How to Introduce Solids to Babies to Prevent Allergies

When it comes to food allergies and how to prevent them, recommendations have changed drastically over the last several years. But just what does that mean for you?

How to Decrease the Chance of Food Allergies in Kids

It used to be that doctors and researchers recommended waiting for several years before introducing highly allergenic foods into your child's diet. The thought was that by waiting to introduce common food allergens, a child's immune system would be less likely to react once they did ingest them. And then the risk of food allergies would be less.

In 2015, groundbreaking food allergy research was published in the form of the LEAP study. This study was the first of it's kind to find overwhelming evidence that introducing peanuts early was a great way to help with food allergy prevention.

By introducing allergens like peanuts right around when babies start eating solid foods, and continuing with frequent exposures for several years, we have a great chance at allergy prevention.

Since that study, there have been many more looking into the connection between introducing allergens early and the risk that a child will develop food allergies. Most of the studies to date have been done with peanuts, tree nuts, and egg allergies.

When it comes to the other common allergens, the research is still developing. We cannot say 100% definitively that early introduction will help prevent the development of food allergies.

But the science is promising enough that health organizations like the American Academy of Pediatrics recommend introducing common food allergens towards the beginning of solid foods, as well.

What Foods Are Babies Most Allergic To?

When it comes to foods, there are 9 foods that cause the majority of food allergies in the US. Every country will have their own list, although most are pretty similar.

The most common food allergens:

• Peanuts 
• Tree nuts
• Cow's milk
• Wheat
• Eggs
• Fish
• Shellfish
• Soy
• Sesame

While these are the top food allergy causing foods, it doesn't mean that other foods can't cause allergies. Almost any food can cause an allergy, these are just the culprits for the majority of food allergies.

When Should Babies Be Exposed to the Top Food Allergens?

When it comes to introducing allergenic foods for babies, their risk profile matters.

If your baby is not at risk for food allergies, the general recommendation according to health organizations like the American Academy of Pediatrics is to introduce the top food allergens to them right around the time you introduce solid foods. This is generally around 6 months of age.

Risk Factors for Food Allergies in Babies

Just how do you know if your baby is at risk for a food allergy? If your baby has previously had a food allergy diagnosed they are at high risk. We often see this specifically with an egg allergy. As eggs are a component of some vaccines, an allergic child might react during vaccination before starting solid foods.

If your baby has severe eczema, they are at high risk of developing a food allergy. If your baby has mild to moderate eczema, they are at an elevated risk, but not considered to be at severe risk.

When it comes to a family history of food allergies, the guidelines on risk are mixed. Some organizations recognize a close family member with an allergy as a risk factor, others do not.

If your child has a close family member, like a parent or sibling with a food allergy, it doesn't hurt to consider them high risk.

When a child is at risk for a food allergy, the recommendation is to talk with your doctor early about a plan for introducing foods. This should happen before 4 months of age. In some cases, your doctor might advise you to offer an allergen between 4 and 6 months of age.

What Order Should You Introduce Allergens In?

There is no particular food that needs to be served first, and no order where certain foods need to be served before others. When it comes to preventing food allergies, the key is to introduce allergens early, and to continue serving those foods as a normal part of their diet for several years.

What Speed Should You Introduce New Foods?

There is a common recommendation to serve a new food for 3-5 days before introducing other foods. This has been thought to ensure that a child isn't allergic to that food before moving on to others.

However, there was never any research to actually back up that recommendation. We know that people can develop allergies to foods at any point.

And we also know that introducing a variety of new foods to a baby's diet before they are a year is vital. We do have research that shows us the importance of that variety on their future food acceptance as well as allergy prevention.

Following the recommendation to introduce solid foods slowly, and serve the same foods repetitively, can interfere with introducing variety. It is no longer the recommendation to wait in between introducing new foods.

More: For more help with baby led weaning and how to help your baby succeed with eating, be sure to check out this article with a comprehensive guide to baby led weaning and first baby foods!

How to Introduce Baby to Allergenic Foods

If there's no order, does that mean there's no guidelines? Not necessarily!

The current generally accepted recommendations are to introduce a few non-allergenic foods first when introducing solid foods. Once they seem to be tolerating foods in general, you can start to introduce the allergens.

Introduce one allergen at a time, but it is fine to introduce them with other types of foods. When introducing one of the top 9 food allergens, plan to be able to watch your child for about 2 hours after they have ingested it. This is the most common time frame that a reaction would occur in.

Whether you practice a baby led weaning style of feeding and your baby eats finger foods, or you feed your baby using pureed foods, it is important to follow safety guidelines for introducing allergens.

Many allergens, like peanuts and tree nuts, can be choking hazards. Serving a child under 4 a whole nut is unsafe. When it comes to peanut butter, never serve your baby crunchy peanut butter. If serving smooth peanut butter, thin it out with water or breast milk and serve it with a spoon. You can also spread it on a piece of bread or stir it into oatmeal or yogurt for continued exposure.

For dairy foods, recommendations can be confusing. The overall recommendation is not to serve your baby cow's milk, or any other milk outside of breast milk or formula, before a year of age.

This recommendation is not related to allergies, however. It is there to help ensure your child is getting the nutrients they need, and cow's milk cannot provide that.

So while you don't want to serve your baby cow's milk to drink, it is totally fine to serve them dairy foods in general before a year.

Signs of a Food Allergy

With the recommendation to introduce the top 9 allergens early in your baby's eating journey, it is important to know what to watch for when it comes to an allergic reaction.

The signs of an allergic reaction in your baby are:

• Trouble breathing 
• Loss of consciousness
• Pale or blue skin in lighter skinned babies
• Repetitive cough, wheezing
• Hives, redness or itching
• Diarrhea or vomiting
• Swelling of lips or tongue
• Itchy/runny nose, sneezing

What to Do if an Allergic Reaction Occurs

Not all babies will have the same food allergy reactions.

If your child is showing signs of a mild reaction, such as an itchy or runny nose or a few hives, it is generally fine to wait to get an appointment with your health care provider and discuss the symptoms with them or an allergist.

If your child is showing signs of a severe reaction, such as difficulty breathing or loss of consciousness, call 911 and seek immediate treatment.

Food Allergy Symptoms vs Skin Reaction

Sometimes, it is hard to tell the difference between an allergic reaction and a contact rash.

In general, if your baby breaks out in a localized rash after eating a food, and that rash is only where the food has touched, then it is very possibly a contact rash. Your baby's skin is sensitive, and things like tomatoes and other acidic foods, cinnamon, and even butter can sometimes cause contact reactions.

If you are in doubt, it is always prudent to check with your child's doctor. This is not medical advice, and you should always check with a doctor if you have concerns about potential allergic reactions.

What to Do if Your Child is Diagnosed with a Food Allergy

When it comes to food allergies, it is important to understand that we can't prevent them all. Introducing a common allergen early and often helps us to greatly reduce the prevalence of food allergies.

But it won't reduce them all. Your child may still develop food allergies. If that happens, know that it is not your fault. It is hard to think that we might have been able to change something as a parent. But in many cases, there's nothing else we could have done.

If your baby has a diagnosed allergy, be sure to work closely with a healthcare professional. In most cases, a food shouldn't even be attempted to be reintroduced until after the age of 1. Your doctor will be able to provide you with specifics.

You can also find lots of resources on the FARE website, as well as Free to Feed.

If your child has more than one food allergy, I strongly recommend that you work with a registered dietitian. This can help to ensure that all their needs are being met and they have an adequate nutritional intake.

When it comes to multiple allergies, it can be really hard to ensure adequacy without outside help!