Babies and Food Allergies

A lot has changed when it comes to caring for babies, including how to feed them. It used to be that parents were told to wait until their child was 3 to give him or her foods many people are allergic to, like peanuts. Not anymore.

Experts now recommend feeding babies common allergens before they turn 1 to reduce their chances of developing allergies to these foods.

Jill Madison, MS, RD, a Clinical Dietitian at Children’s Hospital Los Angeles, and Jonathan Tam, MD, Medical Director of the Gores Family Allergy Center at Children’s Hospital Los Angeles, offer these tips for feeding your little one.

Feed solids at around 4 months

Your baby is likely ready to start eating food when he or she has good head control, can sit up unassisted, and shows interest in foods, Madison says. At the baby’s 4-month checkup, your pediatrician will tell you whether it’s time to introduce solids. This means giving your baby a single-item food, like steamed carrots, not a combination of foods, like steamed carrots blended with potatoes.

“Historically, we started with purees. Now we know you can give a baby a whole food as long as it’s soft enough to chew, like a slice of ripe peach,” Madison says. To prevent choking, make sure that chunks of food are not round and hard, and can be mashed with a fork.

The first foods babies typically eat are single-grain cereals, vegetables, fruits and meat. Once your baby has gotten comfortable with these foods, you can start feeding him or her common allergens, introducing them one by one.

Safely introduce allergens

The most common allergens are eggs, milk, wheat, soy, sesame, tree nuts, peanuts, fish and shellfish. It’s a good idea to feed these foods to your baby before he or she turns 1, with the exception of milk in liquid form. That’s because cow’s milk has more calcium than breast milk and could interfere with the way your baby absorbs iron. Give your baby cottage cheese, yogurt or other forms of dairy, but wait until 12 months to give a cup of milk, Madison says.

As for nuts, babies can choke on these when they’re whole, so opt instead for nut butters that are creamy and smooth as opposed to chunky. You can make the nut butter less sticky by mixing it with water or breast milk or even blending it with apple sauce, Madison says. Another option is to stir a nut flour such as almond flour into a food your baby has already eaten many times before.

Pay attention to texture when feeding your baby, making sure food is soft enough to chew. Dip whole wheat bread in breast milk or water, for example, and mush shellfish and fish with a fork. You can mash a hardboiled egg and serve it as is or blend it with breast milk. Yogurt is an easy one to introduce since you don’t need to do anything to it. Start with plain yogurt made with whole milk, Madison says. You can also stir the yogurt into a fruit puree to change things up.

Ask your doctor about your baby’s allergy risk

Talk to your pediatrician if your baby has eczema, because this can put your baby at higher risk for developing a food allergy. And children with one food allergy may develop other food allergies. Children with an egg allergy, for example, are at higher risk of developing a peanut allergy, Dr. Tam says. If your child already has a food allergy, your pediatrician can give you advice on when to introduce other potential allergens.

Keep in mind that you should not avoid giving your baby a food just because someone in your family has an allergy to it.

“Since we know that in some context giving food early can prevent food allergy, then it would be even more important for an at-risk child to have it introduced early and purposefully,” Dr. Tams says.

Follow the 3-day rule

Your pediatrician may have told you to give your child a new food for three days in a row before introducing another new food. The same goes for common allergens.

“We want to give the child enough time to actually ingest the food and see how their body does with it,” Madison says.

While you’re doing this, remember to keep offering your baby foods you’ve already introduced.

Prepare foods at home

With all the jars, pouches and puffs available at stores, the options for feeding your baby may seem endless—and overwhelming. But Madison says making meals for your infant can be really simple.

As you’re cooking foods for the rest of your family, you can set aside a portion that doesn’t have salt or other seasoning. Say you’re cooking cod and asparagus, for example. You can cook the cod on the stove with some olive oil and mush it up with a fork for your baby. You can also cook the asparagus with olive oil on the stove top or in the oven and then puree or slice into half-moon pieces for your little one.

Madison says that while store-bought baby foods can be a good option for parents in a pinch, it’s best not to depend on them too much since studies show they can have unsafe levels of lead, mercury and other metals.

Looks for signs of a food allergy

How do you know if your baby is having an allergic reaction? Look for changes that begin within minutes to two hours after he or she ate the food. Hives and vomiting are the most common symptoms in infants, Dr. Tam says. Shortness of breath, coughing or wheezing can also happen, but are more common reactions in older children. If your baby develops a rash, take photos to track whether it’s getting worse, he says.

Seek medical attention for serious symptoms

If your baby is acting normally but has a mild rash or some hives, you could give your baby an antihistamine. Diphenhydramine (Benadryl) can provide comfort, but second-generation antihistamines like cetirizine (Zyrtec) and loratadine (Claritin) last longer and are less likely to make your baby sleepy, Dr. Tam says.

If your baby is vomiting, coughing, having difficulty swallowing (pay attention to new, suspicious drooling), or acting very sleepy, seek immediate medical attention. Try to get a doctor on the phone or go to the emergency department, Dr. Tam says.

Focus on variety over the long term

As your baby grows up, remember to keep feeding your child a variety of flavors and textures to help him or her develop a taste for different types of foods.

“Children eat what their parents eat,” says Madison. “If parents eat vegetables and try new foods readily, babies and kids will too.”

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