Weaning for Allergy Prevention
Weaning advice for families that have already been assessed in our specialist clinic.
Most paediatric guidelines throughout the world suggest first introducing single-ingredient foods between 4 and 6 months of age, one food at a time.
Based on our landmark LEAP and EAT Studies, there is a particular emphasis on peanuts and, to a lesser degree, the introduction of cooked eggs, but recommendations now generally extend to all common food allergens (geographic location depending)
In the UK, the focus should be to introduce at least the following sesame, peanut, cashew (which shares allergens with pistachio) and walnut (which shares allergens with pecan nut).
Trust your ‘maternal/paternal instincts’, and when your baby appears hungry despite adequate milk intake (e.g. waking at night, hunger cries more frequently, following and grasping at foods, tongue thrust reflex lost...), then commence weaning.
There is no need to wait until six months of age; most infants will demand additional nutrition before this age.
If your child has eczema, the chance of developing a food allergy is substantially higher, so this must be treated “practively’ and early weaning becomes a priority and ideally you should aim to wean betwen 4-6 months. Doing so at 6 months may be too late for many infants.
Initial weaning foods in the Western diet typically include rice or oat cereals, yellow/orange vegetables such as sweet potato, squash, carrots, fruits, e.g. apples, pears, bananas, and green vegetables. There is, however, little evidence that any specific sequence is superior; the priority is for foods that are safe to swallow and have dietary diversity.
It is typical for acidic fruits and the nightshades, e.g. berries, tomatoes, citrus fruits, aubergine, tomato and some vegetables, to cause, upon contact with the skin, localized, peri-oral reactions that may include an erythematous rash (even urticaria) due to irritation from the acid in these foods and high levels of histamine-releasing compounds within the foods, respectively. These do not usually result in systemic reactions; therefore, delayed introduction of such foods is not recommended. Such foods will be best tolerated when cooked and if a thick emollient is applied to any dry skin or eczema on the checks.
Even highly allergenic foods such as peanut, cashew and sesame may be introduced as weaning foods (if the tests were negative to that food in high-risk babies).
Allergenic foods are healthy and typically rich in protein and healthy foods, e.g. peanut, egg, milk, cashew, sesame …
The Food Standards Agency has details on other foods to be avoided in the first year for reasons other than allergy concerns, e.g. whole cow’s milk (not appropriate in make-up for children's needs, dairy products are fine (if NOT milk allergic), honey (risk of Botulism), certain fish species, under-cooked egg (risk of Salmonella), whole nuts (risk of choking).
For families who have been seen in our practice, more detailed advice will be provided regarding feeding regimens, such as amount, frequency, and specific foods.