Nuts! The milk, egg and nut recommendations are changing—again.

The recommendations are changing (insert collective sigh). As parents, we are used to it. “When can we turn our infant car seat around?” (That recommendation changed between our first and second child.) “What is our baby’s vaccine schedule?” (That answer changed after our second.) The good news is that as research advances in each field, we are able to make the best decisions concerning the health and care of our children.

The Journal of Allergy and Clinical Immunology: In Practice went straight for the hot button issue of infant food introduction in its January 2013 issue. In their article titled Primary Prevention of Allergic Disease Through Nutritional Interventions, summary statements were given for breastfeeding, diet during lactation, introduction of solid foods and the introduction of the most common culprits of food allergies. There is a marked difference in these recommendations versus the American Academy of Pediatric’s recommendations in 2000 that suggested delaying cow’s milk until age one, egg until age two and peanuts, tree nuts and fish till age three. Let’s touch on the major themes.

Avoidance During Pregnancy

At this time, no conclusive data exists to recommend specific avoidance diets during pregnancy. In fact those who pursue avoidance diets are cautioned to do so with the aid of a nutritionist to ensure adequate nutrition.

Avoidance During Lactation

Data is again inconclusive to recommend avoidance diets during lactation for normal infants. However, dietary interventions may be necessary in infants who are already showing signs of allergic disease.

Duration of Breast Feeding

The article maintains exclusive breast feeding is recommended for the first four to six months of life to reduce some diseases in the first few years of life including atopic dermatitis, wheezing and cow’s milk allergy. If infant formula is needed, choosing an extensively hydrolyzed or broken down formula may offer a benefit over partially hydrolyzed formulas.

Introduction of Solid Foods

It is recommended that solid food introduction be delayed until four months of age with exclusive breastfeeding until six months of age being preferred. Introduction of solid foods prior to four months of age has been associated with greater amounts of atopic dermatitis or eczema with a persistent effect even 10 years later. It is still recommended to introduce one food at a time every three to five days usually starting with rice or oat cereal, then vegetables and fruits followed by age-appropriate staged foods with meat.

Introduction of Highly Allergenic Foods

Once a child has been introduced to the more common grains, vegetables and fruits, introduction of some of the highly allergenic foods can proceed. It is now acceptable to ingest cow’s milk or egg in small quantities such as baked goods before the age of one. It is recommended to continue to avoid cow’s milk as a main drink or with other dairy products until age one for non-allergic reasons. It is still recommended to avoid whole peanuts and tree nuts for concerns of aspiration until felt no longer at risk. Otherwise, cooked milk and egg, nut butters and fish are okay as early as four to six months of life.

The authors of the article specifically state the report “provides general guidelines and suggestions.” They note, “There may be situations when it is appropriate to vary this advice…” If eczema develops, a food allergy already exists, blood work shows detectable allergic antibodies to a food in the absence of a reaction, or a sibling has food allergies, consultation with an allergist is recommended.

So who is frustrated the “no milk until age one, no egg until age two and no peanuts, tree nuts, fish and shellfish till age three” mantra has been thrown out only to find out earlier may be better? When my wife asked if our avoidance measures with our first child were unnecessary, I reminded her he had classic eczema and dietary avoidances measures still would have been reasonable…at least until the guidelines change AGAIN!

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Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.