Food allergies and weaning | Everything you need to know

Reduce your baby’s risk of developing food allergies when introducing solids with this practical advice from nutritional therapist Hannah Kaye.

Weaning is an exciting time. There’s nothing quite like watching your baby’s facial expressions the first time he tastes a particular food, and you’ll take special pride in your little one enjoying your latest puréed creation.

It can, however, also be a worrying time. There has been a steep rise in food allergies over the last 10 to 15 years – an epidemic that has not spared South African children. As a result, many parents are fearful about introducing potentially problematic foods.

When to start weaning

Most health authorities recommend exclusive breastfeeding for the first six months of your baby’s life. However, there is emerging research suggesting that introducing solids at four to seven months, while continuing to breastfeed, may help to prevent food allergies and coeliac disease.

Whether you choose to start introducing solids at four or six months, it’s important to start with low-allergenic foods. These are the foods that are least likely to cause an allergic reaction. Highly allergenic foods should not be introduced first and certainly not before your baby is six months old.

Plain vegetables and fruits should be the first weaning foods. Not only are they nutrient dense, but repeated exposure tends to increase acceptance of them at the fussy toddler stage. Vegetables and fruits (excluding tomatoes, strawberries, citrus and kiwis) are also unlikely to cause allergic reactions and are ideal first foods for all babies – especially those under six months.

Historically, baby rice has been promoted as a first weaning food. However, it provides little to no nutrients and is usually highly refined. Additionally, rice is now recognised to cause allergic reactions in the guts of a few susceptible babies.

After you’ve introduced a range of vegetables, you should introduce the foods listed below, one at a time, so you can spot any reactions:

  • Rice
  • Ground quinoa
  • Cornmeal/polenta (good for finger foods)
  • Rice, corn or quinoa pasta
  • Red meats as well as puréed or finely shredded pork and poultry
  • Lentils and pulses such as mashed haricot beans, kidney beans and butter beans
  • Any of the above in cooked tomato or fruit-based sauces.

Many babies react to tomatoes and strawberries. In the majority of cases, these tend to be more localised skin reactions associated with the fruit’s acidic nature or naturally high histamine content. They should be avoided if there is obvious discomfort. Cooking tomato changes the nature of the protein that can cause a reaction, so it is better to initially offer cooked tomatoes.

Weaning at six months

The following make for wonderful finger foods:

  • Fresh tomatoes
  • Citrus
  • Kiwi
  • Berries.

In the past, most doctors recommended avoiding highly allergenic foods for the first year. However, it is now recommended to introduce them between six and nine months. The theory is that by repeatedly exposing the immune system to potentially allergenic foods, you are teaching the body to tolerate these foods and prevent allergies later on. If you suspect a food has caused an allergy, it is essential to speak to your doctor.

When you start introducing highly allergenic foods into your baby’s diet, they should be introduced one at a time with a gap of three days in between each new food. This will make it easier to identify any food that causes a reaction. The most problematic foods are:

  • Milk and eggs
  • Wheat and gluten
  • Soy
  • Fish and shellfish
  • Peanuts, tree nuts and seeds.

Food allergy symptoms

It’s a good idea to keep a food and symptom diary when weaning. This will help you to identify foods that have triggered a reaction. Symptoms commonly caused by immediate (IgE mediated) reactions to food include:

  • Hives
  • Swelling
  • Itchiness
  • Eczema (often triggered by cow’s milk and eggs)
  • Breathing difficulties (runny or congested nose, wheezing or coughing).
  • Delayed reactions to food (usually two hours after ingestion) are known as non-IgE mediated food allergies, and are more difficult to diagnose. Symptoms are mainly gastrointestinal and can include:
  • Loose, offensive stools
  • Mucus or blood in stools
  • Constipation
  • Vomiting
  • Reflux
  • Nappy rash
  • Poor weight gain.

Once your baby has attempted the individual foods, you can start mixing them together. It is extremely important to introduce different textures to avoid sensory issues around food.

 

Is your baby at risk of allergies?

Babies are more likely to develop allergies if there is a family history of eczema, asthma or hay fever (known as atopic conditions) or allergic reactions to foods and pets. Additionally, if your baby had eczema in the first three to six months of life, he is at a higher risk.
Where there is a family history of atopy or coeliac disease, it is recommended to breastfeed for six months or longer. Weaning before four months is discouraged and the introduction of foods traditionally regarded as allergenic should be delayed until six months at the earliest.

What about peanuts?

In 2009, a review of the available research investigating peanut allergies showed there was no clear evidence that eating, or not eating, peanuts (or foods containing peanuts) during pregnancy, breastfeeding or early childhood had any effect on the chance of a child developing a peanut allergy. If you would like to eat peanuts during pregnancy and while breastfeeding, you can do so unless you are allergic to them yourself or your health professional advises you not to.
You should avoid giving your baby peanuts and foods containing peanuts before the age of six months. Foods containing peanuts include peanut butter, peanut (groundnut) oil and some snacks. Whole peanuts or nuts should not be given to children under five years of age as they are a choking hazard.

Other risk factors

Most food allergens are susceptible to acid digestion in the stomach. This has raised concerns that changes in stomach acid may make babies more susceptible to allergies. Many babies are incorrectly diagnosed with reflux and put onto proton pump inhibitors to lower stomach acidity. There is a delicate balance between gut bacteria and the immune system. The beneficial flora that live in your baby’s intestinal tract play an important role in preventing allergies. In South Africa, the increase in the rate of C-sections and more frequent use of antibiotics affect a baby’s beneficial flora, potentially making them more prone to allergies. Taking probiotics as a supplement when breastfeeding, or adding it to formula milk, may help to reduce the risk of your baby developing allergies.

What does it all mean?

The best advice when it comes to weaning is to start off with low-allergy vegetables and fruits and work your way out slowly from there. Be gentle with your baby’s digestive system. Even in the weaning stages, opt for nutritious foods as opposed to quick and easy refined ones. Trust your parental instincts – if you think a food has been problematic, chat to your healthcare provider about it. Ultimately, healthy food makes healthy babies.

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