Saturday, February 6, 2016

Can giving babies solids sooner prevent food allergies?

Christopher C. Chang, M.D., Ph.D., division chief of the division of pediatric allergy/immunology at Nemours/Alfred I. duPont Hospital for Children, weighs in a recent study that found introducing solid foods earlier to infants was associated with lower rates of allergies and asthma.

Can giving babies solids sooner prevent food allergies?


Rice cereal first and then vegetables? What about fruit? I get these questions often from my patients. The timing of when to introduce solid foods to infants can be confusing for parents, and the recommendations can vary slightly from doctor to doctor.

The research is ongoing, but there is a growing body of evidence which suggest introducing solid foods early may increase tolerance and reduce incidence of allergies.

In one recent study, researchers followed 3,781 Finnish children for five years to examine the association between duration of breastfeeding and timing of introduction of complementary foods and the development of allergic disease and specific IgE sensitization to foods and inhalants. (IIgE is an antibody involved in immune system response and allergic reactions.)

Introduction of wheat, rye, oats, and barley before age five and a half months, fish before age nine months, and egg before age 11 months was associated with lower rates of asthma, allergic rhinitis, and sIgE sensitization. Total breast-feeding duration of 9.5 months or more was associated with lower risk for nonatopic asthma (asthma not triggered by allergies, but most likely by an infection), and the benefit seemed to correlate with the duration of total breast-feeding rather than exclusive breast-feeding.

Another study showed that many parents in Israel give their babies a peanut spread called bomba and that there are fewer peanut allergies in Israel compared to other countries. But these are just two studies. In short, we can’t base our recommendations on two studies. More evidence is needed.

There is also no conclusive evidence that withholding solid foods in infancy provides health benefits, such as lowering the incidence of allergies and asthma. The current recommendations are to breastfeed exclusively for the first four to six months, after which solid foods may be introduced according to one’s preferences, culture and the advice of the baby’s physician.

Every doctor practices a little differently; some may advise introducing a certain order of solid foods, such as rice cereal first, followed by yellow vegetables, followed by orange vegetables – a typical progression based on what babies are likely to tolerate well. However, if your family eats a lot of fish, there is no reason not to offer mashed fish to a baby.

So while the jury is still out, I reiterate my advice to offer foods based on what the family would normally eat and their doctor’s recommendations. Be more concerned about food safety, i.e., don’t offer peanut butter, thinking you’re going to boost tolerance to peanuts, until you’re sure it doesn’t pose a choking hazard for the child.

Several years back, pediatricians recommended a progression something like this: no milk until age one, no eggs until age two, no peanut products until age three. This advice is not typically given nowadays, and our recommendations for the future may change yet again as more evidence is uncovered as to the optimal time to introduce solid foods.

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The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

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Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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