FAMP-IT
Food Allergy Management and Prevention
for Infants and Toddlers
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For Newborns

Breastfeeding

Why is breastfeeding good for your baby?

Human milk has a lot of important nutrients. Colostrum, the first milk that comes out after giving birth, helps to protect your baby, as it is rich in antibodies. This can help build their immune system.

Additionally, breastmilk also:

If you cannot or choose not to breastfeed, support is available to help you find the best infant formulas. Reach out to your healthcare team for guidance.

What should the mother’s diet be when breastfeeding?

Energy, protein, and other essential nutrients that make up breast milk come from what the mother eats. It is important for women who are breastfeeding to eat a healthy, well-balanced diet and stay hydrated.

It’s best if mothers can eat a variety of foods while pregnant and breastfeeding. If mom is not allergic to any foods, then keeping the common food allergens in the diet is great.

Good handwashing habits are important for managing 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

Additional Resources

Use the QR code below or click on the hyperlink to watch a video, Preventing Food Allergies — What You and Your Family Can Do in the First Several Months, with simple tips on what you can do in the early months of your baby’s life to help prevent food allergies.

vimeopro.com/user22732304/preventing-food-allergies

QR code for video

Visit fampitfamily.org for detailed resources on Early Introduction, Food Allergy Management, and more.

Introducing Complementary Foods

What are the current recommendations for complementary feeding and food allergens?

Waiting to introduce common food allergens to your child may increase the chance of food allergies, especially if they have eczema or a previously diagnosed food allergy.

The common food allergens are:

Begin complementary feeding (giving solids while breastmilk or infant formula are still the main food source) around 6 months, and as early as 4 months to 6 months, if your child is developmentally ready.

The common food allergens should be introduced at the same time as complementary foods.

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

Healthy Dietary Patterns in Your Baby’s First Year of Life

Give:

Limit:

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

What is Shared Decision Making?

Shared Decision Making (SDM) is an intentional, collaborative process between healthcare providers and patients that improves the quality and sustainability of healthcare (Nager, 2026). This process integrates patients’ needs and values with clinician input on evidence-based guidelines and available options. The included options are supported by professional standards that allow clinicians to uphold their ethical and legal commitments (Nager, 2026). Shared decision-making has been shown to improve patients’ understanding of their disease, medication adherence, and health outcomes; in other words, it can be a sustainable and effective approach (Anagnostou, 2023).

For example, 2-way communication between patient and physician can involve active listening. There is the decision talk, which results in reaching correct decisions based on the patient’s values and preferences. (Blaiss et al., 2019 & Anagnostou, 2023) 

Another example is the SHARE model, identified by the Agency for Healthcare Research and Quality (AHRQ),  a 5-step approach that (1) seeks patient participation, (2) helps patients explore and compare treatment options, (3) assesses the patient’s values and preferences, (4) reaches a decision with the patient, and (5) evaluates the patient’s decision. (Makoul and Clayman et al., 2006 & Hargraves et al., 2020 & Anagnostou, 2023) 

Shared decision-making has been highlighted by the AAP, ACAAI, and AAAAI.

Shared Decision Making in the Early Introduction of Food Allergens

Screening Step

The 2017 Addendum Guidelines for the Prevention of Peanut Allergy in the United States suggest performing a skin prick test under the guidance of an allergist or sending specific IgE prior to introducing developmentally appropriate foods to a baby who has severe eczema or already has an egg allergy. Because this screening step may result in barriers to access and an increased age when peanut is ultimately introduced, it has come under scrutiny. In contrast, the 2021 Consensus Approach to the Primary Prevention of Food Allergy Through Nutrition de-emphasized screening, suggesting that SDM may be incorporated into discussions about targeting early introduction between 4-6 months of life in high-risk infants (those with eczema or egg allergy) without first getting an allergy evaluation, a blood draw, or a skin test. 

Each approach has its own challenges: screening high-risk infants first can delay opportunities for early introduction and may also be a barrier for some families. In these cases, introduction may not occur at all. Challenges for simply feeding include having the time, knowledge, and comfort required for education and shared decision-making during a busy well-child visit.

Timing of Complementary Foods and Allergens

The timing of breastfeeding and solid food introduction is a topic that benefits from shared decision making. Some parents may consider exclusive breastfeeding until 6 months of age. Solids are also recommended to be introduced around this time. However, some infants who are at high risk of developing food allergies may benefit from allergen introduction as early as 4 months if developmentally ready. The guidelines and studies below, discussed in a shared decision-making context, are important to consider for timing the introduction of complementary foods and allergens. 

The 2021 Consensus Approach and USDA Dietary Guidelines for Americans recommend introducing complementary foods around 6 months of life, including allergens. These guidelines allow flexibility as early as 4 months in children who are developmentally ready. Delaying beyond 6 months of age is not recommended. In a 2021 study, children with severe eczema had a significantly increased chance of developing peanut allergy over time. While less than 20% of children under 6 months had a positive oral food challenge to peanuts, about 50% of children over 8 months had a positive oral food challenge to peanuts (Keet et al).

 The American Academy of Pediatrics, 2022, Policy Statement: Breastfeeding and the Use of Human Milk recommends exclusive breastfeeding for approximately 6 months after birth, with the exception of infants who are high risk, who follow the 2017 Addendum Guidelines (mentioned above) for peanut introduction as early as 4 to 6 months of age.

Shared decision-making is particularly relevant when discussing the duration of exclusive breastfeeding and the timing of complementary solids, including allergenic foods for a child without severe eczema. An important distinction to make when discussing with families is that the introduction of complementary foods is not the same as weaning. Breastmilk and/or formula should continue to be the main source of calories and nutrition for infants at this age. Additionally, parents who choose to breastfeed can continue to do so as long as both mother and child are happy to do so, even past 6 months of age.  

Overall, approach these guidelines with shared decision-making, considering caregivers’ and families’ cultural, societal, and economic circumstances and expectations (Netting & Allen, 2019).

Shared Decision Making in the Management and Treatment of Food Allergy

Management

In a patient with a known IgE-mediated allergy, Shared Decision-Making can be used in discussions between a primary care clinician or an allergist about managing food allergies. During anaphylaxis, shared decision-making can also address emergency planning, including when to activate EMS; discussions include access and aid considerations during emergent scenarios (Anagnostou, 2023). Additionally, for infants and toddlers weighing less than 15 kg, clinicians and families may discuss the choice between a 0.1 mg (less readily available) and 0.15 mg epinephrine autoinjector, as outlined in the 2023 Anaphylaxis Practice Parameters. (Anagnostou et al., 2025)

Treatment

Through all of these discussions, primary care clinicians play a critical role in shared decision-making by inviting families to discuss their fears, questions, and uncertainty about allergy management. Primary care clinicians can refer families to their allergy specialist, who will be positioned to implement more specialized decision-making about food allergy treatments. For example, they can guide shared decision-making on avoidance strategies, including the psychosocial burden and high risk of accidental exposure; Oral Immunotherapy (OIT), including the benefits observed in reducing accidental exposures or downsides being daily administration, reactions from treatments, increased risk of eosinophilic esophagitis, and regular clinician follow-ups (Abrams, 2026); and Omalizumab (Xolair®), an FDA-approved biologic medication, reduces the likelihood of severe reactions but requires regular subcutaneous injections, can be indefinite in length, and may be costly. (Anagnostou, 2023)

 

References

Abrams EM. Communication, compassion, and shared decision-making in allergy. Annals of Allergy, Asthma & Immunology. 2026 Mar 22.

Anagnostou A. Shared decision-making in food allergy: navigating an exciting era. Annals of Allergy, Asthma & Immunology. 2024 Mar 1;132(3):313-20.

Blaiss MS, Steven GC, Bender B, Bukstein DA, Meltzer EO, Winders T. Shared decision making for the allergist. Annals of Allergy, Asthma & Immunology. 2019 May 1;122(5):463-70.

Anagnostou A, Bird JA, Chinthrajah S, Dribin TE, Fleischer DM, Kim E, Nowak-Wegrzyn A, Rachid R, Shaker MS, Shreffler W, Sicherer S. The use and implementation of omalizumab as food allergy treatment: Consensus-based guidance and Work Group Report of the Adverse Reactions to Foods Committee of the American Academy of Allergy, Asthma & Immunology. Journal of Allergy and Clinical Immunology. 2025 Jan 1;155(1):62-9.

Fleischer DM;Chan ES;Venter C;Spergel JM; Abrams EM;Stukus D;Groetch M;Shaker M;Greenhawt M; “A Consensus Approach to the Primary Prevention of Food Allergy Through Nutrition: Guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical Immunology.” The Journal of Allergy and Clinical Immunology. In Practice, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/33250376/.

Keet C, Pistiner M, Plesa M, Szelag D, Shreffler W, Wood R, Dunlop J, Peng R, Dantzer J, Togias A. Age and eczema severity, but not family history, are major risk factors for peanut allergy in infancy. J Allergy Clin Immunol. 2021 Mar;147(3):984-991.e5. doi: 10.1016/j.jaci.2020.11.033. Epub 2021 Jan 19. PMID: 33483153; PMCID: PMC8462937.

Meek JY, Noble L, Section on Breastfeeding. Policy statement: breastfeeding and the use of human milk. Pediatrics. 2022 Jul 1;150(1):e2022057988.

Nager AL. Shared decision-making in pediatric practice: a broad view. American Academy of Pediatrics; 2026. Available from:https://publications.aap.org/pediatrics/article/142/Supplement_3/S129/34129/Shared-Decision-making-in-Pediatric-Practice-A

National Institute for Allergy and Infectious Disease. Addendum Guidelines for the Prevention of Peanut Allergy in the United States.; 2017. doi:10.1097/01.JAA.0000512231.15808.66

U.S. Department of Agriculture & U.S. Department of Health and Human Services. (2020). Dietary guidelines for Americans, 2020–2025 (9th ed.). https://www.dietaryguidelines.gov/