Weaning for Allergy Prevention
Weaning advice for families that have already been seen and tested in the clinic by Dr Du Toit
Most paediatric guidelines suggest first introducing single-ingredient foods between 4 and 6 months of age, one food at a time
Based on our landmark LEAP and EAT Studies, there is a particular emphasis on peanuts and, to a lesser degree, the introduction of cooked eggs, but recommendations now generally extend to all common food allergens (geographic location depending); in the UK, this would be to at least the following sesame, peanut, cashew, walnut.
Trust your ‘maternal/paternal instincts’, and when your baby appears hungry despite adequate milk intake (e.g. waking at night, hunger cries more frequently, following and grasping at foods, tongue thrust reflex lost...), then commence weaning.
There is no need to wait until six months of age, the majority of infants will demand additional nutrition before this age.
If your child has eczema, the chance of developing a food allergy is substantially higher and so this must be treated “practively’ and early weaning becomes a priority; these are the only two strategies for the prevention of food allergy.
Initial weaning foods in the Western diet include rice or oat cereals, yellow/orange vegetables such as sweet potato, squash, carrots, fruits, e.g. apples, pears, bananas, and green vegetables. There is, however, little evidence that any specific sequence is superior; the priority is for foods that are safe to swallow and have dietary diversity.
It is typical for acidic fruits and the nightshades, e.g. berries, tomatoes, citrus fruits, aubergine, tomato and some vegetables to cause, upon contact with the skin, localized, peri-oral reactions that may include an erythematous rash (even urticaria) due to irritation from the acid in these foods and high levels of histamine-releasing compounds within the foods, respectively. These do not usually result in systemic reactions; therefore, delayed introduction of such foods is not recommended. Such foods will be best tolerated when cooked and if a thick emollient is applied to any dry skin or eczema on the checks.
Even highly allergenic foods may be introduced as weaning foods (if the tests were negative to that food in high-risk babies).
Allergenic foods are healthy and typically rich in protein and healthy foods, e.g. peanut, egg, milk, cashew, sesame …
The Food Standards Agency has details on other foods to be avoided in the first year for reasons other than allergy concerns, e.g. whole cow’s milk (not appropriate in make-up for children's needs, dairy products are fine (if NOT milk allergic), honey (risk of Botulism), certain fish species, under-cooked egg (risk of Salmonella), whole nuts (risk of choking).
For families that have been seen in our practice, more detailed advice will be issued with respect to feeding regimens e.g. amount, frequency, specific foods …
Herewith a link to the helpful Baby’s First Website as well as the British Society of Allergy and Clinical Immunology recommendations regarding early weaning