This is a guest post by Lauren Morgan, a dietetic intern at the University of Maryland and blogger at The Blue Plate Special. Having grown up with food allergies, and because of her training as a dietitian, she has a strong interest and technical knowledge of this topic. In this article, she presents the latest research and recommendations for preventing food allergies in high risk infants.

photo credit: saia.neogaia

The American Academy of Pediatrics (AAP) reviewed older recommendations (from 2000) and the current research to publish their most current recommendations for the prevention of food allergy in high risk infants.  The AAP defines a high risk infant as a child with at least one parent or sibling with documented allergic disease.  Several factors stayed the same from their 2000 recommendations, but there were also newer recommendations thanks to research.  Here are some of the most important factors when it comes to prevention of food allergies:

Breastfeeding

The AAP, World Health Organization (WHO), American Academy of Allergy Asthma and Immunlogy (AAAAI), all recommend breastfeeding as the best source of nutrition for an infant as well as the best approach for preventing food allergy development.  According to AAAAI, breast milk strengthens the infant’s immune system and is the least likely food to trigger an allergic reaction.  The AAP’s recommendation is exclusive breastfeeding for at least four months.  While the evidence for breastfeeding preventing the development of food allergies is lacking, there is evidence for many other benefits that come along with breastfeeding.  Therefore, it is still the most highly recommended feeding method.

Maternal Pregnancy Diet

There is a long-standing thought that moms of high-risk infants should avoid certain foods during pregnancy; however this thought is not backed up by the research.  Researchers have not found conclusive evidence that moms should make any dietary restrictions during pregnancy.  In 2000, the AAP recommended there be no dietary restriction except the possible avoidance of peanuts.  The 2008 recommendations do not state an avoidance of peanuts during pregnancy is necessary.

Maternal Lactation Diet

Should moms avoid certain foods while they are breastfeeding?

The most recent research says no.  In the year 2000, the AAP recommended eliminating peanuts and nuts and consideration of elimination of eggs, cow’s milk, and fish.  However, in the updated 2008 recommendations the AAP states there is no dietary restriction needed.  According to the AAAAI, while research has been done on changes in mom’s diet, it has not proven to be as effective as the careful and timely introduction of foods to infants.

Soy Formulas

Should soy formulas be used for infants at high risk of developing food allergies?

The research again says no.  Previously, it was thought this might be an appropriate intervention; however, there has been no conclusive evidence to support this.  In fact, it is common for infants with cow’s milk allergy to be allergic to soy as well.  If breastfeeding is not an option the best alternative is providing the infant with a special hypoallergenic formula that has hydrolyzed protein.  These formulas need to be carefully considered and only used when necessary as instructed by your pediatrician.  These are very specialized and are much more expensive than standard formulas.

Introduction of Solid Foods

Should I wait to give my child certain foods like milk, eggs, and nuts?

Solid foods can be introduced between four and six months of age.  Cereal grains, vegetables, and fruits are the best to begin introducing.  Make sure you only give your child one ingredient at a time when introducing foods.  If they have apples, oranges, green beans, and grains and have a reaction you will not be able to tell which food they are allergic to.  Start with one food and wait several days before trying another one.  In the AAP’s 2000 recommendations it was recommended to delay introduction of foods with the most common allergens.  The recommendations included cow’s milk at twelve months, eggs at twenty-four months, peanuts, nuts and fish at thirty-six months; however, these recommendations have changed based on more current research.  The AAP now recommends no delay in introduction of any of these foods.  They state “there is no evidence for delaying introduction of any foods beyond this period [4-6 months], including those considered highly allergenic (e.g., fish, eggs, foods containing peanut protein)” (Greer).

The Take Away

While there is still so much unknown about the development of food allergies, it is encouraging to have solid, science-based recommendations for the prevention of food allergies.  I have continued hope that there will be great revelations in research that help find answers to food allergy questions.  Until then I rely on recommendations like these from credible institutions to help guide my practice as a nutrition professional and in my personal life as well.

References

• American Academy of Allergy, Asthma, and Immunology.  Tips to Remember:  Prevention of Allergies and Asthma in Children.
• World Health Organization.  10 Facts on Breastfeeding
• American Academy of Pediatrics, Committee on Nutrition.  Hypoallergenic infant formulas.  Pediatrics.  2000; 106: 346-349.
• Greer FR, Sicherer SH, Burks AW, and the Committee on Nutrition and Section on Allergy and Immunology.  Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.  Pediatrics.  2008; 121(1): 183-191.

Parents: do you have a child with food allergies? What steps do you take to prevent or manage your child’s allergies?

©2010 Littlestomaks.com

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, Registered Dietitian Preethi Rahul explains how you can manage the vitamin D intake of breastfed infants and children.

Question:Is it true that breastfed babies need more vitamin D and can it be obtained through breast milk if the mother increases her vitamin D intake?

Answer:

Yes! Definitely breastfed babies need more vitamin D as human milk contains five metabolites of Vitamin D, providing 40-50 IU/ L of vitamin D activity. The need for additional vitamin D becomes progressively important with increasing age. Cow’s milk is usually fortified with 400 IU/L of vitamin D.

Vitamin D does not occur naturally in foods that humans normally eat. Moreover, the widespread use of sunscreens and public health recommendations to avoid sun exposure reduces dermal synthesis of vitamin D₃. Most people therefore get vitamin D₃ by taking a vitamin D supplement or by consuming vitamin D–fortified milk.

Vitamin D is undoubtedly important for fetal development and for bone development in childhood; it plays a much wider role in health and disease prevention. Vitamin D is essential for cell differentiation, the functional maintenance of membranes, as well as the functions of several organs including skin, muscle, pancreas, nerves, parathyroid gland and the immune system. It is important to understand that vitamin D is not really a vitamin; vitamin D₃ is a pre-pro hormone made in the skin in response to ultraviolet-B light exposure. Vitamin D3 is the precursor to form 25-hydroxyvitamin D₃ [25(OH)D₃], a pre hormone, which is ultimately converted to 1,25-dihydroxyvitamin D₃ [1,25(OH)₂D₃]. One of the most potent steroid hormones known, 1,25(OH)₂D has the capacity to affect many bodily functions beyond calcium metabolism.

All infant formulas sold in the United States must have a minimum vitamin D concentration of 40 IU/100 kcal (258 IU/L of a 20 kcal/oz formula) and a maximum vitamin D3 concentration of 100 IU/100 kcal (666 IU/L of a 20 kcal/oz formula).All formulas sold in the United States have at least 400 IU/L of vitamin D₃. Because most formula-fed infants ingest nearly 1 L or 1 qt of formula per day after the first month of life, they will achieve a vitamin D intake of 400 IU/day. Infants who receive a mixture of human milk and formula also should get a vitamin D supplement of 400 IU/day to ensure an adequate intake. As infants are weaned from breastfeeding and/or formula, intake of vitamin D–fortified milk should be encouraged to provide at least 400 IU/day of vitamin D.

Although vitamin D concentrations can be increased in milk of lactating women by using large vitamin D supplements, such high-dose supplementation studies in lactating women must be validated and demonstrated to be safe in larger, more representative populations of women across the world. Recommendations to universally supplement breastfeeding mothers with high dose vitamin D cannot be made at this time. Therefore, supplements given to the infant are necessary.

Check out the following articles related articles on vitamin D

Ask the Expert – Vitamin D Deficiency
40% of infants and toddlers have vitamin D deficiency – should you worry?
5 reasons to consider a multivitamin supplement

©2009 Littlestomaks.com. All Rights Reserved
Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, Registered Dietitian Victoria Retelny offers some tips for switching your baby from infant formula to cow’s milk.

Question: Can you give some tips for switching my child to milk from infant formula?

Answer:

Typically, by 12 months old, infants can be completely weaned from infant formula to cow’s milk.  Be sure to choose whole, full-fat milk as your baby needs the fat and calories for healthy brain development until he/she turns two (at that point you can switch to low-fat or fat-free milk).   However, moving from formula to milk does not have to a cold turkey proposition.  Although it seems like a big transition, it can be a gradual change. Weeks before a baby’s first birthday, you can begin mixing milk in with formula, cereals, vegetables, such as creamed corn, spinach, peas, broccoli, and fruit like mashed bananas.

Since cow’s milk is one of the major food allergens for infants and children, a slow introduction is the ideal way to get your child’s delicate system used to cow’s milk as well as give you an opportunity to see if he/she has any reactions, such as gas, bloating, diarrhea, constipation or skin rashes, which may be associated with lactose/dairy intolerance or allergies.   If you suspect a reaction has occurred from milk, contact your pediatrician or a pediatric allergy specialist for further evaluation.   Have no fear, there are other options to cow’s milk – try soy milk or rice milk.  Always look for added calcium and vitamin D as you don’t want your child to miss out on those key nutrients for healthy bone development.

©2009 Littlestomaks.com. All Rights Reserved

Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.