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say that allergens should be avoided during pregnancy and lactation, however these recommendations have been retracted.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

What is Shared Decision Making?

Shared Decision Making is a major component of patient-centered care. It is an evidence-based approach that allows for the collaboration between patients, family members and providers. Through the exchange of information about evidence, options, benefits and risks, the clinician can work together with the patient and family to make medical decisions and treatment plans which best reflect patient preferences, values and expected outcomes. Shared Decision Making has been shown to improve decision satisfaction and fulfillment of the patient’s treatment plan. 

Shared decision-making is recommended by many healthcare and pediatric regulatory organizations including the National Institutes of Health, the US Preventive Services Task Force, the American Medical Association, and the American Academy of Pediatrics. Various tools and patient decision aids have been developed to facilitate Shared Decision Making in the clinical setting. For information on allergy-related information that could be valuable during Shared Decision Making discussions, resources are available through organizations such as the American Academy of Allergy Asthma & Immunology and the American College of Allergy, Asthma, & Immunology.

Why is Shared Decision Making Important to Food Allergy Management, Prevention and Care?

Due to the evolving development of infants and toddlers, pediatric decision-making incorporates multiple stakeholders, each with their own preferences and values.  Shared Decision Making is particularly important in the context of chronic conditions, like food allergies, which often require long-term and potentially complex treatment plans. Adherence to these treatments is driven by patient or family characteristics and preferences, which cannot be explored without the use of Shared Decision Making.

Shared Decision Making is also important when there is not a clear best choice for disease management. For example in the context of early food introduction, the NIAID Addendum Guidelines provide recommendations for early peanut introduction but not for other major allergens such as egg, dairy, tree nuts and fish. In such cases, where clinicians are providing guidance on early introduction of foods, utilizing Shared Decision Making will help individualize care and improve adherence, outcomes and patient satisfaction.  

References

  1. Blaiss, M. S., Steven, G. C., Bender, B., Bukstein, D. A., Meltzer, E. O., & Winders, T. (2019). Shared decision making for the allergist. Annals of Allergy, Asthma & Immunology: Official Publication of the American College of Allergy, Asthma, & Immunology, 122(5), 463–470.
  2. Boland, L., Graham, I. D., Légaré, F., Lewis, K., Jull, J., Shephard, A., Lawson, M. L., Davis, A., Yameogo, A., & Stacey, D. (2019). Barriers and facilitators of pediatric shared decision-making: A systematic review. Implementation Science, 14(1), 7.
  3. Shared Decision Making Fact Sheet. (2013, December). National Learning Consortium.
  4. The SHARE Approach. (2014, April). Agency for Healthcare Research and Quality.