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When Should You Expose Food Allergens to Baby? U.S.D.A.’s Advice
We asked Registered Dietitian, Nicole Silber, RD, CSP, CLC, for her take on the USDA’s 2020-2025 Dietary Guidelines for Americans. Nicole is a board-certified specialist in pediatric nutrition and has worked with hundreds of children with chronic medical conditions, food allergies, picky eating, oral-motor and sensory processing disorders, breastfeeding, gastrointestinal conditions, prematurity and obesity.
Scientific recommendations for when and how to introduce potential food allergens to your little ones are ever evolving and changed, once again. New research shows that the timing of allergen introduction matters and can potentially prevent some food allergies from developing in the first place.
Today, in the U.S., about 1 in 13 children have a documented food allergy. The nine most common food allergens in the U.S. are peanuts, tree nuts, eggs, cow’s milk, wheat, shellfish, fish, soy, and sesame.
A (Confusing) Timeline of Allergen Recommendations 🙄
For decades, parents were told to delay introducing potentially allergenic foods to their children until they were older, even until the age of three! In 2008, the American Academy of Pediatrics (AAP) revised their previous guidelines, concluding that there were no benefits to be gained by delaying allergen introduction; however, research did not yet exist to recommend earlier introductions. Finally, in 2015, compelling research from the New England Journal of Medicine’s Leap Study found that when infants with a high risk for developing peanut allergies were fed peanuts early and consistently, between 4-6 months, their risk of developing peanut allergies later was reduced by about 80%! This study shaped the AAP’s 2019 recommendations, which were adapted by the Dietary Guidelines for Americans 2020-2025.
Current Food Allergy Guidelines for Babies:
- 🥄 Feed Potential Food Allergens when Solid Food Feeding Begins: Introduce the allergens at the time of, or shortly after, introducing other complementary foods.
- 🥜 Peanuts for your Peanut: Introducing peanut-containing foods in the first year reduces the risk that an infant will develop a food allergy to peanuts.
- 👩🏾⚕️ Ask your Pediatrician: Babies with moderate-to-severe eczema, an egg allergy or both, are at a high risk for a peanut allergy and can benefit from introducing peanuts as early as 4-6 months. Your child’s pediatrician should determine your child’s individual risk, and if allergy testing is warranted to determine whether and how peanuts should be introduced.
- 🧀 Don’t Delay Solid Dairy: Cow’s milk products, such as yogurt and cheese (but not cow’s milk, itself), should be introduced around the age of 6 months. If your baby has a milk protein intolerance to formula or breast milk, please consult with your child’s pediatrician before introducing dairy.
- 🥛 Hold on the Moo Juice: Wait until baby is one year old to introduce cow’s milk as a beverage. Cow’s milk has a high protein and mineral content that may be too much for a younger baby to process. However, Cow’s milk as an ingredient, like “whole milk mixed into eggs,” is OK before one year old.
Favorite Ways to Introduce Food Allergens to Babies:
- Tree Nuts (Almonds, Cashews, Walnuts & Pecans): Mix a spoonful of smooth, moist, creamy, and unsweetened almond butter with apple puree and cinnamon. Blend with a food processor or blender or mix by hand until smooth. Tip: Avoid chunky nut butters and the dry nut butters at the bottom of the jar, which are choking hazards.
- Peanuts: Mix a spoonful of smooth, moist, creamy, and unsweetened peanut butter or unsweetened peanut powder with banana or a mixed berry puree. Blend with a food processor or blender or mix by hand until smooth. Tip: Avoid chunky peanut butters, and the dry peanut butters at the bottom of the jar, which are choking hazards.
- Eggs: Combine a hardboiled egg with avocado. (It is OK to introduce the yolk and egg white together at the same time). Depending on what consistency baby is eating, mash together with a fork, or blend until smooth and creamy in the blender or food processor, adding some milk, if necessary, to thin it out. If baby is eating finger foods, serve small pieces of a cut up hardboiled or scrambled egg.
- Wheat: Blend cooked whole wheat couscous with sweet potato puree and olive oil. For extra flavor, add a pinch of fresh dill. Depending on what consistency baby is eating, mash together with a fork, or blend until smooth and creamy in the blender or food processor. If baby is eating finger foods, offer small pieces of spongy, moist whole wheat bread with spreads like avocado or mashed sweet potato.
- Dairy: Serve unsweetened, whole-milk or full fat yogurt by itself or blended with a fruit puree. If baby is eating finger foods, shredded cheese is usually a hit!
- Fish: Cooked salmon and cod are two fish that are high in omega 3’s and low in mercury. They pair well with cooked greens like spinach or green bean puree. Depending on what consistency baby is eating, mash together with a fork or blend until smooth and creamy in the blender or food processor. If baby is eating finger foods, serve small pieces of cooked fish. Make sure to inspect and remove any small bones.
- Shellfish: Combine cooked shrimp with cooked butternut squash pieces or puree. Depending on what consistency baby is eating, mash together with a fork, or blend until smooth and creamy in the blender or food processor. If baby is eating finger foods, serve finely diced pieces of cooked shrimp or small pieces of cooked shrimp cakes.
- Soy: Blend tofu with cooked cauliflower and carrot puree along with some olive oil, and a pinch of cumin for flavor. Depending on what consistency baby is eating, mash together with a fork or blend until smooth and creamy in the blender or food processor. If baby is eating finger foods, offer small pieces of tofu.
Nicole is the creator of Tiny Tasters, a series of on-demand and live classes that teach parents everything they need to know about how to feed their babies and toddlers. Prior to her current roles she was a clinical nutritionist at the Morgan Stanley Children’s Hospital at New York-Presbyterian/Columbia and at NYU Langone/Fink Children’s Ambulatory Care Center. Nicole lives in New York with her husband and her toddlers, Lily and Luna!
To read more about the Dietary Guidelines for Americans 2020-20205, click here.