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say that allergens should be avoided during pregnancy and lactation, however these recommendations have been retracted.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

For Clinicians: WIC Information

What is WIC?

WIC, or the Special Supplemental Nutrition Program for Women, Infants and Children is a federal assistance program that serves low-income pregnant, postpartum, and breastfeeding women, infants, and children up to age 5. WIC provides these women, infants, and children with access to nutritious foods, information on healthy eating habits that include breastfeeding promotion and support, and referrals to health care.

wic

Who qualifies for WIC?

In order to qualify for WIC, potential applicants must meet categorical, residential, income and nutrition risk requirements.

  • Categorical Requirement:
    • Pregnant women
    • Breastfeeding women
    • Non-breastfeeding postpartum women
    • Infants
    • Toddlers and children up to age 5
  •  Residential Requirement:
    • Applicants must live in the state in which they apply.
    • Applicants residing in areas where WIC is administered by an Indian Tribal Organizations (ITO) must meet residency requirements enacted by the ITO.
  • Income Requirement:
    • Applicants must be at or below an income level standardized by the state agency OR
    • Applicants may be determined automatically income eligible based on participation in certain financial assistance programs such as:
      • SNAP
      • Medicaid
      • Temporary Assistance for Needy Families (TANF)
  • Nutrition Risk Requirement:
    • “Nutrition risk” means that an individual has medical based or dietary based conditions (i.e., anemia, underweight, poor pregnancy outcome).
    • Applicants must be seen by a healthcare provider to determine whether the individual is at nutrition risk. This can be done by the applicant’s physician or in the WIC clinic at no cost to the applicant.

Applicants can also utilize the WIC Prescreening Tool to help determine if they are likely to be eligible for WIC benefits. If they are likely to be eligible, the web-based prescreening tool will provide applicants with state-specific information as well as a printable summary of their responses.

WIC: Spreading awareness

The American Academy of Pediatricians (AAP) suggests that pediatricians provide information about the nutritional and educational benefits of WIC to potentially eligible patients and families while also working collaboratively with local WIC agencies to ensure the most effective treatments and dietary guidance for patients. The AAP also recommends that pediatricians work with state and local WIC agencies to maximize efforts to promote, support, and manage breastfeeding methods for infants. Following breastfeeding guidelines goes hand in hand with the early introduction of common allergens, such as peanut. Pediatricians can help increase awareness about the benefits and resources provided by WIC by sharing information about WIC to eligible patients and families.
For more information on WIC, please visit: https://www.fns.usda.gov/wic

For WIC Staff Tips: Food Allergen Introduction in Infants

When should complementary foods be introduced?

USDA/HHS Dietary Guidelines for Americans recommends: At about 6 months, introduce infants to nutrient-dense complementary foods. Foods like peanuts, egg, dairy products, tree nuts, wheat, shellfish, fish, and soy should be introduced when other complementary foods are introduced.

When is my baby ready for solids?

Signs your baby is ready for solid foods:

  • They can sit up.
  • They can control their head and neck.
  • They bring objects to their mouth.
  • They swallow food instead of pushing it out.

Some infants may show signs of readiness before age 6 months, but complementary food introduction before age 4 months or waiting until after 6 months is not recommended.

How do I introduce possibly allergenic foods?

Start with a small tip of a spoon amount. Wait for about 10 to 15 minutes and then slowly feed the rest. Set two hours aside to watch your child. Avoid whole nuts and loose seeds as these are choking hazards. Make sure to thin out nut butters and tahini with fruit or vegetable purees, infant cereals, breast milk or formula to avoid choking.


How much allergen should I introduce?

NIAID Peanut Introduction Guidelines recommend two teaspoons of smoothed-out peanut butter (about 2 grams of peanut protein) three times a week. At this time there are no quantitative guidelines for other allergenic foods, but consider a goal of 2 grams of the food protein twice a week (e.g. 1/3 of an egg or 2 tsp of smoothed-out nut butters/tahini).


What is the Dual Allergen Exposure Hypothesis?

The theory that regular exposure to food allergens through the skin can lead to allergy, while consumption of these foods at an early age may result in tolerance of these foods.





What does an allergic reaction look like?

Mild reaction:

  • A new rash or a few hives around the mouth or face.

More severe reaction:

  • Lip swelling
  • Vomiting
  • Hives over the body
  • Face or tongue swelling
  • Difficulty breathing
  • Repetitive cough
  • Change in skin color
  • Sudden tiredness or turning limp

If this happens, call 911.

If an infant has severe eczema, egg allergy, or both, families should discuss with their pediatrician how and when to introduce peanuts. Ideally, peanut-containing foods should be introduced as early as age 4-6 months as developmentally appropriate to help reduce the risk of developing a peanut allergy. Keep in mind that family history of food allergy, mild to moderate eczema, and milk or soy proctocolitis do not require any screening before adding peanut to an infant’s diet.

Massachusetts WIC Program Advanced Nutrition Training: Food Allergy Prevention (Archived Training; October 20, 2022)

Video 1: Training Webinar

Video 2: Cases and Q+A

Test your knowledge

References:

WIC Eligibility Requirements. USDA. (2020, June 19). 

American Academy of Pediatrics. (2001, November 1). WIC Program. American Academy of Pediatrics.

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov. 

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