'I don't think you're ready for this jelly': Starting solids & food allergies

Immune tolerance is key to success in allergy prevention

Food allergies are common

Food allergy occurs in 5-10% of children in Australia with the most common triggers being egg, cow’s milk (dairy), peanuts, tree nuts, sesame, soy, wheat, fish and seafood (1). However almost all foods have the potential to cause an allergic reaction and some parents can become anxious about introducing solids to their baby for this reason.

Research recommends food exposures from age 4 months

The latest research demonstrates that delaying the introduction of potential food allergens until after 12 months of age can actually increase the chance of developing food allergies. It’s now recommended that babies start solids at around 6 months of age when they are developmentally ready and that they have food exposures from 4 months of age (but not before this). Food exposures can be licks from a finger or tastes from a parent's plate and research shows that these exposures might help prevent allergies (1). Remember that these are just small exposures of food, not complete meals as babies at 4 months of age still have a relatively immature digestive system and are usually not developmentally ready to start solids.

Allergy guidelines recommend introducing all common allergy causing foods by age 12 months because this introduction and immune tolerance may reduce the chance of developing food allergy. This advice includes babies with severe eczema, babies with a diagnosed food allergy and babies with first degree relatives with diagnosed food allergies. Smearing food on the skin will also not help to identify possible food allergies.

Introduction of common allergy causing foods

Families may choose to introduce a new food during the day time rather than the evening, or only introduce one new food at a time so they can monitor for potential reactions. Parents can rub a small amount of the food inside their baby’s lip as a starting point. If there is no allergic reaction after a few minutes, then introduce ¼ of a teaspoon of the food mixed with your baby’s usual food and if there is no allergic reaction, they can gradually increase the amount, for example to ½ teaspoon the next time.

Once your baby has started these foods, try to give them to your baby regularly (twice weekly is ideal), as part of a varied diet, to maintain immune tolerance. Trying a food once and then not eating it regularly may contribute to the development of food allergy. It is important to note that some babies may still develop a food allergy despite following this advice. If your baby has an allergic reaction, stop giving that food and seek medical advice.

Remember, delaying the introduction of a potential allergen might actually increase your child’s chance of developing food allergy. Dietary avoidance should only be undertaken under medical supervision, to prevent complications such as nutrient deficiency, food aversion or malnutrition. If your infant already has one food allergy, it's important to replace that food with a nutritional equivalent food to prevent nutritional deficiency. These families should discuss with their doctor how best to proceed.

Help! I think my child has a food allergy! Facial skin in babies is very sensitive and many foods (including citrus, tomatoes, berries) can irritate the skin and cause redness on contact – this is skin irritation, not food allergy.

Allergic reactions usually occur quickly, within minutes (although they can take up to 2 hours or be delayed). Symptoms of mild-moderate food allergy can include: - Swollen lips, eyes, face - Hives or welts on the skin - Vomiting and abdominal pain - Change in your baby’s behaviour (becoming very unsettled) If you notice any of these soon after giving a new food, your child could be having an allergic reaction. Stop feeding them the food and seek medical advice. Symptoms of severe allergic reaction (anaphylaxis) include:

- difficulty breathing - noisy breathing - tongue swelling - your child becoming pale and floppy or unresponsive

Call an ambulance immediately if there are signs of a severe allergic reaction (anaphylaxis). The most common foods that can cause anaphylaxis are peanuts, tree nuts, shellfish, milk and egg.

There is also a unique subset of food allergies called 'food protein-induced enterocolitis syndrome' (FPIES), which usually occur in infants less than 1 year of age. Commonly FPIES presents like a bad bout of gastroenteritis with profuse/projectile protracted vomiting, beginning 1-3 hours after ingestion of the allergen and also watery or bloody diarrhoea about 5-10 hours after ingestion. Other symptoms include lethargy, pallor, low blood pressure, and abdominal distension.

I’m pregnant: should I change my diet to help prevent my baby from developing food allergies? It’s not recommended that a pregnant mother exclude common allergy causing foods. It’s also not recommended that a breastfeeding mother restrict them in her diet either, if her child is otherwise well. Maternal exclusion diets have not been demonstrated to reduce the chance of children developing food allergies. Furthermore, the use of soy milk or goats milk formula over cow’s milk based formula does not prevent development of food allergies in children.

I have a family member with a food allergy and I’m concerned about introducing solids Although infants with a family history of allergic disease (such as asthma, eczema, and food allergies) are at higher risk of allergies, infants with no family history can also develop allergies. But whilst these allergic or ‘atopic’ genes do tend to run in families, it doesn’t mean that a specific food allergy will also be inherited. For example, just because a parent has a nut allergy, it doesn’t mean that their child will inherit the same nut allergy. Some tips to keep the other family member with food allergies safe:

- Clean up the kitchen and eating area promptly - Ensure everyone washes their hands after eating

- Clean utensils after food preparation and after eating the food - Keep face washers separate

If you have questions or concerns, then please message us via the website or contact your doctor.

About held.

held. proudly support families using the Possums Approach or Neuroprotective Developmental Care (NDC). It's a revolutionary way of supporting babies and their families that incorporates the latest neuroscience, gut science, lactation science, and sleep science. NDC is based on cued care: responding to your child in the way you think they are asking. held. are proudly the first accredited Neuroprotective Developmental Care Practitioner in Asia providing holistic evidence-based care in: antenatal education, sleep, settling, breastfeeding support and newborn care. held. is based in Hong Kong and provides online consultations to families all around the world. Click here to read more about our services

References:

(1) ASCIA patient resource ‘Food Allergy’ https://www.allergy.org.au/patients/fast-facts/food-allergy (accessed 10/9/20)

(2) ASCIA Guidelines - Infant feeding and allergy prevention https://www.allergy.org.au/hp/papers/infant-feeding-and-allergy-prevention (accessed 8/9/2020)

About the author:

Dr Clementine David is an Australian trained paediatrics doctor, the CEO and Founder of held. and a mum of two young children who love both broccoli and ice cream!

Tags: Starting solids, food allergies, food allergy, pregnancy, what does food allergy look like, when should I start my baby on solids