not make any difference between baby’s allergies. Babies born into families with established allergies can be more susceptible to the same so your pediatrician may order infant allergy testing. Another approach, if your pediatrician agrees, is to introduce, in small doses, foods that parents and siblings may be allergic to.
Early introduction of these foods can possibly provide a tolerance, thus heading off dangerous allergies. Always consult your pediatrician before proceeding.