When to Introduce High Risk Foods to Kids

I decided to write this post after making a comment on Facebook and realizing few parents are aware of the new guidelines for introducing high risk foods to babies.  After doing some research, I also realized some pediatricians are not aware of the new guidelines either!  With all the allergies nowadays, it is scary giving your kid peanut products for the first time, so at the very least, we want to know what the experts are saying.  I put together a summary of what I found and if you want to investigate further, my sources are listed below.  My primary source is the American Academy of Allergy Asthma & Immunology (AAAAI).  These are the people the experts go to for clarification on this type of stuff!

The AAAAI recently did a review of literature and studies on food allergies.  Their findings where published in the their journal which you can access by clicking here.  The primary finding is that a delay in the introduction of solid foods, especially highly allergenic foods, can increase the risk of that child developing a food allergy.  Here is the  summary  of my findings (Note:  My list includes both highly allergenic foods and other high risk foods):

GUIDELINES

------First rule of thumb, before giving your child any highly allergenic food, introduce some of the basics first (rice cereal, pureed carrots, etc).  Do not make the high allergenic food the first one they try!!

------Second rule of thumb, after introducing the highly allergenic food and if there is no reaction, it can be increased in gradual increasing amounts. 

------Third rule of thumb, if your child has moderate to severe eczema that is poorly controlled with treatment; if your child has a sibling with severe food allergies; or if your child has shown a reaction to other foods, you should consult an allergist and/or pediatrician before introducing a highly allergenic food.  

------Fourth rule of thumb, new food should be introduced in intervals of 3-5 days. 



HIGH RISK FOODS

Yogurt and Cheese:  Introduce at 4-6 months based on existing studies. A note on cheese, do not give baby big chunks of cheese, it is a choking hazard.

Egg: Introduce at 4-6 months based on existing studies.

Wheat: Introduce at 4-6 months based on existing studies.

Soy: You may introduce at 4-6 months.  There are no studies showing early introduction or delay has any effect on the risks, but the experts do not think there is any harm in introducing it early.

Shellfish: You may introduce at 4-6 months.  There are no studies showing early introduction or delay has any effect on the risks, but the experts do not think there is any harm in introducing it early.

Fish: Introduce at 4-9 months based on existing studies.

Peanut or Tree Nut Butters: May be introduce at 4-12 months.  Do not give baby whole peanuts because of the high risk for choking and do NOT give them a spoonful of peanut butter for the same reason.  A little dab of peanut butter mixed in with something they already eat, may be a good way to start.

Honey: Introduce after 12 months.  This is NOT highly allergenic food but it in rare instances it may cause botulism in babies younger than one year old.

Cows Milk:  Not so much because of allergies, but due to other reasons, cow's milk as a drink should not be introduced until after the 1st birthday.  Milk products however like cheese and yogurt are okay before the first year.  Cow's milk in small amounts in baked goods or added to other foods the baby is already eating is okay too.

Popcorn, hot dogs, sausages, grapes, large uncooked chunky fruits or vegetables (carrots), marshmallows, gum, chewy sticky candy, chunks of peanut butter, chunks of meat:  Not highly allergenic, but because of the choking hazard, they should not be given before 4 years of age.  A special note on popcorn, the danger lies mainly with the little pieces of the kernel.  Those little bits can get stuck in the airway and cannot be forced out in a normal way (Heimlich Maneuver for example.) Also, use good judgement.  I give my 18th month old grapes, but I cut them in small pieces.



Sources:

Primary Source:  "Primary Prevention of Allergic Disease Through Nutritional Interventions" published by the American Academy of Allergy Asthma & Immunology

Other Allergy Sources: http://www.aaaai.org/ask-the-expert/introduction-of-solid-foods-into-the-diet-of-infan.aspx

http://www.niaid.nih.gov/topics/foodAllergy/understanding/Pages/Pregnancy.aspx

Honey Source: http://www.babycenter.com/408_when-can-my-baby-eat-honey_1368490.bc

Other High Risk Foods: http://www.med.umich.edu/yourchild/topics/choking.htm


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