What are the rules on foods for babies?
Q: Why is it OK to feed my 6-month-old daughter fish, eggs, dairy and peanut butter? With my first child, I was told I had to wait until he was 12 months old to feed him those foods.
A: Feeding recommendations have changed over time. Years ago, pediatricians recommended waiting to feed your baby fish, whole eggs, dairy, peanut butter and soy until he or she was 12 months old. While this can be confusing, it is actually a good thing because this means that your pediatrician is practicing evidence-based medicine. Mosby’s Medical Dictionary defines this as “the practice of medicine in which the physician finds, assesses, and implements methods of diagnosis and treatment on the basis of the best available current research, the physician’s clinical expertise, and the needs and preferences of the patient.”
According to many families in my office, they were advised by their grandmothers to start feeding their baby vegetables first and then fruit. This was felt to encourage a varied diet and to keep a child from developing a sweet tooth. I have also heard that they were encouraged to start with green foods, followed by orange and then yellow foods. To my knowledge, there is no evidence-based research to support this advice.
The most current recommendations are to exclusively breastfeed your baby (if possible) for the first six months, followed by the introduction of solid foods. Introduce a new food every 2 to 3 days to allow time to monitor for any signs of an allergic reaction (rash, vomiting or diarrhea). Aside from choking foods, the only food that is not recommended until your baby is 12 months old is honey. This is not due to
the risk of an allergic reaction, but due to the risk of infant botulism, or “floppy baby syndrome.” Honey may contain Clostridium botulinum spores. The toxin from these bacterial spores can cause paralysis and even death.
It does appear that the number of people who suffer from food allergies has increased. For example, the prevalence of peanut allergy has doubled in the past 10 years and is the leading cause of food allergy-related deaths in the United States. It is unclear if this is a true increase or if physicians are better at diagnosing and correctly coding for food allergies. Some theorize that food allergies have increased because we are avoiding feeding our kids allergenic foods or that we are just “too clean,” not allowing kids to get dirty and play outside. At one point, pediatricians recommended waiting to give children food containing peanuts until they were 3 years old. Now we have learned that early introduction is actually beneficial in preventing peanut allergies.
A few years ago, it was recognized that Jewish children living in the United Kingdom had a ten-fold increase in peanut allergy when compared to Israeli children of similar ancestry. The children living in the United Kingdom were not fed peanuts in their first year of life, while the children living in Israel were fed peanut-based foods starting around 7 months of age. This was mainly through a popular peanut-based snack food called Bamba. This finding led researchers to study whether or not giving babies peanut protein early on could, in fact, prevent peanut allergies. The Learning Early About Peanut Allergy (LEAP) trial, performed by Du Toit, Roberts, Sayre, et al, did find that children who are at higher risk of allergies had lower rates of peanut allergies when they were fed peanut protein daily.
Children who have food allergies typically outgrow them by 5 years of age; however, this is less likely with a nut or seafood allergy. The management of food allergies is strict avoidance of the allergenic food. This entails careful label reading, and employing a strict “no sharing” policy when it comes to school lunches and snacks. Treatment of an allergic reaction is usually an oral antihistamine for mild symptoms, such as itching or hives. For more severe symptoms, such as throat tightness, or difficulty swallowing or breathing, injected epinephrine may be necessary. Having an allergy action plan under guidance from your pediatrician or allergist is extremely important. If you think your child might have a food allergy, discuss it with your child’s doctor. Two great resources are: www.kidswithfoodallergies.org and www.healthychildren.org.