Question: Should I delay introduction of certain foods to my baby to lower the risk of food allergy?
Answer: Based on available research, the consensus among the American Academy of Pediatrics (AAP) is that delaying the introduction of solid (complementary) foods until at least 4 months of age and delaying the introduction of liquid cow’s milk until 12 months are the two practices parents can adopt to lower the risk of their child developing a food allergy.
Beyond these two practices, there is no scientific consensus about whether other feeding strategies can prevent–or promote—the incidence of food allergy in kids.
For years, conventional wisdom has held that parents should delay introducing potentially-allergenic foods like eggs, nuts or fish to kids at high risk for food allergy for anywhere from 1-3 years. However, there is surprisingly little evidence to support this practice. In fact, the most recent emerging research actually seems to point in the opposite direction: much of it seems to indicate that delaying introduction of certain foods too long may actually increase the risk of food allergy.
While there is not a large enough body of evidence to make definitive recommendations about timing food introductions to prevent food allergy, here are some of the most recent research highlights:
- Among 1,612 infants who were not at high-risk for allergy, delaying introduction of wheat until after 6 months was associated with a 4x higher risk of developing wheat allergy than introducing wheat before 6 months.
- Among over 10,000 Jewish children in the UK and Israel who were at high risk for developing peanut allergy, the prevalence of peanut allergy was 10x higher among children in the UK. The authors attributed this finding to the fact that Israeli infants were exposed to peanuts during early weaning and throughout infancy in greater amounts than infants in the UK.
- Among 994 Finnish children at risk for Type I diabetes, late introduction of eggs (>10.5 months), oats (>5 months) and wheat (>6 months) were most strongly associated with the risk of developing food allergy by age 5. There was also an increased risk of food allergy associated with late introduction of fish, meat, potatoes and rye (a more popular grain in Finland than here in the U.S.).
Although the research is not yet conclusive, as a dietitian, my recommendations would be as follows:
- If your child is at high risk for peanut allergy based on family history, avoid using soy formula during infancy unless medically indicated or your child is being raised vegan. A large study of almost 14,000 infants found that children fed soy formula or soymilk in their first 2 years of life had a 2.6x greater risk of peanut allergy than children in control groups at both low-risk and high-risk for allergies. Because soy and peanut are both legumes, it’s possible that early exposure to soy may sensitize infants to peanut protein due to a ‘cross-reactivity’ of their similar proteins.
- Start introducing solid foods between 4-6 months of age, when baby shows developmental readiness signs such as including minimally-supported sitting, head control, and interest in solid foods (like opening the mouth when a spoon is approaching or reaching for food when others are eating).
- Introduce one food at a time and separate new food introductions by 3-5 days so you can identify the cause of any possible allergic reactions more readily. Remember that even if baby seems not to “like” a new food, it doesn’t necessarily indicate an allergy; sometimes it can take multiple exposures to a new food before a child’s taste buds acquire a taste for it.
- Do not delay the introduction of potentially allergenic foods in infants unless they have been medically diagnosed with a food allergy. Introduce a variety of texture-appropriate foods in the first year of life, such as cooked cereals, soft breads and grain products (including wheat by 6 months), scrambled eggs (~7 months), soft-cooked fish and meat, cheese, yogurt and a variety of soft fruits and vegetables. If/when introducing peanut butter, provide only a very thin layer, as large amounts can be sticky and pose a choking hazard to young children.
- Wait until baby is 12 months old before introducing liquid cow’s milk, though texture-appropriate dairy products such as cheese, cottage cheese or yogurt can be introduced earlier (usually at about 9 months).
Tamara Duker Freuman, RD