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

This post is a guest post by Kayris, a mom to two in Maryland. She writes about raising kids in the big city at The Great Walls of Baltimore. A proud AP mom, she especially uses the principles of Attachment Parenting in the kitchen.

Attachment Parenting is a style of parenting that focuses on creating strong and healthy emotional bonds between child and parent. AP parents believe that using love and respect to guide parenting decisions–from nutrition to discipline to how you teach your child to sleep–forges a strong and secure bond that lasts beyond childhood into adulthood. For more on the eight principles of Attachment Parenting, please visit Attachment Parenting International.

Among the many milestones a baby will reach in his first year, beginning the transition from breast milk or formula to solid food is one of the most fun. What parent doesn’t have a video of a young child sucking in spaghetti one noodle at a time, or a photo of a child wearing (rather than eating) the first birthday cake?

In the wake of the recent childhood obesity epidemic, it’s my opinion that introducing solids to your baby is one of the most important milestones as well. Starting in babyhood, you can stress the importance of respecting your body by practicing good nutrition, and by modeling healthy eating habits, you give your child tools to make healthy food choices as an older child and adult.

Think about all the people in your life and there is bound to be at least one, facing diabetes or another medical crisis, struggling to change a lifetime of bad food habits. It might seem difficult to imagine your baby as an adult, but the attitude you impart to your child NOW will last a lifetime.

As a mom to two, I’ve spent plenty of time wondering if my babies were eating enough, often enough, or a wide enough variety of foods. By making good nutrition and a healthy lifestyle a priority for our family, I now have two children that I consider to be good eaters. Each has their challenges, but here are some of the points that have worked for our AP family.

• Introduce Solids When Your Baby Is Ready–Most doctors will say this happens between four and six months, but let your child lead the way. Don’t let others pressure you into starting solids before your child is ready. My son, now 5 years old, let us know he was ready at 4 months when he would reach for food on our plates. My daughter, now 2, was closer to six months.. She showed no interest before then and it wasn’t until her sleep patterns changed that she was ready.
• Go Slow, And Keep Food Allergies In Mind–If your family has a history of food allergies, ask your pediatrician for specific instructions on when and how to introduce solids. Otherwise, try one new food at a time and wait several days in between new foods so you can be sure there isn’t a problem.
• Make Breast Or Bottle Number One–For the first year, breast milk or formula should supply most of your baby’s calories. Solids are extra. If you are breastfeeding, keep an eye on your supply, as introducing solids can decrease your supply. Read more about maintaining and increasing your supply at Kellymom.com. Personally, I always ended each solid feeding meal with my two children with a short five minute pumping session to keep my milk supply up.
• Never Force A Child To Eat–A baby that is not hungry won’t eat. Try to avoid forcing food on your child, and let his or her natural ability to gauge hunger and satiety develop. This is key to raising an older child that knows when to stop eating! If your baby isn’t interested, put away the food and try again later.
• Have Reasonable Expectations–Some children are better eaters than others. Food preferences are also partially genetic, so don’t be surprised if your baby strongly dislikes something. While some kids need to be offered a food ten times or more before they will accept it, some foods may never be accepted! Think about your own food preferences and you’ll likely find some strong favorites and some strong un-favorites. Neither of my children will eat carrots in any form, no matter how I prepare them; I’ve had to conclude that, for now, it’s a food they don’t like. In addition, pickiness is a natural stage that many children go through. Likes and dislikes will change over the years. Don’t be surprised if your baby happily accepts every food you give him, only to refuse to eat them as a strong willed toddler.
• Respect Your Child’s Individuality–This is especially important if your baby is your second child. Don’t expect or pressure your baby to do things like their older sibling did, or like the child next door. Each child develops at their own pace and in their own way. That goes for eating habits as well.
• Eat As A Family–Get your child used to sitting down with the family to eat at an early age. A study at Columbia University showed that teens who eat dinner with their families six to seven times a week are almost 50 percent more likely to remain substance-free than teens who eat dinner with their families twice a week or less. Teens who eat dinner often with their families are more likely to have better grades, lower stress levels and healthier diets. Family dinners three or more nights per week reduce a child’s likelihood to engage in risky behavior. Start your baby eating with the family now, so it’s an ingrained habit when they are older. In addition, eating as a family is a great way to bond with your children.
• Model Healthy Habits–Long before your baby becomes aware of advertising and is susceptible to tricky marketing aimed at kids, the person with the most influence is YOU. Make sure when your baby sees you eat, it’s wholesome and healthy food. If your diet could use some improvement, this is a great time to do it.

Finally, always remember the AP principle to feed with love and respect.  The healthiest food in the world doesn’t mean as much if the bond between parent and child isn’t there.

Find more information on Attachment Parenting and toddler nutrition here.

Photo source: marekf on Flickr
©2009 Littlestomaks.com