Human milk provides virtually all the protein, sugar, and fat your baby needs to be healthy, and it also contains many substances that benefit your baby’s immune system, including antibodies, immune factors, enzymes, and white blood cells. These substances protect your baby against a wide variety of diseases and infections not only while he is breastfeeding but in some cases long after he has weaned. (read more here)
Breastfeeding and infant formula
- Breastfeeding is recommended for at least 6 months and for as long as mother and infant wish to continue. There is no consistent evidence that breastfeeding is effective for the prevention of allergic disease. However, breastfeeding is recommended for the many benefits it provides to mother and infant.
- Breastfeeding during the period that solid foods are first introduced to infants from around 6 months may help reduce the risk of the infant developing allergies, although evidence for this is low.
- If breastfeeding is not possible, a standard cow’s milk based formula can be given. There is no evidence that soy or goat’s milk formula reduce the risk of allergic disease when used in preference to standard cow’s milk based formula.
- Based on a recently published review of studies, there is no consistent convincing evidence to support a protective role for partially hydrolysed formulas (usually labelled ‘HA’ or Hypoallergenic) or extensively hydrolysed formulas for the prevention of eczema, food allergy, asthma or allergic rhinitis in infants or children.
- Regular cow’s, goat’s milk (or other mammal derived milks), soy milk, nut and cereal beverages are not recommended for infants as the main source of milk before 12 months of age.
*Ref: ASCIA 2016 guidelines (*this information is still current ,Jan 2018)
World Health Organisation (WHO) guidelines: for infants and young children
“In the first 2 years of a child’s life, optimal nutrition fosters healthy growth and improves cognitive development. It also reduces the risk of becoming overweight or obese and developing NCDs later in life.
Advice on a healthy diet for infants and children is similar to that for adults, but the following elements are also important.
- Infants should be breastfed exclusively during the first 6 months of life.
- Infants should be breastfed continuously until 2 years of age and beyond.
- From 6 months of age, breast milk should be complemented with a variety of adequate, safe and nutrient dense complementary foods. Salt and sugars should not be added to complementary foods.”
Ref: WHO reference
Introducing Allergenic Foods
Australia has been identified as the food allergy capital in the world and new infant feeding guidelines are currently being introduced to curb those statistics. The following new recommendations will clear up any confusion for parents:
2018 Key recommendations
- When your infant is ready, at around 6 months, but not before 4 months, start to introduce a variety of solid foods, starting with iron rich foods, while continuing breastfeeding.
- Introduce solid foods from around 6 months, but not before 4 months, when your infant is developmentally ready whilst continuing to breastfeed
- Signs that your infant may be developmentally ready to start solids include: being able to sit relatively unaided, loss of the tongue-thrust reflex that pushes food back out, and trying to reach out and grab food.
- All infants should be given allergenic solid foods including peanut butter, cooked egg and dairy and wheat products in the first year of life. This includes infants at high risk of allergy.
- Hydrolysed (partially and extensively) infant formula are not recommended for prevention of allergic disease.
- Infants differ in the age that they are developmentally ready for solid foods
- When your infant is ready, introduce foods according to what the family usually eats, regardless of whether the food is considered to be a common food allergen. There is some evidence that the introduction of common allergenic foods (including cooked eggs as raw egg is not recommended, peanuts, nuts, wheat, fish) should not be delayed. However further evidence is required to clarify optimal timing for each food.
- Cow’s milk or soy milk (or their products, such as cheese and yoghurt) can be used in cooking or with other foods if dairy products/soy are tolerated.
- There is good evidence that for infants with severe eczema and/or egg allergy, that regular peanut intake before 12 months of age can reduce the risk of developing peanut allergy. If your child already has an egg allergy or other food allergies or severe eczema, you should discuss how to do this with your doctor.
- There is moderate evidence that introducing cooked egg (raw egg is not recommended) into an infant’s diet before 8 months of age, where there is a family history of allergy, can reduce the risk of developing egg allergy.
- When introducing foods that other family members are allergic to, it is important to follow risk minimisation strategies to prevent cross contamination of allergens, for those who are allergic to the foods.
- It is important to understand that the facial skin in babies is very sensitive and that many foods (including citrus, tomatoes, berries, other fruit and vegemite) can irritate the skin and cause redness on contact – this is not food allergy. Smearing food on the skin will not help to identify possible food allergies.
- Some infants will develop food allergies. If there is any allergic reaction to any food, that food should be stopped and you should you should seek advice from a doctor with experience in food allergy.
Read all the 2016 Infant Feeding guidelines here. (Note, Jan 2018: The Infant Feeding guidelines on the ASCIA website are the current versions. The ASCIA resources are reviewed annually, however the documents will only be updated if there are changes in the literature).
- When giving your baby allergenic foods (i.e. eggs, dairy, nuts, wheat) you may like to offer your baby one of these new foods at a time, and wait at least 2 to 3 days before starting another. After each new food, watch for any allergic reactions such as diarrhea, rash or vomiting. If any of these occur, stop using the new food and consult with paeditrition or family doctor. (Ref: APP)
These new guidelines were shared at an international allergy conference in Melbourne in August 2016 where experts discussed research that could one day help children build their immunity.
How to introduce solid foods to babies for allergy prevention?
- When introducing foods to your baby, include those which may cause an allergy , within the first 12 months of life . Studies show that this may reduce the chance of your baby developing a food allergy.
- Start to introduce solid foods around 6 months, but not before 4 months , when your baby is ready .
- If possible continue to breastfeed your baby while you are introducing solid foods .
- Include cow’s milk, egg, peanut, tree nuts, soy, sesame, wheat , fish and other seafood .
- Once introduced, continue to regularly include these foods in your baby’s diet .
- This advice is based on evidence, including research in babies with severe eczema and egg allergy.
- Unfortunately, some babies may still develop a food allergy despite following this guide.
- If your baby has an allergic reaction, stop giving that food and seek medical advice.
More info here: https://www.allergy.org.au/patients/allergy-prevention
Content updated November 2017
According to the recent guidelines from the American Academy of Allergy, Asthma and Immunology, potentially allergenic foods like nuts are safe to introduce to babies as young as 6 months of age, once they have had exposure to a few typical first foods like cereals, fruit and vegetables. This is great news because nuts and nut butters like peanut, cashew, and almond are nutrition powerhouses, providing protein, beneficial fatty acids, vitamin E and minerals like manganese, potassium and iron. Lumps of nut butters are a choking hazard for small babies so try mixing it in foods or spread a thin layer over a long strip of toast to serve as a finger food.
Eggs are a great first food! They are easily digestible, and they offer the important nutrition your baby needs including iron, folate and choline, high-quality protein, plus vitamins A, D and E. Eggs are also a quick and easy meal to prepare. Just hard-cook an egg, make eggy bread, your could also mash the yolk and thin it with breast milk make it a dressing over foods etc. Hard-boiled and chopped egg white is a perfect finger food, as are scrambled eggs or omelets cut into thin strips.
Wheat Products i.e. Bread and Crackers
There are some parents that may think to limit gluten in their baby’s diet in the hope to reduce risk of developing celiac disease later in life. But although more research is needed on how to prevent celiac disease, there is now some evidence that keeping wheat away from babies is not helpful and may even increase their risk for this autoimmune disorder.
Introducing fish to your baby is simple, you can bake it, pan fry it or steam a boneless fillet. Cold-water fish including salmon, herring, canned salmon, canned tuna light or sardines are a great source of DHA in a babies diet. DHA plays a crucial role in retinal and brain development and is especially important for children in the first two years of life. (note: ensure all bones are removed from fish as they may be a choking hazard).
The Environemental Defense Fund (one of the world’s largest environmental organizations, with more than 1.5 million members and a staff of 500 scientists, economists, policy experts, and other professionals around the world) looks at safety of canned tuna and fish. There are two main kinds of canned tuna: chunk light and solid or chunk white (albacore). Most canned white tuna is albacore. Its mercury levels are almost three times higher than the smaller skipjack, used in most canned light tuna.
The following are recommendations based on EPA guidance and estimates of mercury in the most popular canned tunas:
- Canned white, or albacore (0.32 parts per million of mercury). Children under six can eat up to one 3-ounce portion a month; children from 6–12, two 4.5-ounce portions a month. Adults, including pregnant women, can safely eat it up to three times a month (women, 6-ounce portions; men, 8-ounce portions).
- Canned light— the safer choice (0.12 parts per million of mercury). Children under six can eat up to three 3-ounce portions per month. Older children and adults can safely eat it once a week. But look out for “gourmet” or “tonno” labels. They are made with bigger yellowfin tuna and can contain mercury levels comparable to canned white.
- A better alternative is canned salmon(mostly sockeye or pink from Alaska), which is low in contaminants and high in heart-healthy omega-3s. It’s also sustainably caught in Alaska and similarly priced, making it a great choice all around.
Governing authorities & bodies around the world:
- World Health Organisation (WHO)
- American Academy of Pediatrics (AAP)
- The Murdoch Children’s Research Institute
- Australiasian Society of Clinical Immunology and Allergy (ASCIA)
References & articles:
- 2016 ASCIA Infant Food Allergy Guidelines (Note: The Infant Feeding guidelines on the ASCIA website are the current versions (updated in 2016). The ASCIA resources are reviewed annually, however the documents will only be updated if there are changes in the literature).
- ASCIA Introducing Food Guidelines
- What to feed your kids so they don’t get food allergies
- New Foods to Feed Babies
- AAP article Breastfeeding Benefits your babies immune system
- Mercury Levels in Canned Tuna
- Infant Feeding Summit hosted by the Centre for Food & Allergy Research (CFAR) in May 2016
*These guidelines have been developed by the ASCIA Paediatric and Dietitian Committees, and reviewed by the ASCIA membership, with significant input from the Centre for Food & Allergy Research (CFAR), a National Health and Medical Research Council (NHMRC) Centre of Research Excellence (CRE).
- ASCIA guidelines on this webpage are for parents and health professionals.
- Food service providers (such as childcare centres) should refer to the ASCIA guidelines for prevention of anaphylaxis in schools, preschools and childcare services: www.allergy.org.au/schools-childcare
- ASCIA guidelines for infant feeding and allergy prevention: www.allergy.org.au/patients/allergy – prevention
- ASCIA food allergy information: www.allergy.org.au/patients/food – allergy
- Allergy & Anaphylaxis Australia – phone 1300 728 000 or visit: www.allergyfacts.org.au
- Allergy New Zealand – phone 0800 34 0800 or visit: www.allergy.org.nz