Food Allergy Management and Prevention
Support Tool for Infants and Toddlers

For Newborns


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.


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say that allergens should be avoided during pregnancy and lactation, however these recommendations have been retracted.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

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:

Specialist Referrals

Pediatric Allergist

consultation request form
Specialty Consultation Request

A pediatric allergist is a medical doctor who specializes in managing allergic issues for children.

When experiencing any of the following allergic issues, an allergist can also assist patients in determining the best course of treatment:

  • Anaphylaxis, a severe allergic reaction involving one or more bodily symptoms.
  • Food Allergies, in which a patient may experience any of the following symptoms, including but not limited to urticaria, angioedema, itching, wheezing, or gastrointestinal symptoms, if they are exposed to a food allergen they are allergic to.
  • Drug allergies, such as reactions to different medications.
  • Environmental allergies, to things common in different environments, including pollen, dust, pet dander, and mold.
  • Stinging insect allergies, such as to bees.

Pediatric allergists also help managing non-IgE mediated allergies and various atopic conditions, including the following:

  • Allergic rhinitis, inflammation of the nose in response to allergens in the air and surroundings. This may cause symptoms including stuffy nose or rhinorrhea (a runny nose).
  • Asthma, and related issues including therapies, reliever medications, and associated rhinitis or sinusitis.
  • Atopic Dermatitis (eczema), and all other issues related to eczema including, contact dermatitis, environmental allergies, etc.
  • Eosinophilic GI disorders, and helping patients determine what foods may be causing GI issues.

For infants and toddlers specifically, pediatric food allergists assist families to determine when and in what form to introduce commonly allergenic foods into the diet, and what strategies and steps to take in the lifestyle and in the home to prevent the development of food allergies. Allergists work closely with families to determine the best course of action for their child’s health needs and help guide families on how to integrate foods back into an infant or toddler’s diet over time and/or in a controlled setting. They are able to update families on the most up to date science when it comes to food allergies in this population.

Allergists perform the following procedures to screen patients for allergies and can help patients interpret the results to proceed with allergy management:

  • Skin prick testing (SPT): also known as a scratch test, a tiny droplet of an allergen is placed on the skin, then lightly scratched. Allergists wait 15 minutes to observe for a reaction in the form of a hive
  • Blood testing: a blood test called Immunocap Specific IgE, measures the concentration of antibodies created in response to the presence of antigen that the body deems harmful.
  • Oral Challenges: a procedure where a patient is administered incrementally increasing doses of a food or drug to assess if they are tolerant to it.

Older populations can participate in studies that utilize immunotherapies (including oral immunotherapy, subcutaneous immunotherapy, or sublingual immunotherapy), which may help research subjects decrease the likelihood of reacting to foods that they are allergic to.

If you would like to refer your patient to a pediatric allergist, American Academy of Allergy, Asthma and Immunology (AAAAI) and American College of Allergy, Asthma, and Immunology (ACAAI) both have information on how to find a local allergist in your community.

Pediatric Dermatologist

A pediatric dermatologist is a medical doctor who specializes in managing issues pertaining to the skin, hair, and nails. Similar to a pediatric allergist, they can also work with patients in managing medical issues including the following:

  • Atopic diseases, such as atopic dermatitis (eczema)
  • Urticaria (hives)

Pediatric dermatologists also assist patients with issues specific to that patient’s age group. In infants and toddlers, this can sometimes include

  • Infantile hemangioma: blood vessels that may have grown out of control during development, and are likely to create red rubbery lesions on the skin
  • Psoriasis: a skin disease the causes itchy, dry patches
  • Cradle cap: itchy and/or oily scales that may appear on an infant’s scalp

They may prescribe that you use specific medications or products including ointments and creams that may help in resolving/improving certain skin conditions. They work closely with a patient’s pediatrician in order to create the best care plan for a patient’s needs.

If you would like to refer your patient to a pediatric dermatologist, American Academy of Dermatology (AAD) has information on how to find a local dermatologist in your community.

Pediatric Gastroenterologist

A pediatric gastroenterologist sees a wide variety of diseases but works specifically with the allergist to manage non IgE mediated food reactions, such as food protein enterocolitis or eosinophilic esophagitis.  Here they play an essential role in helping the allergist diagnosis, monitor, and treat the disease. In eosinophilic esophagitis endoscopy can be particular helpful when deciding what foods to remove or re-introduce based on esophageal biopsy. To find a pediatric gastroenterologist in your area you can use this search engine found at the North American Society for Pediatric Gastroenterologist, Hepatology, and Nutrition.