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Allergies and Starting Solid Foods

What About Children at High Risk for Allergies?

Children at high risk for allergic conditions are defined as those with either a parent or sibling with an allergic condition (atopic dermatitis, food allergy, asthma, or allergic rhinitis).
 
You might have read that in these cases, parents should wait to introduce highly allergenic foods. This includes eggs, cow's milk, shellfish, peanuts, and tree nuts. However, based on many years of research, healthcare providers found that these recommendations did not decrease the chances that a baby would develop an allergic condition.
 
Now, in many situations, healthcare providers recommend that certain foods be introduced to infants at risk for allergies similar to the normal progression for infants not at risk for these problems.
 
This means that a parent should first make sure that their baby has accepted cereal, pureed meats, vegetables, and fruits without any adverse reactions. Then additional single foods can be introduced gradually, including foods that are more likely to cause allergies. This includes eggs, peanut butter, fish, shellfish, and tree nuts (although not whole because they would be a choking hazard).
 
One exception is cow's milk, which should not be given until an infant is one year of age. The reason for this is not because of its potential for allergies but because of other factors, such as because it is low in iron.
 

How to Introduce Solid Foods in High-Risk Children

The first thing to keep in mind is that every situation is different. Therefore, it is best to come up with a plan together with your healthcare provider before introducing solid foods in a child at high risk for an allergic condition.
 
This is especially important if your child:
 
  • Developed atopic dermatitis (eczema) while breastfeeding
  • Had an allergic reaction during or after breastfeeding
  • Has a sibling or parent with a more severe form of allergies.
     
If a child has no history of an allergic reaction or an allergic condition, your child's healthcare provider might recommend that highly allergenic foods be introduced in the following manner:
 
  • Start with a taste of the new food
     
  • Give your child the first taste at home (not at daycare or a restaurant)
     
  • Have an oral antihistamine, such as diphenhydramine (Benadryl®) or cetirizine (Zyrtec®) available in case of an allergic reaction.
     
  • If no allergic signs or symptoms occur over the next few days, offer the food again in increasing amounts over several days.
     
If your child does show possible signs or symptoms after eating the food, talk with your healthcare provider again before any new foods are offered, especially the highly allergenic foods.
 
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