Feeding the Infant With Possible Food Allergy: What's Best?

Jennifer S. Kim, MD

Disclosures

June 18, 2014

Introducing Solid Foods

The AAP recommends that complementary foods not be introduced until an infant is at least 4 months old.[2] The expert panel from the European Society for Pediatric Allergology and Clinical Immunology recommends introducing complementary foods between 4 and 6 months of age in breastfed or formula-fed infants.[3] The World Health Organization recommends exclusive breastfeeding for the first 6 months of life.[4]

Previous AAP recommendations had advised delaying introduction of highly allergenic foods in infants at high risk for allergic disease to prevent the development of future allergy. In a recommendation published in 2000, parents were advised to delay cow's milk until age 1 year; eggs until age 2 years; and peanuts, tree nuts, and fish until age 3 years.[5] However, in January 2008, the AAP Committee on Nutrition and Section on Allergy and Immunology published an updated Clinical Report based on a careful review of literature published subsequent to that earlier recommendation.[2] The authors determined that there was no convincing evidence for delaying the introduction of specific highly allergenic foods. In consensus with this conclusion were other professional societies, including the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Committee and the Section on Pediatrics of the European Society for Pediatric Allergology and Clinical Immunology.[3]

Feeding solids before 4 months of age was associated with a higher incidence of atopic dermatitis 10 years later in unselected populations of children.[6,7,8] However, no current evidence suggests that delaying introduction of solid foods beyond 4-6 months of age will prevent allergic disease.[9,10,11,12]

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