Raising new little ones in an ever-changing world brings its own set of challenges. But when you're parenting in a pandemic, it becomes more important than ever to keep up healthy routines, including early allergen introduction.
Don’t wait on introducing new foods and especially new solids to your baby during the COVID-19 pandemic. Period.
Pediatricians all over the country, and elsewhere in the world, have talked with me about a new, heightened worry parents have with interventions right now, especially when it comes to prevention efforts. Parents are hesitating on seeing their pediatrician for vaccines, they are hesitating to do routine health visits, and they hesitate to do things that feel risky. New unfolding data in the past 5 years has made it increasingly clear that we gave the wrong advice about food introduction, creating both confusion, and worry in parents, when it comes to solid food introduction to infants. This is especially true with foods that are known common allergens, like peanut or egg, dairy or nuts, fish or shellfish.
Outdated pediatric advice from the past likely increased the number of children with life-threatening food allergies. From the year 2000 to about 2015, pediatricians like me recommended a delayed approach for certain foods to protect infants. Because of the erred approach, even as guidelines have changed for food introduction, parents have remained worried about introducing new foods for fear of a potential allergic reaction and the eventual need for a subsequent trip to the ER.
The increased worry today is rooted in parents’ concern that an ER visit could incur a COVID-19 exposure. Reality is, most babies will NOT have any reaction to any food introduction, especially if done at 4 to 6 months of age. Further, even in therare case of an IgE-mediated food allergy at first feeding, research shows the two most common signs of an allergic reaction for infants and toddlers are hives and vomiting, both of which often do not require a trip to the ER.
Feeding your baby all sorts of foods should and can feel free and celebratory, it does not have to feel scary. And you certainly don’t want to wait to introduce common allergens. The USDA now recommends feeding babies all the common allergens in foods you start right at 4 to 6 months of age when complementary foods are begun.
Also: in the very rare case of needing to see an ER for any reason during the pandemic know that there are numerous safeguards in place to ensure maximal safety and prevention against exposure to COVID-19 for every patient, staff member, and care provider that enters the hospital. Health care organizations, urgent cares, and ER offices have gotten very good at protecting patients from exposures in the last year or more. The safeguards and protocols in place at clinics and hospitals further decreases the risk of exposure to any viral or infectious pathogens.
When it comes to food allergies in babies, the true risk to babies at large, may be the tendency to dial back or wait on food introduction. Babies are at increased risk for development of food allergies if they are not introduced to potential allergens during infancy. They are are at lower risk when introduced early.
I spend the majority of my time working to help parents and pediatricians recognize the huge opportunity we have to prevent food allergies because of new science around how we feed babies. My strong and passionate recommendation is to encourage early and diverse food introduction to infants at 4 to 6 months of age. Once an infant shows signs of readiness (sitting without support and with good head control, opens mouth when food presented, shows excitement, and no tongue thrust when the food is in their mouth), introduce common allergens (peanuts, fish, egg, sesame, wheat, etc) regularly like you introduce fruits and veggies, meats and cereals. And keep at it so as your baby grows up, and their immune system does too. Help your child grow up to be able to eat everything!
5 Reasons To Encourage Early, Diverse Food Introduction and Inclusion:
Delaying introduction increases risk. The Canadian CHILD study demonstrates that avoiding during the first year increased the risk of food-specific sensitization.6 In fact, infants who were not introduced peanut by 12 months had 4 times increased chance of developing a food allergy.6 If families waited until 18 months the risk was 7 times as high as those babies who got peanut in and continued to eat it through infancy.
Allergic reactions in infancy and toddlerhood are rare, and when they present they are typically hives and vomiting. There was a recent Children’s Hospital study evaluating food reaction severity among a large pediatric population.7 Allergic reactions tend to get more severe as your baby gets older, so starting as early as possible is the safest way to feed potential allergens to your baby.7 “Severe (food allergic) reactions and mortality…are particularly low in infants,” with no food allergy deaths ever reported in infants under age 1 year.7Before your baby turns 1 is the safest time to feed them allergens like peanut, egg, milk, shellfish, tree nuts, etc in efforts to avoid becoming sensitive. If your child has severe eczema, risks for food allergy are higher so talk with your pediatrician and/or a pediatric allergist about making a good plan for introduction and keeping all sorts of common allergens in the diet as your baby grows.
Let’s enjoy feeding babies without such worry! Feeding babies is a beautiful, nearly spiritual experience. The introduction of solids can be a joy for both families and babies. As pediatricians, we need to begin to liberalize our approach to food introduction as joyful and healthful. And stop positioning food introduction in the framework of risk and fear. I want families to know that the more they introduce a wide variety of foods early in a child’s life, and keep that diverse diet all along, the better the prevention!
Get those foods in the tummy! Let babies learn first about food through their tummy, not their skin. About 70% of the immune system lives in the GI tract (mouth, esophagus, stomach, intestines) – the introduction of food should begin there, not elsewhere.8 This is especially during early, critical immune development. Research confirms the #1 risk for developing a food allergy is eczema (because the introduction of food first through the open skin in eczema tends to be sensitizing) therefore ensuring food introduction commences in the tummy will ensure those at highest risk avoid the increased likelihood of sensitizing events in infancy.9