Question: My Family Has a History of Food Allergies. How Should I Feed My Infant?
Answer:
Parents often wonder if there's anything they can do to prevent food allergies in their children, especially if they themselves have food allergies, or if an older child does. The American Academy of Pediatrics (AAP) and the American College of Asthma, Allergy & Immunology (ACAAI) have both released guidelines intended to help prevent food allergies, or at least delay them, in children considered at high risk for allergic conditions. Most of these guidelines relate to breastfeeding, formula choices for non-nursing families, and timing of introduction of solid foods.
Breastfeeding
There have been several contradictory studies about the benefits of breastfeeding in preventing food allergies, with some studies showing little or no benefit from extended breastfeeding and others demonstrating a strong protective effect against allergies. However, the majority of studies about nursing and food allergies have demonstrated at least some benefit from breastfeeding.How long mothers need to nurse for their kids to get the benefits of breastfeeding is another controversial research question. One study in the October 2007 Journal of Pediatrics suggested that breastfeeding may need to be continued for nine months or more to protect against food allergies. A January 2008 position statement by the American Academy of Pediatrics indicated that exclusive breastfeeding for four months had some impact on preventing cow's milk allergy in high-risk infants. It may be worth noting that the World Health Organization recommends that children be exclusively breastfed until the age of six months, and thereafter for two years or more (along with solid food) as long as breastfeeding is pleasurable for both mother and child.
Infant Formula
Not every mother can breastfeed, and in some cases breastfeeding is a poor idea for other reasons (for example, when the mother must regularly take a prescription medication that passes through the breast milk and can affect her baby). For families with a very strong history of food allergies and whose mothers cannot breastfeed or who need to supplement with formula, the AAP recommends the use of hypoallergenic baby formulas. These baby formulas are made with cow's milk proteins that have been broken down (hydrolyzed) into their component amino acids. As a result, they are easy to digest. The AAP recommends extensively hydrolyzed formulas over partially hydrolyzed formulas for allergy prevention.Free amino acid-based (elemental) formulas are another hypoallergenic formula option, although the January 2008 AAP recommendations note that their potential to protect children from developing food allergies has not been widely studied.
Neocate, Elecare, and Nutramigen are among the more widely available brands of hypoallergenic infant formulas. Health insurance may cover the high cost of these formulas if your doctor prescribes them for your child.
Solid Foods
Your pediatrician will probably recommend exclusive breastfeeding or feeding with a hypoallergenic formula for a period of four to six months. When the time comes to wean your baby to solid foods, the ACAAI recommends that children in atopic families (that is, families with a history of allergies) be weaned slowly. Here are four principles to keep in mind:- Recommendations released in January 2008 by the AAP now recommend that solid foods not be introduced before four to six months of age, but that the timing of introducing common allergens (such as dairy, eggs, and nuts) is no longer believed to have an impact on a child's later probability of developing allergic diseases.
- The ACAAI recommends that even foods with a low likelihood of causing allergies (like simple fruits, vegetables, and less allergenic grains) be introduced one at a time, and not be combined until parents are sure that each individual ingredient is well-tolerated. Parents should note, however, that "stage 2" and "stage 3" commercial baby foods -- even from organic and natural manufacturers -- may include unexpected grains or fillers. Always check ingredient labels.
- The ACAAI recommends that fruits and vegetables be introduced in their cooked form, as many of them are less allergenic when cooked.
- Parents concerned about keeping track of which foods their infants can tolerate might consider making a food log during the period in which their child is being introduced to new foods.
Finally, parents should keep in mind that no matter how many precautions they take, there is no proven way to prevent food allergies in any particular child. These steps are simply believed to be good practices for reducing the risk of developing food allergies over large populations of children.
Sources:
American Academy of Pediatrics Committee on Nutrition. "Hypoallergenic Infant Formulas." Pediatrics. Aug. 2000 106(2): 346-49. 23 Dec. 2007.
Fiocchi, Alessandro, Amal Assa'ad & Sami Bahna. "Food Allergy and the Introduction of Solid Foods to Infants: A Consensus Document." Annals of Allergy, Asthma & Immunology. Jul. 2006 97(1): 10-21.
Greer, Frank R., et al. "Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas." Pediatrics. Jan. 2008 121(1): 183-91. 14 Jan. 2008.
Sicherer, Scott H. "Food for Thought on Prevention and Treatment of Atopic Disease through Diet." Journal of Pediatrics. Oct. 2007 151(4): 331-3. 23 Dec. 2007.
Snijders, Bianca E. P. et al. "Breast-Feeding Duration and Infant Atopic Manifestations, by Maternal Allergic Status, in the First 2 Years of Life (KOALA Study)." Journal of Pediatrics. Oct. 2007 151(4): 347-51.e2. 23 Dec. 2007.
World Health Organization. "Exclusive Breastfeeding." 2007. 23 Dec. 20007.
