Introduction of Allergenic Solids
Timing of the introduction of allergenic solids for high allergy risk infants
Food allergy affects an estimated 2% to 10% of the population. As a result, preventing food allergy is an important public health goal. There is emerging evidence that early introduction, between 4 to 6 months of age, may have a role in preventing food allergy, particularly for egg and peanut, in high-risk infants. Based on the current evidence, Southwestern Public Health supports and recommends the Canadian Paediatric Society’s ‘Timing of introduction of allergenic solids for infants at high risk’ position statement and the guidance found within the Ontario Dietitians in Public Health Pediatric Nutrition Guidelines (Birth to Six Years) for Health Professionals document:
- Infants considered to be at high-risk for allergic disease have either a personal history of atopy, including eczema, or having a first-degree relative with atopy (e.g., eczema, food allergy, allergic rhinitis, or asthma).
- For high-risk infants, and based on developmental readiness, consider introducing common allergenic solids at around 6 months of age, but not before an infant is 4 months of age. Common allergenic foods include milk products, egg, peanut, tree nuts, fish, shellfish, wheat and soy.
- For infants at no or low-risk for food allergy, introducing complementary foods at about 6 months is recommended.
- Breastfeeding should be protected, promoted and supported for up to 2 years and beyond.
- Allergenic foods should be introduced one at a time, to gauge reaction, without unnecessary delay between each new food.
- If an infant appears to be tolerating a common allergenic food, advise parents to offer it a few times a week to maintain tolerance. If an adverse reaction is observed, advise parents to consult with a primary care provider about next steps.
- The texture or size of any complementary food should be age-appropriate to prevent choking. For young infants, smooth peanut butter can be diluted with water or mixed with a previously tolerated puréed fruit or vegetable, or with breast milk. For older infants, smooth peanut butter can be spread lightly on a piece of thin toast crust, or a peanut puff product could be offered.
References:
- Canadian Paediatric Society: Timing of introduction of allergenic solids for infants at high risk
- Ontario Dietitians in Public Health: Pediatric Nutrition Guidelines (Birth to Six Years) for Health Professionals