Written by Rachel Rothman, MS, RD, CLEC
A frequent question I encounter in my practice and in my Introduction to Solids classes, is how to introduce foods that may be allergenic to babies. The last 15 years have brought significant attention to allergens, and most parents are now keenly aware of the risks. However, a drumbeat of new research published on the causes of allergies and allergy prevention has brought new strategies to light and debunked old myths. Until 2008, the American Association of Pediatrics recommended that parents delay exposing infants to certain allergens until after one year of age. The guideline changed because after a review of research and patient outcomes, there was no evidence for waiting. I help many moms and dads make sense of this new world, as they are understandably cautious about what this all means for their child.
What are the top 8?
The “top eight allergens” are: cow’s milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat. These foods are associated with the eight most common food allergies, though it is possible for an allergy to occur with any food.
So when can I introduce these foods?
Most pediatricians will tell you that you can begin to introduce these foods soon after starting solids. I usually recommend starting solids with foods not on the top 8 list, and getting 1-2 months of solids before introducing any of these more common allergens, just to note whether baby has any reactions to other foods. That might mean you begin to offer the 'top 8' foods around 7-9 months of age. And if your child is at a higher risk for food allergies, consult with your pediatrician.
When offering one of the top 8 allergens, it will be easiest if you only introduce one at a time, and that you observe and note any changes in baby in the first minutes, hours, or days. If all goes well, wait a few days before offering another new food so you’ll be able to isolate any food that may be causing an issue. If you’re concerned that something seems different, consult your pediatrician.
Let’s break down each of the allergens and discuss some ways to introduce:
Cow’s milk: Most of us have heard, no cow’s milk before one year of age. This refers to the fact that cow’s milk should not be a replacement for breast milk or formula before the first year. Why? Cow’s milk has different nutrient properties than breast milk/ formula, primarily a higher proportion of protein and lower amount of fats and carbohydrates, including some differences in vitamins and minerals. Breast milk contains the perfect proportion of all nutrients. Cow’s milk should not be used as a replacement for breastmilk or formula. But, cow’s milk can be used in recipes, like soups, baked goods, or other foods before the first year. Some families choose not to introduce cow’s milk, which is fine too. This is a hot topic, so stay tuned for a post dedicated to the dairy debate!
Eggs: Eggs are a staple in my house for my daughter, my husband, and myself. It was previously thought to hold off on egg whites before one year of age, but like the recommendations for allergens, most pediatricians say you can introduce whole egg soon after starting solids- just be sure the egg is thoroughly cooked! I love eggs as a finger food- they are so nutritious, and easy for baby to pick up and eat relatively early on. Making an egg and vegetable scramble or frittata is a great way to include vegetables in baby’s breakfast as well.
Peanuts and Tree nuts: These are among the most highly allergenic foods, so be sure to monitor for reactions when introducing peanuts and tree nuts. Keep in mind that whole nuts are a choking hazard for children until about 4 years of age. When introducing nuts, try spreading a thin amount of nut butter on a piece of bread, mixing a bit of peanut butter into oatmeal or putting a very small amount of nut butter on a spoon (too large of a scoop can be a choking hazard, as well). If your baby loves peanut butter as much as mine did, she’ll be well on her way to learning how to use a spoon!
Fish: Fish is great food for babies because of all of the nutrient benefits- just be sure fish is thoroughly cooked. Fatty fish is an excellent source of omega-3 fatty acids (specifically DHA) which baby needs for brain growth, especially under 2 years of age. You will want to choose a fish type that is lower in mercury (some fish to avoid include King mackerel, marlin, orange roughy, shark, swordfish, tilefish, ahi tuna, and bigeye tuna). The EPA has this great guide which lists the mercury content and sustainability level of many types of seafood. Flaked salmon can be a great finger food (or even mashed with avocado or sweet potato), or try making crab cakes or tilapia cakes.
Soy: Some pediatricians do recommend waiting to introduce soy until baby is tolerating other foods. If your baby has already been diagnosed with a soy allergy, you will want to speak with your pediatrician on it’s introduction, and keep in mind many packaged foods contain soy-based ingredients. Baked or sautéed tofu can be a great finger food, or try adding tofu into lasagna in place of ricotta cheese. You may want to wait until baby is about 9 or so months of age before introducing soy.
Wheat: Research and opinions are mixed on the introduction of wheat. Many pediatricians recommend waiting on introducing wheat until other grains have been introduced (like oats, rice, or barley) to see if baby has any reaction to grains. Wheat does contain gluten, and some babies might have a gluten intolerance or sensitivity, but note this will be different than a true wheat allergy.
And again, always follow your pediatrician’s recommendations and speak with your pediatrician if food allergies run in your family, as the recommendations may be different. Families of babies that have a history of an allergic condition, including a food allergy, asthma, allergic rhinitis or eczema, should absolutely speak with their pediatrician before offering any of these foods.
Want to learn more about introducing solid food to your little one? Join me at the San Diego Breastfeeding Center for my next introduction to solids class on January 28th at 10:00-11:30am. Learn more here
Rachel Rothman, MS, RD, CLEC is a mom, pediatric dietitian, and instructor at the San Diego Breastfeeding Center. Rachel specializes in working with children and families. She lives in San Diego with her husband, Ben, and daughter, Sydney. You can contact Rachel here.
Introduction of Solids and Allergic Reactions. (2009, December 7). Retrieved from https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Introduction-of-Solid-Foods-and-Allergic-Reactions.aspx
Fliescher, D. M. (2013, January 28). Early introduction of allergenic foods may prevent food allergy in children. Retrieved from https://www.aappublications.org/
Greer, F. R., Sicherer, S. H., & Burks, A. W. (2008, January). 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. Retrieved from http://pediatrics.aappublications.org/content/121/1/183