By Carolyn Sax, MD, a primary care physician with the Pediatric Physicians’ Organization at Children’s and practices at Hyde Park Pediatrics in Hyde Park, Mass.
In an effort to prevent food allergies, the American Academy of Pediatrics (AAP) has recommended introducing white rice cereal as an infant’s first food for years. Bland rice cereal was felt to be unlikely to cause digestive problems or allergies. Doctors suggested delaying a baby’s exposure to some of the more common food allergy triggers—milk, eggs, fish and nuts—until a child is between 1 and 3 years old, because they worried that exposure too early would stress a child’s immune system and increase the risk of developing allergies.
However, during the years that these recommendations were in effect, the number of children with food allergies skyrocketed. And, during this same time period, the rates of childhood obesity multiplied.
Is this a coincidence? Probably not.
Turning over a new leaf
These days the AAP and the American Academy of Allergy, Asthma and Immunology (AAAI), based on several studies, now recognize that delaying the introduction of foods that commonly cause food allergies doesn’t prevent food allergies—even in infants born into a family with a history of food allergies.
In fact, several studies have shown that introduction of foods like eggs, fish, milk and nuts when the baby is between 4 and 12 months old actually reduces a child’s risk of developing food allergy.
Current understanding of food allergies suggests that 6 to 12 months old may be a critical time when a baby’s immune system needs to meet a new protein to learn how to accept it, rather than fight it. Introducing a wider variety of foods and nutrients in that window helps to better educate and guide the infant’s young immune system as it develops.
Several recent studies as well as epidemiologic data support a new understanding of how and when solid foods should be introduced to infants. For instance, in Israel, a puff snack containing peanuts is one of the most common first foods mothers and fathers give their infants—and the rate of peanut allergy is 10 times lower in Jewish Israeli children than in Jewish children in the United States.
Similarly, studies of Celiac Disease have shown that the disease occurs less frequently in children who first eat wheat between 4 and 7 months, than in those given wheat for the first time after 7 months. Likewise, a Dutch study found that infants who began eating fish between 6 and 12 months had less asthma at 4 years old than children who did not begin eating fish until after their first birthday.
Based on these studies and many others like them, the AAAI now recommends that:
Solid, single ingredient foods like fruits, vegetables and cereal grains can be introduced between 4 and 6 months
Common allergenic foods such as milk, eggs, wheat, peanuts, tree nuts, ﬁsh and shellﬁsh can be introduced anytime once a few other less allergenic solid foods like whole grain cereal, bananas, avocados or puréed meats have been tolerated.
Highly allergenic foods should be introduced for the first time at home, rather than at day care or a restaurant. These first tastes should be separated by a few days, so if an allergic reaction does occur, it will be easier to identify the trigger. During these trials, parents may want to keep some liquid diphenhydramine (Benadryl) in the medicine cabinet. If rash, swelling or vomiting occur after the introduction of a new food, families should call their pediatric provider immediately to be advised of the appropriate steps to take.
Bucking the white rice cereal trend
Contrasting with earlier views, more and more doctors agree that heavily processed white rice cereal may be a particularly unhealthy first food when compared with fresher, more natural foods. A recent study from the United Kingdom found that babies who do not develop food allergies ate more homemade foods like fresh fruits and vegetables, poultry and fish, as well as fewer pre-made and processed food, compared with babies who go on to develop food allergies.
White rice cereal, the most common first food in the United States, is highly processed and is metabolized by the body just like sugar, which I think most people would agree is not a quality first food choice. Letting babies develop a taste for this overly processed glop—the Wonder Bread of baby food—may set them on a course to prefer processed, low-fiber, high-sugar foods throughout their lifetime. This preference in turn may lead to a number of health concerns including heart disease and obesity.
When choosing your infant’s first solid foods, opt for healthy, fresh, homemade foods that are enjoyed by the rest of your family. For example, an infant’s first food could be puréed brown rice mixed with breastmilk, mashed avocado, stewed pears or meat purée, to name just a few. Once your baby has tolerated and enjoys eating a few of these foods, introduce more allergenic foods, one at a time.
Before introducing solid foods, it’s important that you talk with your pediatrician to ensure your infant is ready. And when the time is right, choose healthy, REAL food (not processed white rice cereal). As your infant begins to accept new foods, introduce eggs, fish, nut butters, milk and wheat—one at a time. Not only are these foods nutritious, their introduction may help to prevent food allergies in the long-run.