FAMP-IT
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recommendations say that allergens should be avoided during pregnancy and lactation, however these recommendations have been retracted.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

Early Food Introduction
Skincare and Eczema Management
IgE Mediated
Food Allergy
Non-IgE Mediated
Food Allergy

Health Literacy and Cultural Competency

Definitions of Health Literacy

“Health literacy the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions”
U.S. Department of Health and Human Services (HHS)

“Health literacy is the use of a wide range of skills that improve the ability of people to act on information in order to live healthier lives. These skills include reading, writing, listening, speaking, numeracy and critical analysis, as well as communication and interaction skills. Health literacy allows the public and personnel working in all health-related contexts to find, understand, evaluate, communicate and use information.”
Calgary Charter

“Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health related decisions and actions for themselves and others.”
“Organizational health literacy is the degree to which organizations equitably enable individuals to find understand, and use information and services to inform health-related decisions and actions for themselves and others.”
Healthy People 2030

What is Health Literacy?

The various different definitions of health literacy demonstrate how the field has grown and evolved. At its core, health literacy is the use of reading, listening, analytical and decision-making skills as well as the ability to apply these skills to health contexts. Examples include: the ability to understand consent forms, doctor’s instructions, using health technology, instructions on how to use auto-injectors, understanding medical education material and the ability to navigate and negotiate complex health care systems.

A 2003 U.S. Department of Education National Assessment of Adult Literacy survey found that 36% of adult participants had basic or below basic health literacy skills. People with low health literacy use more healthcare services, are at greater risk for hospitalization and incur more healthcare costs. Vulnerable populations include older adults, low-income populations, minority populations and immigrant populations.

Why is Health Literacy Important to Food Allergy Management, Prevention and Care?

Both health care providers and their patients play a major role in health literacy. Health literacy is more than just skills to navigate the health care system; clear communication between providers and patients is crucial. People make decisions that affect their health on a day-to-day basis, most of which do not take place in a medical facility. In order to stay healthy and prevent or manage food allergies, people need to know what and what not to feed their child, how to read food labels, when to get evaluated by a specialist, how to report symptoms, when to introduce food allergens, how to avoid cross contact, where to find breastfeeding recommendations and how to seek emergency care. These complex skills are not taught by health, educational and social institutions. It is therefore the responsibility of the healthcare system and health professionals to educate and empower individuals.

Moving towards a patient-centered healthcare delivery system will improve the quality of health care and reduce costs. Patients should play an active role in medical decisions and develop a strong understanding of food allergy management and prevention information through the effective communication skills of the provider. Providers should distribute patient education materials written in clear, plain language to aid with knowledge dissemination. Patients and providers need to work together to develop health literacy skills, which would facilitate informed decision-making about managing food allergies.

Health Literacy and Culture

Cultural and social contexts influence how people communicate, understand and respond to health information, it plays an important role in health literacy. Ethnic backgrounds, belief systems, communication styles and social communities shape an individual’s health literacy. When cultural norms do not align with the dominant ideologies of the healthcare system, individuals will have difficulty communicating with providers, adhering to medical advice and accessing health services. These disparities are exacerbated in individuals with low health literacy and those of low socio-economic status.

What is Cultural Competence?

Cultural competence in healthcare refers to practices and behaviors that allow all patients to receive high-quality, effective care, irrespective of cultural background, language proficiency, socioeconomic status and other factors that may influence a patient’s characteristics. Both patients and providers alike bring their own cultural affiliations into healthcare. Improving cultural competency in healthcare services, through patient-provider interactions and education materials, will help meet patients’ social, cultural and linguistic needs.

Why is Cultural Competence Important to Food Allergy Management, Prevention and Care?

Food is a social construct; it is deeply rooted in our culture, traditions, social relationships and interactions. Thinking about food from a cultural perspective is important in the context of food allergies. People from cultures around the world prepare and consume the same food in many different ways. For example, dry roasted peanuts are commonly consumed in North American diets and confer higher allergenicity compared to boiling peanuts, which is customarily practiced in Asian cuisine. In Israel, a puffed peanut treat is one of the first finger foods given to babies.  

Different cultures have different norms, especially when it comes to early introduction of foods. It is imperative to keep cultural contexts in mind when giving early introduction guidance. Clinical care should be patient-centered and tailored to individuals within the context of their family and community. Healthcare services that are inclusive of the health beliefs, practices and cultural needs of diverse patients can increase adherence and help improve health outcomes.

References

  1. Cultural Competence and Patient Safety | AHRQ. (n.d.). Retrieved October 25, 2020.
  2. Cutilli, C. C., & Bennett, I. M. (2009). Understanding the Health Literacy of America Results of the National Assessment of Adult Literacy. Orthopaedic Nursing / National Association of Orthopaedic Nurses, 28(1), 27–34.
  3. Health Literacy| NIH. (n.d.). Retrieved October 25, 2020.
  4. Health Literacy Fact Sheets. (2013, October 1). Center for Health Care Strategies.
  5. Saha, S., Beach, M. C., & Cooper, L. A. (2008). Patient Centeredness, Cultural Competence and Healthcare Quality. Journal of the National Medical Association, 100(11), 1275–1285.
  6. Tham, E. H., & Leung, D. Y. M. (2018). How Different Parts of the World Provide New Insights Into Food Allergy. Allergy, Asthma & Immunology Research, 10(4), 290–299.
  7. The Blueprint | National Standards for Culturally and Linguistically Appropriate Services. (n.d.). Think Cultural Health. Retrieved October 25, 2020.
  8. US Department of Health and Human Services, The Office of Minority Health—What Is Cultural Competency? (n.d.). Retrieved October 25, 2020.
  9. What is Health Literacy? | CDC. (2020, September 18).

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