Learning how to introduce allergens to babies is essential for preventing food allergies and managing fussy eating. Recent evidence suggests that introducing allergenic foods early, even in babies with a family history of allergies, can reduce the risk of developing those. In this blog, we will explore how to safely introduce allergens and why it is crucial not to avoid them entirely, even if you have concerns about food allergies. We will also dive into the relationship between allergies and feeding difficulties—two issues that often go hand-in-hand.
Understanding Allergic Reactions
Adverse food reactions can be broadly categorised as either allergies or intolerances. Food allergies involve an immune system response to proteins in food, leading to various reactions:
- IgE-mediated reactions: These are immediate reactions, including symptoms like hives, swelling, vomiting, and in severe cases, anaphylaxis.
- Non-IgE-mediated reactions: These are delayed immune responses that may cause gastrointestinal symptoms such as diarrhea, vomiting, or blood in the stool.
In contrast, non-immune-mediated reactions (commonly known as food intolerances) do not involve the immune system. For example, lactose intolerance leads to discomfort like bloating or gas but does not trigger allergic symptoms.
Why Early Allergen Introduction is Important
Studies, such as the LEAP (Learning Early About Peanut) study and the EAT (Enquiring About Tolerance) study, have shown that introducing allergenic foods like peanuts, eggs, and gluten between 4-6 months can help reduce the likelihood of developing food allergies. The window between 4-12 months is seen as critical for developing tolerance.
This research is especially relevant for high-risk infants—those with eczema or a family history of food allergies. Contrary to earlier advice, like when my kids were little, delaying the introduction of allergens increases the risk of allergies.
Gluten Introduction
Even for families with a history of celiac disease, introducing gluten during this window (while breastfeeding, if possible) may help reduce the chances of developing coeliac disease an auto-immune disease, not an allergy.
Should You Avoid Allergens If There’s a Family History of Food Allergy?
It may be tempting to avoid introducing certain foods if food allergies run in the family, but recent guidelines suggest the opposite. Introducing small amounts of allergens early can help the immune system build tolerance, reducing the chances of developing an allergy later in life. For example, peanut butter can be introduced in small amounts to babies, even with a family history of peanut allergies.
However, for high-risk babies, it’s recommended to consult a healthcare provider such as a paediatrician or allergist before introducing allergens. These professionals can help you create a safe, individualised plan and may suggest introducing allergens in a controlled setting, like a doctor’s office.
Feeding Difficulties and Allergies: A Chicken-and-Egg Scenario
Children with feeding difficulties, such as selective or fussy eating, are more likely to have food allergies, and vice versa. According to research such as the PediEAT study (Paediatric Eating Assessment Tool), feeding behaviours can be complex, often intertwined with allergic reactions.
Common Behaviours Noted in Children with Allergies
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Physiologic Symptoms: Gagging, coughing, or difficulty swallowing, which may be misinterpreted as fussy eating but could indicate an allergic reaction.
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Problematic Mealtime Behaviours: food refusal or avoidance, often due to negative experiences linked to eating certain foods.
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Selective/Restrictive Eating: children may instinctively avoid foods that cause discomfort or allergic reactions, limiting their diet to safe options.
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Oral Processing Issues: challenges with chewing and swallowing, which can overlap with allergic reactions and lead to food aversions.
The PediEAT study shows that children with feeding difficulties may experience a cycle where aversions are exacerbated by physiological reactions, leading to heightened mealtime concerns.
Link Between Fussy Eating and Food Allergies
The relationship between fussy eating and allergies is bidirectional:
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Children with food allergies may develop fussy eating behaviours as a way to avoid foods that cause discomfort.
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On the other hand, fussy eaters who avoid certain foods may miss out on the opportunity to develop tolerance to allergens, increasing their risk of developing food allergies.
Early introduction of a variety of foods, especially allergens, can help prevent this cycle. Varied exposure to different tastes and textures during the critical 4-6 to 12 month window may not only reduce the risk of allergies but also promote more adventurous eating.
How to Safely Introduce Allergens
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Start Small: Offer a tiny amount of the allergenic food first. For example, mix a small amount of peanut butter with breast milk, formula, or offer finely mashed eggs. Once you’re reassured there is no reaction, ensure the food is regularly included in your baby’s diet to help build tolerance. A one-off exposure could be counterproductive.
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One Food at a Time: Introduce allergens one at a time with a 2-3 day gap between each new food. This gives you time to monitor for any potential reactions.
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Watch for Signs of Allergies: Be alert for symptoms like hives, swelling, vomiting, or difficulty breathing. If these occur, stop feeding the food and seek medical advice.
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Continue Breastfeeding: Continue breastfeeding as you introduce allergens. Some studies suggest that breastfeeding alongside solid foods may provide added protection against developing food allergies.
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Frequency Matters: Once introduced successfully offer the allergenic food 2-3 times a week to maintain tolerance.
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Supervise Closely: Always supervise your baby when feeding allergens, especially during the first few exposures. If your child is at higher risk for allergies, consult with a healthcare professional before introducing allergens and have an emergency plan in place.
General Guidance for Allergenic Foods
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Texture is Key: Match the texture of foods to your baby’s developmental stage. Younger infants should have well-mashed or pureed foods, while older infants can handle more solid forms as their chewing and motor skills develop.
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Timing: After each new allergen, wait 2-3 days to monitor for potential allergic reactions before introducing another allergenic food.
Food-Specific Recommendations
Dairy and Cow’s Milk
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Yogurt and Cheese: For 4-7 months, offering plain yoghurt. For a more advanced stage (10-12 months), introduce cheese in small cubes or grated, always soft or meltable. Yogurt can also be mixed with iron-fortified cereals to ensure adequate iron intake.
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Hard Cheeses: By 10-12 months, harder cheeses (like cheddar) can be introduced in small pieces, helping babies practice chewing.
Soy
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Silken Tofu: At younger stages (4-7 months), silken tofu can be mashed with other purees or even mixed into a cereal. For 7-9 months, soft or silken tofu can be cut into small, manageable pieces or strips.
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Soy Sauce Alternatives: If introducing soy, consider limiting or diluting soy sauce due to its high sodium content. You can also offer soy-based smoothies made with fortified soy milk.
Eggs
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Scrambled Eggs: Scrambled eggs can be offered as finger foods for babies over 7 months. These can also be blended with purees or cereals for an easier texture.
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Baked Goods: Egg-based foods like pancakes and muffins are excellent options for introducing eggs in a baby-friendly form. Ensure no choking hazards by mashing or crumbling.
Wheat
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Wheat Bread: Soft wheat or wholegrain bread pieces can be an option for 7-9 months, but ensure they are moist (like with a spread) to avoid choking.
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Variety: Whole wheat pasta, couscous, and other grains provide additional textures and can be combined with vegetables or protein sources like fish or tofu.
Peanuts and Tree Nuts
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Dilution: smooth peanut, tree nut butters must be thinned out with water or mixed into baby cereal or purees.
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Puffs: Peanut butter puffs are also an effective way to introduce peanuts safely.
Fish
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Variety of Fish: Ensure you are providing a variety of fish like salmon, sardines, or cod. These are rich in omega-3 fatty acids, crucial for brain development. The soft texture of canned fish (as you mentioned) is perfect for younger babies.
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Avoid High Mercury Fish: Stick with low-mercury options and avoid fish like swordfish and shark.
Shellfish
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Texture Consideration: For younger babies, shellfish should be well-cooked and finely pureed to minimise the risk of choking. By 9-12 months, small pieces of cooked shrimp or crab can be offered, finely chopped.
Sesame
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Tahini-Based Foods: In addition to hummus, sesame seeds can be introduced through tahini-based dips mixed with yoghurt or pureed vegetables for younger babies. As they grow, spreads like hummus on soft crackers or bread are great choices.
Key Takeaways for Parents
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Introduce Allergens Early: Studies suggest that introducing allergenic foods between 4-6 months may reduce the risk of developing allergies, even in babies with a family history of allergies.
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Watch for Reactions: Be mindful of signs such as gagging, coughing, vomiting, or swelling, which could indicate an allergic reaction. Always consult a healthcare professional if you notice any concerning symptoms.
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Don’t Avoid Allergens: as you embrace the chance to introduce allergens early, you can help build your baby’s tolerance and confidence with food, and take a positive step towards a healthier future. In other words even if food allergies run in the family, eliminating allergens from your baby’s diet can increase the risk of allergies.
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Consult a Healthcare Provider: If your child has eczema, asthma, or a family history of food allergies, consult your doctor or allergist before introducing allergens. They can offer guidance and may recommend introducing allergens in a controlled environment.
Balance Early Introduction with Caution
Introducing allergens to your baby does not have to be a stressful experience. By understanding the science behind early allergen introduction and working closely with healthcare professionals, you can help reduce your baby’s risk of developing food allergies while promoting healthy, varied eating habits. Additionally, being mindful of the link between food allergies and feeding difficulties can help you navigate mealtime challenges with more confidence.
