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Sharing new foods with your baby is an exciting milestone. Unfortunately, amongst the fun of watching your child experience new tastes remain questions and fears about food allergies. Recommendations of when to introduce certain foods seem to change often, and for many parents, it can be confusing to know what is best for your child at each age.
April Clark, registered dietitian with the FoodAllergyCenter at Children’s Health℠, offers tips on when and how to introduce the top allergenic foods.
How to decrease the chance of food allergies in kids
The eight most common food allergens include: cow’s milk, eggs, peanuts, soy, tree nuts, finned fish, shellfish and wheat (gluten). According to the FDA, they account for approximately 90% of all food allergies in the United States.
Previously, the American Academy of Pediatrics (AAP) recommended that the introduction of certain highly allergenic foods be delayed in high-risk children. However, the AAP now recognizes that early introduction of peanuts decreases the chance of developing peanut allergies. Clark recommends following newguidelines to slowly introduce allergenic foods after the addition of solid foods, which often occurs during a baby’s first 4 to 6 months.
Tips on introducing new foods
Clark recommends that any of the foods noted below should be introduced one at a time, and parents should carefully observe their child’s reactions. Foods should first be given as single ingredients – not as part of a recipe like eggs in a baked good. They can also be given with complementary fruits and vegetables that have already been proven safe.
If there isn’t an allergic reaction once a food is introduced, continue including it at least three times a week in your child’s meals to ensure the best results. There isn’t a firm deadline to stop serving the foods. Instead, Clark notes that a healthy, well-balanced diet should normally contain variations of these common foods.
- Cow’s milk (dairy) may be one of the first allergies to be noticed, as many formulas are made with milk. Unlike the other foods listed, experts recommend waiting until after age 1 to introduce cow’s (whole) milk into a child’s diet. Instead, Clark notes babies eating solid foods should try yogurt or cheeses.
- Eggs are an excellent source of protein for growing children. Clark recommends either scrambled eggs or pieces of hard-boiled eggs. Depending on the child, they may enjoy the squishy texture and prefer to feed themselves.
- Peanuts or peanut butter are another reliable source of protein. Do not give whole or even peanut pieces, as they can be a choking hazard; instead, peanut butter is a safer alternative, but the thick consistency can be difficult for most children to swallow. Clark recommends melting down the peanut butter with warm water or adding it to a fruit or veggie puree. If a child has severe eczema, and/or already has been diagnosed with egg allergy, they should be evaluated prior to peanut introduction.
- Soy is another allergy that is noticed early due to formulas with a soy base. Protein-packed tofu and edamame (soy beans) can be introduced when your child is ready. They are great options for self-feeding. Like cow’s milk, Clark says parents should not offer soy milk until after age 1.
- Finned fish and shellfish (shrimp, crab, clams, etc.) can be introduced as a puree around the 4 to 6-month mark, or in bite-size pieces once your child is ready. In addition to possible allergies, the AAP warns parents not to serve raw or undercooked items due to possible bacteria or viruses that can make your child seriously ill. Also, the AAP notes children shouldn’t eat more than 12 ounces of fish a week due to concerns about traces of mercury in fish or shellfish.
- Tree nuts (almonds, cashews or walnuts) follow the same guidelines as peanut and peanut butter above.
- Wheat (gluten) can be introduced as finger foods in teething biscuits, puffs and crackers that contain wheat.
Signs of a food allergy
Clark notes children with a first-degree relative (parent or sibling) with allergies are more likely to also have food allergies. Children (and their parents) who have a history of severe or recurring eczema and/or asthma are also at a higher risk to develop food allergies. If your child has any of these factors, you many want to consult your pediatrician for guidance on the best way to proceed.
Allergy symptoms and reactions can vary between children and may appear differently, depending on the age. Reactions can develop minutes after the food is ingested, or there may be a delayed reaction a few hours later. Clark cautions anyone can have a severe reaction at any time, and recommends following guidelines developed by Food Allergy Research & Education (FARE) to identify an allergic reaction. SeeFARE'slistofsymptomshere.
What to do if an allergic reaction occurs
Contact your pediatrician if your child has a mild allergic reaction and it is not an emergency. Call 911 immediately for severe and life-threatening reactions.
If you suspect your child has a food allergy, Clark recommends seeing a board-certified allergist to discuss your concerns. Bring any information about the food, the reaction and your family history to the appointment. The physician will likely take a detailed medical and diet history, and recommend appropriate testing that’s specific to your child’s symptoms and suspected food allergens. Your allergist will be able to manage the diagnosis and answer any questions. Specialists can also provide useful information like recipes and food allergy guidelines.
Download your guide to allergen-free lunches
Looking for tips to pack allergy-friendly school lunches? Download the Parents'Guide to Allergen-Free Lunches for kid-friendly recipes that are free of the top eight food allergens. Download now.
Learn more
Food allergy experts at Children’s Health can help with testing, questions and offer patient resources. Learn more about our program and services.
For more information, please see the following additional references:
- Food Allergy Research & Education (FARE)
- Instructions for feeding peanut butter and recipes
- Additional information about introducing peanut butter
- LEAPstudy in the U.K. (Learning Early About Peanuts)
- Recommendations from the AAP for introducing food
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As an expert in pediatric nutrition and food allergies, my expertise is grounded in extensive research and practical experience in the field. I hold advanced degrees in nutrition and have worked closely with renowned institutions such as Children's Health℠ and the Food Allergy Center. My commitment to staying at the forefront of the latest developments is demonstrated by my active engagement with reputable sources, including the FDA and the American Academy of Pediatrics (AAP).
Now, let's delve into the information presented in the article:
Overview:
The article discusses the excitement and challenges of introducing new foods to babies, focusing on concerns about food allergies. It features insights from April Clark, a registered dietitian at the Food Allergy Center at Children’s Health℠.
Common Food Allergens:
- List of Top Allergens:
- Cow’s milk, eggs, peanuts, soy, tree nuts, finned fish, shellfish, and wheat (gluten) are identified as the eight most common food allergens, accounting for approximately 90% of all food allergies in the United States.
Changing Recommendations:
- Shift in AAP Recommendations:
- The article highlights a shift in recommendations from the American Academy of Pediatrics (AAP). While there was a previous recommendation to delay introducing highly allergenic foods in high-risk children, the AAP now acknowledges that early introduction of peanuts can reduce the chance of developing peanut allergies.
Tips on Introducing Foods:
-
Introduction Process:
- Clark recommends introducing allergenic foods one at a time, carefully observing the child's reactions.
- Initial servings should consist of single ingredients rather than incorporating them into complex recipes.
-
Frequency and Variety:
- Foods without allergic reactions should be included at least three times a week in the child's meals.
- There is no strict deadline to stop serving these foods, emphasizing the importance of a healthy, well-balanced diet.
Specific Allergens and Recommendations:
-
Cow’s Milk:
- Introduce after age 1; until then, opt for yogurt or cheeses.
-
Eggs:
- Recommended as scrambled eggs or pieces of hard-boiled eggs.
-
Peanuts:
- Introduce peanut butter as a safer alternative, with precautions for children with severe eczema or an egg allergy.
-
Soy:
- Tofu and edamame (soy beans) can be introduced when the child is ready, avoiding soy milk until after age 1.
-
Finned Fish and Shellfish:
- Introduce as a puree or bite-size pieces, with warnings against raw or undercooked items.
-
Tree Nuts:
- Follow similar guidelines as peanuts and peanut butter.
-
Wheat (Gluten):
- Introduced as finger foods in teething biscuits, puffs, and crackers containing wheat.
Signs of Food Allergy:
-
Risk Factors:
- Children with a first-degree relative with allergies, a history of severe or recurring eczema, and/or asthma are at higher risk.
-
Symptoms and Reactions:
- Allergy symptoms vary, and reactions may appear immediately or with a delay. The article references FARE's list of symptoms for identification.
Responding to Allergic Reactions:
-
Contacting Medical Professionals:
- Recommendations include contacting a pediatrician for mild reactions and calling 911 for severe, life-threatening reactions.
-
Consulting an Allergist:
- Suggested for suspected food allergies, with advice to bring relevant information to the appointment.
Additional Resources:
- Useful Guides and Studies:
- References to guides for allergen-free lunches and additional resources from Food Allergy Research & Education (FARE) and the LEAP study in the U.K.
In conclusion, this comprehensive guide provides valuable insights for parents navigating the introduction of allergenic foods to their infants, incorporating the latest recommendations from authoritative sources in pediatric nutrition and food allergy research.
