How To Introduce Baby To Allergenic Foods
If there’s no order, does that mean there’s no guidelines? Not necessarily!
The current generally accepted recommendations are to introduce a few non-allergenic foods first when introducing solid foods. Once they seem to be tolerating foods in general, you can start to introduce the allergens.
Introduce one allergen at a time, but it is fine to introduce them with other types of foods. When introducing one of the top 9 food allergens, plan to be able to watch your child for about 2 hours after they have ingested it. This is the most common time frame that a reaction would occur in.
Whether you practice a baby led weaning style of feeding and your baby eats finger foods, or you feed your baby using pureed foods, it is important to follow safety guidelines for introducing allergens.
Many allergens, like peanuts and tree nuts, can be choking hazards. Serving a child under 4 a whole nut is unsafe. When it comes to peanut butter, never serve your baby crunchy peanut butter. If serving smooth peanut butter, thin it out with water or breast milk and serve it with a spoon. You can also spread it on a piece of bread or stir it into oatmeal or yogurt for continued exposure.
For dairy foods, recommendations can be confusing. The overall recommendation is not to serve your baby cow’s milk, or any other milk outside of breast milk or formula, before a year of age.
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Introducing Foods That Could Trigger Allergy
When you start introducing solid foods to your baby from around 6 months old, introduce the foods that can trigger allergic reactions one at a time and in very small amounts so that you can spot any reaction.
If your baby already has an allergy, such as a diagnosed food allergy or eczema, or if you have a family history of food allergies, eczema, asthma or hay fever, you may need to be particularly careful when introducing foods. Talk to your GP or health visitor first.
Foods that can trigger an allergic reaction are:
- cows’ milk
- foods that contain gluten, including wheat, barley and rye
- nuts and peanuts
These foods can be introduced from around 6 months as part of your baby’s diet, just like any other foods.
Once introduced and if tolerated, these foods should become part of your baby’s usual diet to minimise the risk of allergy.
Evidence has shown that delaying the introduction of peanut and hen’s eggs beyond 6 to 12 months may increase the risk of developing an allergy to these foods.
Lots of children outgrow their allergies to milk or eggs, but a peanut allergy is generally lifelong.
If your child has a food allergy, read food labels carefully. Avoid foods if you’re not sure whether they contain the food your child is allergic to.
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What To Do If Baby Is Having A Food Allergy Reaction
Not every episode of hives, vomiting or runny nose is a sign of food allergy in baby. Many things can cause these reactions, including a virus or contact with other non-food allergens . Some foods just irritate the skin where it touchesknown as a contact reactionbut dont prompt any other concerns. When in doubt, stop offering the food and discuss with your childs pediatrician.
If you do notice signs of a food allergy in baby, what to do next depends on how severe the baby food allergy symptoms are.
If baby has a mild or moderate reaction:
- Stop feeding baby the allergenic food immediately after noticing symptoms
- Carefully monitor baby for any other signs of an allergic reaction
- If symptoms progress or dont improve, head to the emergency room
- Consult your childs doctor as soon as possible
- With a doctors recommendation, you can give baby a childrens antihistamine such as Zyrtec or Benadryl
If baby has a severe reaction or anaphylaxis:
- Stop feeding baby the allergenic food immediately after noticing symptoms
- Lay baby flat in your arms do not hold them upright or let them stand or walk
- If baby has fainted or is vomiting, lay them on their side
- If you have an epinephrine auto-injector , administer according to the manufacturer instructions
What To Do If An Allergic Reaction Occurs
Not all babies will have the same food allergy reactions.
If your child is showing signs of a mild reaction, such as an itchy or runny nose or a few hives, it is generally fine to wait to get an appointment with your health care provider and discuss the symptoms with them or an allergist.
If your child is showing signs of a severe reaction, such as difficulty breathing or loss of consciousness, call 911 and seek immediate treatment.
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The Foods Stimulate The Immune System In A Natural Way
When young children are introduced to different foods, the intestines usually ensure that the body learns that the foods are harmless. Little by little, the child then develops a natural tolerance for different types of food.
However, sometimes the immune system thinks that parts of the food are harmful to the body. The immune system’s reaction then leads to the development of food allergies.
We believe that early introduction of peanuts, eggs, milk and wheat is important because it trains the immune system to recognise common foods as harmless. This helps the immune system to accept these foods, which are completely normal foods that children will need throughout life, the researcher says.
Signs Of Food Reaction
- Swelling of the lips, face or eyes
- Hives or welts
- Difficulty talking and/or a hoarse voice
- A wheeze or persistent cough
- Loss of consciousness and/or collapse
- Paleness and floppiness
If your child has an Anaphylaxis Action Plan follow that and call 000 and arrange to be transferred to hospital. Otherwise, please call 000 straight away.
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What Is Early Allergen Introduction And Why Do It
Early allergen introduction is the process of frequently feeding common allergenic foods, such as peanut or egg, to your baby. The 2020 USDA Dietary Guidelines for Americans and other prominent medical associations recommend introducing peanut and egg in the first year of life , otherwise known as early allergen introduction. This is especially important for babies with eczema who have a 1 in 3 chance of developing food allergies. With Ready, Set, Food!, we make it easy to introduce allergens early and often.
Will My Baby Need Allergy Shots
Heres the good news: Food allergies arent treated with allergy shots, which are only given for environmental or seasonal allergies to children 5 and older.
The not-so-good news: The only way to treat food allergies is to avoid the food. That means youll need to become a pro at making sure your child avoids foods he’s allergic to, both at home and when he’s dining elsewhere.
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Can Food Allergy Cause Eczema
Although food allergy is more common in children who have eczema, they are separate conditions.
Food allergy does not normally cause eczema, but having eczema may increase the chance that a food allergy develops. For a description of how eczema may increase the risk of food allergy, please refer to the section on the next page called: How can good eczema control help prevent food allergy?
Ways To Manage Food Allergies And Prevent Allergic Reactions
Avoiding exposure to known food triggers is key to managing food allergies.
Some ways to prevent exposure include:
- Getting familiar with food labels: Food manufacturers in the United States must indicate whether a food product contains any of the eight most common food allergens. Read food labels regularly, and teach your child how to read them to spot any ingredients that can cause allergic reactions.
- Being wary of prepared foods: When consuming food prepared outside of the home or at a restaurant, ask what ingredients are in the food and how the food was cooked or served.
- Working with a professional: Registered dietitians can advise on safe food substitutions and ensuring a childs diet has enough nutrients to support healthy growth when managing food allergies.
Creating an emergency plan is also a critical life-saving strategy for severe food allergies.
Preparing for food allergy-related emergencies can include:
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Are There Exceptions To The New Guidance
One exception to the advice to no longer delay introducing allergenic foods is for infants with older siblings with peanut allergy, because an almost sevenfold increased risk in the younger sibling has been documented. In such circumstances, evaluation by a certified allergist before peanut introduction in the younger sibling is recommended.22 Any infant with a documented reaction to a food should undergo assessment by an allergist before the food is introduced again. In addition, American Academy of Allergy, Asthma and Immunology recommends that infants with moderate to severe atopic dermatitis be evaluated by a specialist before allergenic foods are introduced.20
Introducing Fish And Shellfish
Fish and shellfish are not major childhood food allergens, so its not as important to feed them to babies. Plus, there are way too many varieties of fish and shellfish out there to give baby a taste of all of them. The best approach is to simply offer the seafood that you tend to eat as a family and continue with regular intake. If baby isnt ready for finger food yet, you can puree the fish, or just wait until baby is older.
When Should Babies Be Exposed To The Top Food Allergens
When it comes to introducing allergenic foods for babies, their risk profile matters.
If your baby is not at risk for food allergies, the general recommendation according to health organizations like the American Academy of Pediatrics is to introduce the top food allergens to them right around the time you introduce solid foods. This is generally around 6 months of age.
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Dietary Avoidance Or Introduction Of Allergens
3.1.1 Maternal dietary avoidance
The EAACI Task Force suggests against restricting the consumption of potential food allergens during pregnancy or breastfeeding in order to prevent food allergy in infants and young children .
Reason for recommendation
Our systematic review identified five trials about this topic in women at increased risk, two of which focused on dietary avoidance alone, and three combined with another intervention.- The review concluded that avoiding potential food allergens during pregnancy, when breastfeeding or in infancy, alone or combined with other interventions, may have little to no effect on food allergy in early childhood, but the evidence is very uncertain.
The majority of trials found no reduction in the prevalence of food allergy when women avoided dietary allergens such as egg and milk. The harm associated with avoiding foods during pregnancy and breastfeeding may be greater than any potential reduction in food allergy. Food allergens do not exist in isolation so removing food groups may also reduce the intake of vital nutrients and fibre, adversely affecting the health of women and their infants.
Strength of recommendation
This guideline is against maternal avoidance of dietary food allergens, but this is not the strongest recommendation possible because the certainty of evidence is very low. There were only a small number of studies, they contained varying interventions, and there was very low certainty about their effect on food allergy.
What Are The Symptoms Of Food Allergy
Allergic symptoms may begin within minutes to an hour after ingesting thefood. The following are the most common symptoms of food allergy. However,each child may experience symptoms differently. Symptoms may include:
Lowered blood pressure
According to the National Institute of Allergy and Infectious Disease, itdoes not take much of the food to cause a severe reaction in highlyallergic people. In fact, as little as 1/44,000 of a peanut kernel cancause an allergic reaction for severely allergic individuals.
The symptoms of food allergy may resemble other problems or medicalconditions. Always consult your child’s doctor for a diagnosis.
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Dealing With Conflicting Advice
Peanuts and peanut butter are choking hazards for babies, yet some research indicates that delaying the introduction of these foods beyond six months of age may increase the risk of developing a peanut allergy. What is a concerned parent to do?
Because new studies are constantly being published, feeding guidelines can change from year to year. The best way to handle conflicting advice like this is to talk to your babys pediatrician or pediatric allergist. He or she can take into account your baby’s medical history and risk level for developing food allergies, as well as the most recent feeding guidelines, and give you personalized advice about introducing solids to your baby.
Food Allergy Symptoms Vs Skin Reaction
Sometimes, it is hard to tell the difference between an allergic reaction and a contact rash.
In general, if your baby breaks out in a localized rash after eating a food, and that rash is only where the food has touched, then it is very possibly a contact rash. Your baby’s skin is sensitive, and things like tomatoes and other acidic foods, cinnamon, and even butter can sometimes cause contact reactions.
If you are in doubt, it is always prudent to check with your child’s doctor. This is not medical advice, and you should always check with a doctor if you have concerns about potential allergic reactions.
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Foods You Should Delay Until Your Baby Has Reached 12 Months
Some foods should be delayed until after your babys first birthday, for nutritional or food safety reasons. They include:
- Cows Milk: Cows milk is nutritionally different than human milk or infant formula, which has been made to resemble human milk. Feeding your baby cows milk can cause nutritional deficiencies. After your babys first birthday, you can feed him whole cows milk as part of a balanced diet.
- Honey: Honey can contain botulism spores, and your babys stomach is not acidic enough to destroy the spores .
- Nuts or Peanuts: Whole nuts are a choking hazard for babies and toddlers. Peanut butter can be a choking hazard for children under 2. If there is a family history of severe nut or peanut allergy, talk to your pediatrician about doing an oral food challenge in the doctors office before introducing peanut or nut butter.
- Other Choking Hazards: Popcorn, whole grapes, hot dog pieces, cheese cubes, chunks of uncooked vegetables or fruits, or sticky foods such as peanut butter.
The Most Common Food Allergens
According to the NHS, the 8 food types that are most likely to cause allergic reactions are:
* We touched upon some of these ingredients in our A-Z Guide to Foods to Avoid Giving Infants but will mention the following again: seeds and nuts, including peanuts, should only be served to under-fives crushed, ground or as a butter as they are otherwise a choking hazard eggs should be avoided before the age of 6 months and thereafter never be served raw/lightly cooked except if they exhibit the Red Lion or British Lion Quality stamp shellfish should also never be served to infants raw or lightly cooked.
Always read food labels carefully.
Mustard, celery, the preservative/antioxidant sulphur dioxide, the legume lupin and molluscs are the next most common food allergens after those listed in the table above. Kiwi, the fruit, is also known to cause allergic reactions in some infants, however is apparently the only potential allergen out of those listed above that doesnt have to be listed, by law, on the ingredients list of pre-packaged food products.
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Guidance On The Early Introduction Of Allergens To Babies: Resources For Families And Healthcare Professionals
For parents: Recorded webinar on the updated guidance on the early introduction of allergens
We hosted a webinar in April 2019 on the CPS updatedrecommendations on the early introduction of allergenic foods for high-riskinfants.
The webinar was presented by Canadian paediatric allergist Dr. Elissa Abrams who is an Assistant Professor in the Department of Paediatrics, Section of Allergy and Clinical Immunology at the University of Manitoba and a co-author of the newly released CPS practice point on the introduction of allergenic foods. She is also Vice Chair of the Anaphylaxis and Food Allergy Section of the Canadian Society of Allergy and Clinical Immunology and President of the Allergy Section of the CPS.
You can view a recording of the webinar below, which includes a question and answer period.
Parent resource: Eat Early. Eat Often.
Produced under the National Food Allergy Action Plan, this resource includes practical tips on feeding babies early, recipes for different allergenic foods, and more.