As a pediatrician and Chief Medical Officer at SpoonfulONE, I've spoken with dozens of allergists over the last few years. Here are a few common questions I’ve discussed with many parents. I had a chance to interview and partner with Dr. David Jeong to provide a pediatric allergist’s perspective on these common questions from parents about feeding during infancy, the new recommendations, and ways to reduce a child's risk of developing food allergies. ~ Dr. Wendy Sue Swanson.
When do you recommend introducing common allergens other than peanuts?
There is data to confirm that the early introduction of peanut and egg as early as 4-6 months of age and before the first birthday can significantly decrease the chance of developing allergies.1 Currently, there is less data for other foods like cow milk/dairy, wheat, soy, tree nuts, finned fish, and shellfish. Nonetheless, I usually recommend parents introduce all common allergens during the crucial window of opportunity (4-6 months of age) and definitely before 1 year of age. Early introduction is better!
How many times, or for how long, do babies need to eat foods to reduce their risk of developing food allergies?
There is not one right answer to this question, as it is child-dependent. What appears clear is that timing, amount, frequency, and duration are ALL important. The LEAP Study, for example, examined the rate of peanut allergy after children ate 6 grams of peanut protein per week until 5 years of age, but some experts believe regular exposure to a food for as little as 1 to 2 years may be long enough to induce long-lasting tolerance.2 The most important points here are to introduce early, expose as often as possible and continue regular exposure at least through the first couple years of life.
How many of the common allergenic foods do you recommend introducing to infants?
All of them! No restrictions! Make sure they are age-appropriate for the current developmental stage and not choking hazards.
Is there a specific way parents should introduce foods, and do they need to feed one food at a time and wait between feedings?
To answer this question, I emphasize with parents a couple of key principles from current feeding guidelines, including introduction of all common food allergens as early as 4-6 months of age with maintenance in diet for ongoing tolerance as well as maximizing diversity of food exposures as early as possible. Because the benefits of these practices are so significant, introducing new foods even on the same day as early as possible may be the best strategy to prevent food allergies.
What is the order of introducing solid foods to infants?
There are common first foods that pediatricians often recommend, but there is really no specific order that infants must follow. The most important factors to consider are making sure the food is prepared appropriately for an infant’s developmental stage and avoiding high-risk exposures like choking hazards or honey.
David Jeong MD is the Section Head of the Allergy & Immunology Department at Virginia Mason Medical Center, a Clinical Researcher at Benaroya Research Institute in Seattle, WA, and a Medical Advisor to SpoonfulONE. At Benaroya Research Institute, he serves as a lead investigator on translational research studies focusing on the immune mechanisms of food allergy as well as for numerous clinical trials for food allergy therapeutics.
1. Ierodiakonou D, Garcia-Larsen V, Logan A, et al. Timing of Allergenic Food Introduction to the Infant Diet and Risk of Allergic or Autoimmune Disease: A Systematic Review and Meta-analysis. JAMA. 2016;316(11):1181-1192. doi:10.1001/jama.2016.12623 2. Du Toit G, Roberts G, Sayre PH, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372(9):803-813. doi:10.1056/NEJMoa1414850