Infant feeding to prevent food allergy

Author: Kathy Beck APD, Paediatric Allergy Dietitian

In my daily work and talking to friends I find myself often talking about preventing food allergy in children – usually in response to a friend who is a new grandparent, the families I see as a paediatric allergy dietitian or someone who has read an article in the media.

I’ve worked in paediatric allergy for more than 15 years and have adult sons who were born almost 30 years ago in the era of “delay …” which of course we know now (in hindsight) exacerbated the food allergy situation.

I’ve been lucky enough in my various roles in paediatric allergy to be a contributor to the KOL meetings and then subsequently a co-author of the Australian Consensus on Infant Feeding Guidelines to Prevent Food Allergy in 2017. Read the paper Here.

In summary, research published in February 2015 demonstrated that introducing peanut in an age-appropriate texture to infants before the age of 12 months reduced the risk of peanut allergy by 86%. For me it was one of those “I remember where I was and what I was doing when I heard these research results”. Read more here.

You may wonder why it took so long – from 2015 to 2017 to come out with new infant feeding guidelines. Good question. Just imagine that someone told you to stop using hot water to wash dishes and as cold water works much better! Your reaction would be “are you serious, NO”.

Once we knew the facts as a scientific community, we then had to translate this into practical advice for families, child health nurses, GPs and paediatricians as it was contrary to what had been practiced previously. It was an exciting time. I can now report that 10 years down the track we have made progress, and recent research indicates a pause in the food allergy development in early infancy and potentially a decrease.

The National Allergy Council have produced the Nip Allergies in the Bub website which provides many resources. Have a read Here.

Here are guidelines for safely introducing allergenic solids:

When to Start

• Introduce allergenic foods around 4–6 months of age, when your baby is ready for solids. Signs of readiness include sitting up with support, good head control, showing interest in food, and the ability to swallow small amounts of puree or soft food. Read more here – https://preventallergies.org.au/feeding-your-baby/introducing-solid-foods/

Common Allergenic Foods

In Australian the most common allergenic foods include peanut, egg, cow’s milk, tree nuts (cashew, pistachio etc), sesame, soy, wheat, fish and shellfish.

How to introduce allergenic foods

The most important advice is that babies need to be offered smooth pureed foods that are rich in iron. These foods include iron enriched (fortified) baby cereals, meats, poultry, fish, well cooked egg (not runny) and legumes. Read more Here.

Once your baby has had some positive experiences with foods you can then start to introduce common allergenic foods one at a time whilst watching for any reactions. Small amounts eg. ¼ teaspoon mixed with another food already familiar to the baby.

Read more Here.

Signs of an allergic reaction

Watch for:

• Skin: hives, redness, or swelling
• Digestive: vomiting, diarrhea or abdominal pain
• Respiratory: coughing, wheezing, or difficulty breathing
• Severe reaction: infants may go pale and floppy, anaphylaxis (rare but serious)

If you notice any of these symptoms, stop feeding the food and seek medical attention immediately.

Tips for success

• Peanut: Use smooth peanut butter mixed with water, formula, or breast milk. Avoid whole nuts or thick peanut butter for choking risk
• Egg: Offer well-cooked eggs (scrambled, boiled, or pureed)
• Milk: Add cow’s milk, yoghurt and cheese to other foods (avoid cow’s milk as a main drink until after 12 months of age)

Nip Allergies in the Bub website has some wonderful ideas for introducing first foods – have a look Here

About the author

Kathy Beck is a South East Queensland based paediatric dietitian who specialises in food allergy. Kathy is an active member of the Dietitian’s Committee of the Australasian Society of Allergy and Clinical Immunology (ASCIA). Kathy has been a dietitian for over 30 years with the last 15 years working in paediatrics in various clinical settings in Australia and England.