Introducing Food Allergens during Weaning
Once you have given your baby their first tastes of veggies, fruits and starchy foods, from around 6 months of age (following developmental signs of readiness), you can start giving protein foods. If your baby is at high risk of an allergy (more details given below) then they may benefit from starting solids at 4 months.
The main foods that can cause allergy are:
· Cows’ milk & milk products
· Wheat
· Eggs & products containing eggs
· Fish
· Shellfish
· Tree Nuts
· Peanuts
· Seeds
· Soya
Symptoms of an allergic reaction:
See Bsaci guidelines: http://www.bsaci.org/about/early-feeding-guidance
Many foods (e.g. citrus fruit, tomato, strawberry) can irritate the skin and cause a red rash
(especially around the mouth) in babies – this is not food allergy and you do not need to
avoid the food.
Some important points for introducing allergenic foods for all babies:
· Aim to give these foods before 12 months of age
· These should be given one at a time
· Leave at least 3 days between each allergen so that it is easier to spot a reaction
· Start small with a ¼ teaspoon stirred into other foods your baby has had before and gradually increase over a few days
· Ensure your baby has allergenic foods on a spoon, even if doing baby-led weaning to ensure that they are eaten
· Once tolerated these foods should be given twice weekly in a baby’s diet to continue tolerance and reduce the chance of them developing an allergy to that food later
· Only give a new allergen if your baby is well
· Give a new allergenic food early on in the day so that there is more time to spot a reaction
· Don’t rub food onto your baby’s skin or lips – it is not a good way to test if the baby has an allergy
· If your baby has eczema it is best to make sure the eczema is under control before giving a new allergen. Speak to your GP if necessary
· Evidence indicates that deliberate exclusion or delay of introduction of eggs & peanuts beyond 6-12 months may increase the risk of allergy to these foods
· Do not feed your baby something they are already allergic to
· If you think your baby may be having an allergic reaction stop giving the food and seek medical advice
· Referral to a specialist allergy clinic is recommended for all babies with immediate-type food allergy
High-risk babies
· Your baby is at higher-risk if they have early onset eczema (in first 3 months), moderate-severe eczema or already has a food allergy (such as cows milk allergy).
· Guidelines say if your baby is at higher-risk they may benefit from early introduction of solids from 4 months (when baby is ready), with cooked egg and then peanut (ground or smooth nut butter) given alongside other complementary foods, and then followed by other allergenic foods.
See Bsaci guidelines: http://www.bsaci.org/about/early-feeding-guidance
· Start with purees as babyled weaning is safer for babies aged 6 months plus.
· Avoid any foods that baby is known to be allergic to
· The benefit of early allergy testing in higher risk infants prior to giving egg or peanut needs to be balanced against the potential delay due to lack of available testing
· Families may wish to seek advice from a professional with expertise in allergy, but this should not delay introduction of common allergenic foods beyond 12 months of age
· Be assured that it is very rare to have anaphylaxis
· If you are anxious make sure you have antihistamine available which you can get from your GP
How to give allergenic foods to all babies
Start with egg and then peanut. Once these have been tried you can give the others in any order.
· Egg
Aim for at least 1 egg over a week. At first start small and spread one egg over a week. Hard-boiled egg can be whizzed in a blender and mixed into pureed fruit and veggies and rice dishes. After this, as your baby is more used to different textures, egg can be offered mashed and then chopped and mixed into other foods. Then you can offer boiled egg cut up as finger food or as an omelette or egg muffin cut into strips. Once well-cooked egg has been tolerated a few times you can offer it more lightly cooked i.e. scrambled, soft boiled, as long as it has the ‘British Lion Quality’ stamp.
If your little one struggles with egg it can be incorporated into pancakes, savoury muffins, rice dishes or used as a binder in meatballs, fishcakes, homemade fish fingers or chicken goujons as well as vegetable or potato fritters.
· Peanuts
Do not give whole nuts or coarsely chopped nuts to babies and children under 5, as they are a choking hazard. Aim for 2 level teaspoons per week.
Peanut butter (PB) should be smooth and not offered directly on a spoon because it is also a choking hazard. Offer a ¼ teaspoon of thinned down PB (1 tsp mixed with 1tbsp cooled boiled water) stirred into porridge or fruit puree or offer as finely groundnuts stirred into puree. Puffed peanut snacks can also be given and crushed up. Once baby is ready thinly spread smooth PB on toast can be given or it can be added to yogurts, savoury muffins, curry or casseroles or even used to coat chicken or fish.
· Tree nuts
Don’t give whole nuts or coarsely chopped nuts to under fives, as they are a choking hazard. You can give baby finely ground nuts or nut butters such as almond or cashew nut butter mixed into porridge, cereal, fruit and veggie purees or yogurt.
· Cows milk
Whole cows milk can be added to porridge or mashed potato. Yogurt and fromage frais can be given.
· Wheat
Breakfast cereals such a wheat biscuits or porridge can be given as well as well-cooked pasta, coucous, lightly-cooked toast fingers.
Seeds
· Ground seeds can be added to cereals, porridge, yogurt or purees of fruit and veggies. Houmous containing tahini paste (sesame) can be added to pureed veggies or used as a dip.
· Fish and Shellfish
Cooked fish can be pureed, mashed or flaked. Shellfish such as prawns should be well cooked and flaked or chopped.
· Soya
The majority of bread contains soya. For this reason you don’t need to give soya products unless you want to.
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