Sara Connolly, MD, FAAP, is a Board Certified Pediatrician who practices in Palm Beach County, Florida.
For years, parents have been advised to delay giving their babies and toddlers highly allergenic foods like eggs, peanuts, and tree nuts. The idea was to protect infants and babies from potential, serious allergic reactions, including anaphylaxis. Recently, however, the National Institute of Allergy and Infectious Disease said that it’s safe to give most children over six months of age highly allergenic foods, including peanuts. Bundoo Pediatrician Sara Connolly, MD, helps break down why the recommendation changed and what it means for your family.
Bundoo: Parents hear so much about food allergies and are understandably worried about introducing highly allergenic foods early. What do you say to help explain why it might be a good idea?
Dr. Sara Connolly: There is no question that food allergies are on the rise. While we are not sure exactly why, the rise in food allergies has led to formal studies that are changing the way we recommend the introduction of food. One of the interesting results is that delaying the introduction of the most common allergenic foods does not decrease the likelihood that a child will develop an allergy. In fact, it just might do the opposite. While much more scientific data is needed, the official recommendation is that after six months of age, babies can be introduced to all types of foods. There are exceptions, however, and children with a strong family history of food allergies or severe atopic dermatitis (eczema), as well as a personal history of allergy to human or cow’s milk (formula) should discuss this with their doctors before beginning solids.
Is there a “right” way to introduce these foods, in terms of amounts and timing?
The American Academy of Pediatrics recommends introducing solid foods beginning at age six months in most babies. When infants begin solids, they should try one new food every 3 or 4 days so that in the event of an allergic reaction, the parent will know which offending food was the problem. This is true of all foods and not just the traditionally highly allergic ones. New feeders need to start slow with very soupy, pureed foods and then progress from there to more substantial solids.
What should parents look for when introducing a new potential allergen? Are there signs and symptoms of a food allergy that parents often miss?
Parents should be aware of any immediate reaction such as hives, vomiting, and becoming pale or short of breath. These all warrant a call to the pediatrician or to 911 if the child is in distress. After a day or so, you might see a change in the stool for the worse, like diarrhea, or a diaper rash may develop. Food allergies are tricky and can develop at any time.
Are there particular foods that parents should be extra careful with, like peanuts and shellfish?
These are two common allergens, but nearly every food can cause an allergy. With peanuts, tree nuts, and shellfish, I also worry about the food as a choking hazard. Whole or parts of nuts are not acceptable for infants. Peanuts at this age should come in the form of a flavor, such as a peanut flavored rice puff — something easily dissolvable in the mouth. Shellfish may be used as a broth or soup. Again, if your infant has a family history of these allergies, you should discuss their introduction with your child’s pediatrician.
Does a family history of food allergies raise a baby’s chance of having a food allergy?
According to Food Allergy Research and Education, one in 13 children under the age of 18 has a food allergy in the United States. The risk of a food allergy is higher in kids who have parents with a food allergy, as well as asthma or other types of allergies. If you have a specific concern, it is best to discuss that food with your pediatrician or an allergist before introducing it to your infant.
Reviewed by Dr. Sara Connolly, November 2019