Introducing food to babies is an exciting time in a baby’s development. But for many parents it can be challenging. Parents often worry about the risk of allergic reactions to foods, and conflicting advice can be difficult to navigate.
I am a mum to a two-year-old and a GP with a special interest in allergy and paediatrics. During our weaning journey it became clear early on that our daughter had an egg allergy. We often worried about her having a reaction, and we had to learn to navigate the complexities of allergen labels on packaging and how to eat out safely. So here are some of the things we learnt along the way, some practical tips to make weaning simple, and what the latest evidence tells us about minimising the risk of a food allergy developing.
It is recommended that most babies start food around six months of age. Two large UK trials, called LEAP and EAT, revolutionised our understanding of allergy and changed public health advice from avoiding allergens, as we did in the 1990s and early 2000s, to introducing them within the first year of life. These studies found that infants given peanut and egg early in life were significantly less likely to develop a food allergy to those foods. In babies who are at higher risk of developing a food allergy, research has shown that introducing food from four months of age can reduce the risk, and it is important that allergenic foods such as egg and peanut are introduced early. Babies at higher risk are those with eczema and those who already have a food allergy, but early weaning should be under the guidance of a healthcare professional.
Not every allergy can be prevented. Some children will already be allergic, and some will go on to develop an allergy whatever we do. But we can reduce the risk. In babies, the most common food allergy is to milk, which affects three in 100 infants. The next most common is egg, followed by peanut. Soy, wheat, tree nuts, sesame seeds and fish are also known as allergenic foods.
So how do you go about weaning? Many parents opt to offer a mix of purees and finger foods. Introduce one food at a time, starting with a vegetable, and only start a new food when your baby is well. When we are unwell, our immune system is primed to deal with the infection, which means it can get confused and incorrectly see the food as a threat.
After introducting two or three vegetables, start to introduce egg. Hard boil a lion-stamped egg, mash it up, and add some of it to one of the vegetable purees your baby has already tried. Give a small amount to begin with. As a rule of thumb, start with the tip of a teaspoon and slowly increase the amount over the course of one or two meals. If your baby isn’t interested, try again another day. Monitor for signs of a reaction, and stop the food if you are concerned.
Peanut is the next allergenic food to introduce. Take a teaspoon of smooth peanut butter and add it to one tablespoon of your baby’s normal milk. This can be formula, expressed breast milk, or water if you are unable to express. Mix it up to thin the peanut butter, then start with a small amount.
The other allergenic foods can be started in any order, and it is recommended that all of them are introduced by the age of one. These include cow’s milk, tree nuts (almonds, cashews, hazelnuts, pecans, pistachios, walnuts, Brazil nuts, macadamia nuts), wheat, sesame and fish.
Once a food is in your baby’s diet, keep offering it regularly, once or twice a week. This part matters: if a food is stopped for a period, an allergy can develop when it is reintroduced.
Spotting an allergic reaction can be tricky, as the symptoms can be subtle. Some reactions happen quickly, usually within an hour of eating the food. These are known as immediate, or IgE mediated reactions. Other reactions happen more slowly, with symptoms appearing several hours after eating the food. These are known as delayed, or non-IgE mediated reactions.
Immediate Food Allergy (IgE mediated)
Typically, within 1 hour of eating the food
Mild-moderate symptoms:
- Swelling of the lips, face or eyes
- Itchy rash (hives)
- Vomiting
Severe symptoms:
- Swelling of the tongue, hoarse cry, persistent tongue
- Difficulty breathing
- Pale or floppy, unconscious
What should I do?
- If severe symptoms (anaphylaxis) call 999 immediately
- If mild-moderate symptoms, stop the food and do not reintroduce it
- Seek advice from your health visitor or GP
Delayed Food Allergy
(Non-IgE mediated)
Typically, hours after eating the food
Gut symptoms:
- Increase in vomiting or reflux
- Change in stools. Can be loose (more than 6-8 times per day) or worsening constipation
Skin symptoms:
- Redness of the skin or widespread itching
- Worsening eczema
What should I do?
- Stop the suspected food and symptoms should resolve within days.
- If the symptoms are mild, try the food again a few weeks later.
- If the symptoms recur or are severe, speak to your health visitor or GP
I am often asked if a baby can be tested for a food allergy before the food is given. Testing generally isn’t recommended. This is because the risk of a severe reaction is small, and testing could delay foods being introduced, which can increase a baby’s risk of developing an allergy. Testing can also misdiagnose an allergy, as people can have a positive test but not react to the food when they eat it.
Seeing your little one exploring new foods can be lots of fun. But be prepared: covering themselves, you, the high chair, the floor, the walls and the dog in pureed spinach may well happen!
If you would like more information on weaning, have a look at the websites by using the QR codes below. Your health visitor and GP are a useful first port of call for further advice. For specialist advice, I can assist with weaning, allergy testing and common infant feeding issues, and offer appointments in Allergy Clinic at Healthcare Group alongside my colleague Dr Vicky Carre.
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