INTRODUCING ALLERGENS WHEN WEANING

A BIT OF BACKGROUND ABOUT ALLERGENS

There’s a lot of misinformation around concerning foods that could potentially cause allergic reactions and how to introduce them to little ones. Much of this relates to the emergence of new research.

Offering potentially allergenic foods can actually prevent food allergies because it’s known that if their inclusion is delayed, there’s actually a higher risk of your baby developing an allergy. Furthermore, all of the foods that can be allergenic need to be introduced to your baby before their first birthday, to take advantage of their protective effects.

WHAT ARE THE COMMON FOOD ALLERGENS?

● Egg

● Peanut

● Foods that contain gluten, including wheat, barley and rye

● Fish and shellfish

● Cow’s milk

● Soya

● Tree nuts e.g. almonds, pistachios, hazelnuts, macadamias, pecans, cashews, Brazil nuts and walnuts

● Sesame seeds and other seeds

So, how should these foods be introduced? This depends on whether your baby is considered to be at low risk or high risk of developing an allergy.

Higher-risk babies

A baby is at higher risk of developing a food allergy if they:

● already have a food allergy (for example, a cow’s milk protein allergy that was picked up when they were younger)

● have moderate-to-severe eczema (for example, those who require daily steroid cream and/or developed eczema in the first month after birth)

If your baby is at higher risk, please seek advice from your GP or health visitor, who is likely to refer you to a Paediatric Dietitian who can guide you on the best time to introduce the common allergens. Current research has shown that high-risk babies may benefit from very early introduction to egg and peanut – from 4 months of age – which is of course before the recommended weaning starting point of 6 months.

Lower-risk babies

Most babies are at low risk of developing an allergy, so once they’ve had their first tastes of bitter vegetables and you’re starting to offer more foods, you can also start to introduce the common food allergens.

HOW TO INTRODUCE EACH ALLERGEN DURING WEANING

The first of the allergens to introduce should be egg, then peanut. After this, you can introduce the remaining allergenic foods in any order, though it probably makes sense to go with those foods that you eat regularly as a family.

Introduce one allergen at a time, alongside your baby’s normal weaning foods, and never give two or more new allergens to your baby in one day.

1. Egg (British lion-stamped)

Boil an egg for 10 minutes until it's hard boiled, then mash it and mix it with some of your baby’s usual milk, or another food your baby has already tried. Other options include hard-boiled egg slices, soft boiled dippy eggs (they’ll need to eat the white too), scrambled egg, omelette and egg muffins

Start with a small amount and build up gradually over the next few days. For example, start with a quarter of a teaspoon on day 1, half a teaspoon on day 2 and a whole teaspoon on day 3. You can leave a few days in between the first try and the second if you’re worried about looking out for delayed reactions. Egg can be regarded as having been successfully introduced once your little one has had the equivalent of 1 whole egg across the week. Also, to maintain the protective effect ensure that your baby has egg regularly, for example, at least 1 egg every week.

2.  Peanut

Choose a smooth peanut butter that’s 100% nuts, which means it doesn’t have sugar, salt or other additives. Thin it down with your baby’s usual milk or water. Offer it on the tip of a spoon, or mix it into any wet foods your baby has already tried, such as pureed fruit, vegetables, porridge or yoghurt. You can also use finely ground (unsalted) peanuts mixed into purees, or buy a puffed peanut snack which can be eaten as a finger food or mixed with milk or water to form a paste.

Start with a small amount and build up gradually over the next few days. For example, a quarter of a teaspoon on day 1, half a teaspoon on day 2 etc. You may wish to leave 2 to 3 days between the first time and the next, to check for any delayed symptoms. You will have successfully introduced peanut when your baby has had 2 to 3 heaped teaspoons over the course of a week. Like egg, you need to offer this amount regularly to ensure the protective effect is maintained

Note that it’s best to avoid crunchy peanut butters or smooth peanut butters that haven’t been thinned, as these can be a choking risk because they’re sticky and difficult to swallow. Also, crunchy peanut butter is a combination of two textures which is very tricky for babies to manage in the early stages of weaning. Avoid whole nuts or chopped nuts too, as these are a choking risk for any children under 5 years of age.

3.  Foods that contain gluten, like wheat

You can offer any wheat-based cereal or soft cooked pasta, or try bread that’s been toasted, buttered and sliced into fingers. It’s worth knowing that wholemeal bread is an easier texture to eat than white bread. Note: Check that bread does not contain soya (many do) as soya is another allergen.

4. Fish and seafood

Fish and seafood are actually two different allergens and so both need to be offered independently of each other. You can offer any fish or seafood that you would usually eat as a family. Ensure that it is thoroughly cooked and pureed, flaked or mashed, or given in a form you know your baby can manage. If it helps, fish combines well with potato and root vegetables. Note:each fish and each seafood is its own allergen, so your baby might be ok with salmon and prawns but allergic to cod.

5. Cow’s milk

If your baby has never had formula they won't have had cow's milk, so you need to treat it as one of the allergens. Standard infant formula is based on cow's milk, so if your baby is formula-fed they’ve already tried this allergen. A good way to introduce cow’s milk is to offer your baby natural yoghurt or fromage frais. You can also simply add fresh whole cow’s milk to their meals, for example in cereals, mashed potato or a white sauce.

6. Soya

Soya yoghurt or fresh soya milk can be offered to your baby in the same way as the introduction of cow’s milk. Lots of soya milks or yoghurts contain added sugar, however, so choose one that avoids this. Tofu is soya bean curd and another good option, which you can blend into a puree or offer cooked as a soft finger food.

7. Tree Nuts (ie almond, cashew, hazelnut, brazil, pecan, pistachio, walnut etc)

As with peanuts, these can be offered as smooth nut butters thinned with milk, or finely ground and mixed with other foods. Remember not to offer your baby – or any child under 5 years of age – whole or chopped nuts, as these pose a choking risk.

8. Sesame seeds and other seeds

Sesame seeds often come in the form of a paste called tahini, which can be offered in a similar way to peanut butter. Alternatively, hummus is a good option as it contains tahini paste.

WHAT AN ALLERGIC REACTION LOOKS LIKE

Bear in mind that allergic reactions are very rare, but you do need to know what to look out for.

Immediate allergic reactions

● Vomiting

● Hives

● A red rash

● Swelling of the mouth or throat

● Wheezing

● Shortness of breath

● Difficulty breathing

Delayed allergic reactions

● Colic

● Eczema

● Diarrhoea

● Constipation

● Vomiting

● Stuffy, itchy nose

● Poor weight gain

● Poor growth

If your baby experiences difficulty breathing it is a medical emergency and you should dial 999 immediately. If you suspect they have reacted to a food in another way, don’t give it again until you’ve sought advice from an allergy specialist doctor or paediatric dietitian.

5 top tips for introducing allergens

1. Before offering an allergen, ensure your baby is healthy, well and not, for example, just getting over a bug.

2. If your baby has eczema, the condition needs to be well under control beforehand so you can monitor any changes. Please seek specialist advice early if you’re struggling.

3. Offer the allergen food early in the day, such as breakfast time, so that you have the whole day ahead of you to monitor any potential reactions.

4. If your baby refuses the allergen food, don’t worry, as it’s normal for little ones to be fussy sometimes. Just try again another day.

5. Once you’ve successfully introduced a food allergen, it’s important to keep giving it to your baby regularly. Aim for at least once per week and follow the specific advice above for egg and peanut.