When your baby starts to need more nutrients from food and is showing signs of interest, it's time to introduce solids. This can be a very scary concept for a lot of parents mainly due to the fears that might associate themselves with allergic reactions and choking. When researching about solids one of the popular practices is Baby Led Weaning which you can find out a bit more information about here.
Call in the Experts! So today we have asked Dietitian & Founder Olivia Bates from Nourishing Bubs about introducing allergens. She talks to us about which foods may trigger an allergic reaction in your baby. Olivia looks at peanuts, tree nuts, shellfish, soy, wheat, fish, eggs and cow's milk and how best to introduce these to your baby.
Watch the video for the full recap and you will find a summary below!
Incidence of food allergy has been increasing rapidly around the world. In Australia, we have one of the highest rates of food allergy. It reported that 10% of infants under 1 have a proven food allergy. The high incidence of food allergies has led to much research around the area. The LEAP (Learning Early About Peanut Allergy) study and EAT (Enquiring About Tolerance) study provided ground breaking evidence. It supported the early introduction of allergens, specifically peanuts and eggs which represent the most common allergens.
In 2016, ASCIA (Australian Society of Clinical Immunology & Allergy) released new guidelines for infant feeding and allergy prevention. This reflects the most up to date research findings, including that of the LEAP and EAT studies. These guidelines state infants should commence solids around 6 months, but not before 4 months. This represents a key window between 4 and 6 months where foods should be introduced. In particular, they specified that all allergens should be introduced by 12 months of age, even if considered high risk. (ie. Severe eczema or immediate family history).
While more research needs to be done around the precise timing of introduction of allergens, there is some evidence about eggs. Eggs should be one of the first solid foods given to baby, and should be offered before baby is 8 months old. It is important to note that once baby has tried the allergen, it should be consumed as a regular part of the diet (at least twice a week).
Here we will go through the each of the allergens and provide appropriate ways to offer them and incorporate into baby’s diet.
Peanuts are appropriate to offer baby any time from 6 months on, however it must be done in an appropriate form. Smearing peanut butter (or other allergens) on baby’s skin is unlikely to illicit a reaction and does not indicate whether or not baby has an allergy. Secondly, whole nuts and globs of peanut butter should be avoided as these present a choking hazard.
Peanuts should be initially offered by smearing a small amount of smooth 100% pure peanut butter on the inside of baby’s mouth. Baby should be observed for 5 minutes and if no reaction occurs a 1/4 a teaspoon of peanut butter can be offered to them. Once initially trialled, peanuts can be offered in a variety of ways. Eg mixing a small amount of peanut butter with breast milk or formula. Mixing with previously tolerated foods such as porridge, cereal, yoghurt (if dairy tolerated), chicken or tofu. Or mixing with previously tolerated vegetable or fruit purees. Peanut snacks such as peanut puffs; incorporated into baked goods, with previously tolerated ingredients.
There is a lower incidence of allergy to tree nuts in comparison to peanuts, however they are still considered an allergen and should be offered in the same way as peanuts. It is important when trialling the tree nuts that each one is offered on its own for 3-4 days before progressing to a new one. This way it is easier to determine which tree nut is responsible for the allergy.
A child may have an allergy to one tree nut such as cashews or pistachios but not others, so it shouldn’t be assumed if they are allergic to one, that they will be allergic to others. A skin prick tick will usually be carried out by the allergist to determine which nuts a child is allergic to, if they do have a suspected allergy.
Fish is highly nutritious and a great addition to baby’s diet. Once baby is consuming 3 solid meals per day, fish should be offered 3 times per week. It is important to make sure all fish offered to baby is deboned and well cooked. Their immune systems are still not fully formed and more susceptible to food borne illness. Fish should be baked or poached until cooked through and then flaked into a previously tolerated puree. This will help increase baby’s acceptance of it. Initially, you will need to puree this again until a smooth consistency is reached. As a baby develops and is able to tolerate lumpier purees flaking the fish into a smooth vegetable puree.
Like fish, shellfish is highly nutritious. When offering to baby it is important to ensure there is no shell left on as this can represent a choking hazard. While there is no specific order in which you need to offer the different varieties of shell fish, it is important to introduce one at a time for 3-4 days to observe for any allergy. Crab and lobster are generally a little easier to puree as well. For those following a conventional method of feeding purees, these two foods may be preferred starting options and once again, are best combined with a previously tolerated vegetable puree.
It can take a little longer for baby’s digestive systems to handle grains. It is often recommended that wheat only be introduced after baby has tolerated non-gluten (eg. Rice and quinoa). Once foods such as quinoa and rice have been tolerated, wheat can be offered in the form of pasta or bread. Pasta should be well cooked and again mixed with a previously tolerated food and pureed to ensure smooth consistency. Bread can be offered, usually with a spread such as avocado. This will provide some wetness and make it easier for baby to suck on, until it dissolves.
Soy is a great source of meat-free protein and is found in many packaged foods (soy lecithin is a common food additive). Initially soy can be offered in the form of soy milk which may be mixed into porridge, cereal or purees. Silken tofu which is very soft can also be pureed and mixed into a previously tolerated vegetable puree as a way of exposing baby to soy. It can also boost the protein content of the meal. As baby gets older and is able to handle finger foods (usually by 9 months), firm tofu can be marinated and cooked and offered to baby as well.
Research suggests eggs should be one of baby’s first solid foods and should be introduced before 8 months of age to aid in allergy prevention. Eggs should be cooked whole (white plus yolk) and all the way through. Initially it is best to either hard boil the egg or make a firm scramble. A quarter of a teaspoon of egg can then be mashed into a previously tolerated vegetable puree. If this is tolerated, the amount offered can be gradually increased and offered on its own or mixed with other foods as you wish.
Cow’s milk allergy is different to lactose intolerance and refers to an allergy to the protein in cow’s milk. You may have heard that cow’s milk should be avoided before baby turns one? This simply refers to displacing a bottle of breast milk or formula milk with a bottle of cow’s milk. This is because cow’s milk has a different nutrient profile. In particular it is higher in protein that breast milk or formula and thus it may put undue stress on baby’s kidneys. Cow’s milk can safely be incorporated into baby’s diet before the age of one through offering dairy products. EG yoghurt and cheese, as well as in porridge/cereal, pancakes and baked goods made with other previously tolerated foods.
Important note:Check out more resources on the Nourishing Bubs Blog.Accredited Practising Dietitian & Founder, Nourishing Bubs