Food Allergy Management and Prevention
Support Tool for Infants and Toddlers
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For Newborns

Breastfeeding

What are the benefits of Breastfeeding for infants?

Human milk is rich in essential nutrients. Colostrum, the first milk secreted after giving birth, helps to protect the infant as it is rich in antibodies.

Additionally,

If you cannot or choose not to breastfeed, you should be supported and guided to find the best infant formulas. Reach out to your pediatrician or registered dietitian for guidance.

What are the current recommendations?

Early introduction of peanut may seem to contradict the WHO’s recommendations for exclusive breastfeeding through 6 months of age, yet the LEAP Trial indicated that the duration and frequency of breastfeeding were not influenced. When there is a lack of evidence with conflicting guidelines, shared medical decision-making between providers and families is essential. Healthcare providers should consider talking with the families they serve, as there will be flexibility in allergy prevention and maintenance.

Current Recommendations:

A delay in introducing common food allergens may increase the chance of food allergies. This may be especially seen in children with severe eczema or a previously diagnosed food allergy.

It is important to note- Just because the child has a food allergy does not mean mothers cannot breastfeed.

What should the mother’s diet be when breastfeeding?

Energy, protein, and other essential nutrients that make up breast milk come from the mother’s diet. It is important for women who are breastfeeding to eat a healthy, well-balanced diet and maintain adequate hydration.

Maternal diet directly affects the nutritional composition of breast milk. Eliminating the child’s allergen from the maternal diet may be required. Allergen exposure can occur through breastfeeding as some proteins can be transferred through breastmilk to allergic infants. Preventing infants’ contact to environmental exposures may also be necessary.

Mothers are recommended to consume a variety of foods while pregnant and breastfeeding. No specific foods or allergens should be removed or restricted from their diet during pregnancy or lactation as a means of food allergy prevention in children. Previous recommendations say that allergens should be avoided during pregnancy and lactation, however these recommendations have been retracted.

Promoting good handwashing in your household is essential for the management of food allergies. Always wash hands before and after the following:


Just because a child has a food allergy does not mean the mother has to stop breastfeeding.

Dot phrases modified from PDF found at: https://famp-it.org/wp-content/uploads/Breastfeeding-Education-Pediatrician.pdf

Introducing Complimentary Foods

When is an infant ready for solid food, and what foods are developmentally appropriate?

An infant’s first foods should have a very smooth texture and not require chewing. For thicker foods, such as nut butters, it is best to thin them out with warm water or mix them into something smoother, such as applesauce. Some signs that a baby is ready to try solid foods are:

Some infants may show developmental signs of readiness before age 6 months but introducing complementary foods before age 4 months – or waiting until after 6 months – is not recommended.

Nutrition Guidance for Children During their First 12 Months of Life

The American Academy of Pediatrics states that: “There is no evidence that delaying the introduction of allergenic foods, including peanuts, eggs, and fish, beyond 4 to 6 months prevents atopic disease.”

Why is infant nutrition so important?

During an infant’s first year of life, infants should receive adequate amounts of essential nutrients because these foods are needed for healthy brain development and overall growth. Also, establishing healthy dietary patterns early in life can influence eating behaviors and overall health throughout the course of life.

Key Recommendation:

Between ages 0-4 months: Exclusive breastmilk and/or formula feeding

Between 4-6 months: When your child is ready, start to introduce complementary foods

Between 6-12 months: Introduce complementary foods no later than 6 months

How do know if my child is at high risk of developing a peanut allergy?

Recommendations: age-appropriate, peanut-containing foods should be introduced to the diet as early as age 4 to 6 months.

Establishing Healthy Dietary Patterns in an Infant’s First year of Life

Dietary Components to encourage:

Dietary Components to limit:

Dietary Components to Avoid:

Introducing your child to the 9 major allergens:

The 9 major potentially allergenic foods should be introduced as complementary foods. There is evidence that introducing peanut-containing foods in an infant’s first year of life can reduce the risk that s/he will develop a peanut allergy There is no evidence that delaying introduction of allergenic foods beyond 6 months prevents food allergy.

  1. Dairy
  2. Egg
  3. Peanuts
  4. Tree Nutrs
  5. Soy
  6. Wheat
  7. Fish
  8. Shellfish
  9. Sesame

Dot phrases modified from PDF found at: https://famp-it.org/wp-content/uploads/aap-statement-FAMPIT_Nutrition-Education_less12mo.pdf

FAMP-IT Team

Food Allergy Management and Prevention Tool Kit for Infants and Toddlers (FAMP-IT) Team 

Project Lead
Michael Pistiner, MD, MMSc 

Content Leads
Hannah Martin, MD
Yih-Chie Chen, MD 

Lead Project Coordinators
Samantha Yap
Arielle Hazi, BS 

Supporting Project Coordinators
Mharlove Andre, BS
Zoe Ongaro, BS
Lydia Pan, BS 

Web Design
Robin Friedman  (Visual Velocity) 

Content Contributors
Hanujah Ganesh, MPH
Shelby Oster, MS, RD, LDN
Zoe Ongaro, BS
Micayla Freehan, RN, BS, NP
Rachel Huynh
Rhym El Mahil
Ashley Mclellan, RN, BSN, NP 

QI Data Team
Renee Keets, MPH, PMP (AAP QIDA Team)
Ian Roy, MPH
Isha Taneja, MBBS, MPH 

Spanish Translation
Jose Juan Hermina MD
Vivian Hernandez-Trujillo MD 

Content Reviewers
Alexy Arauz Boudreah, MD, MPH
Wayne Shreffler, MD, PhD
Max Lutskiy MD, PhD
Elizabeth Stieb, RN
Jane Hubbard
Anna Nowak MD, PhD
Qian Yuan, MD
Paul Hesterberg, MD
Sherry Coleman Collins, MS, RDN, LD
Yamani Virkud, MD
Chen Rosenberg, MD
Cynthia Esteban, NP
Jennifer Stockbridge, NP
David Pyle, MD, PhD
Elena Hawryluk, MD, PhD 

Funding
Provided by USDA/National Peanut Board