By Jessica M. Morrison, Chicago Tribune reporter
September 12, 2012
When Elyse Anders had her first child five years ago, her doctor recommended withholding seafood, peanut products and strawberries from her infant son's diet to avoid food allergies.
But when she had a daughter three years later, the advice had changed — no delay was necessary.
As it turned out, her first child has no food allergies, and her second child is allergic to dairy, eggs and penicillin.
Does that mean the new advice was wrong? Experts say no. "There is no evidence that the introduction of any sequence of foods is better than any other," said Dr. Jatinder Bhatia, neonatologist and chair of the American Academy of Pediatrics' committee on nutrition.
Today, experts say that parents hoping to prevent food allergies should pay attention only to the age when babies start on solid foods. Giving an infant such foods before 4 months of age could increase the incidence of allergies, as could waiting until after 7 months, said Bhatia. "We don't know exactly why the window exists, but that window does exist."
Such shifting recommendations can be confusing for new parents and frustrating for experienced parents who note changes in the conventional wisdom, sometimes even from one child to the next.
"During the first year, everything is overwhelming. It's a lot. It's a lot to try to remember," said Anders, who recently moved from Arlington Heights to Irving, Texas.
In the past, doctors would recommend that parents start young children on rice cereal, followed by fruits, vegetables and meats. Some foods needed to be avoided altogether for the first year, among them nuts, eggs, fish and strawberries.
"There was a time when we thought there was a strong relationship between how babies were fed and food allergies," said Dr. Robert Wood, director of the division of allergy and immunology at the Johns Hopkins University School of Medicine. "Back in the 1990s we really thought we had a better understanding of this. Then I would have given (parents) very specific recommendations about how to feed their baby, but it turns out that those recommendations did not stand up to evidence-based research."
Now he says there is no best way to introduce foods to avoid allergies, and that's a good thing when it comes to reducing parents' guilt.
"The development of food allergies is not under (our) control. It's really up to the baby's immune system," Wood said. "We have very little influence over whether that is going to happen or not. (Parents) are not doing anything wrong to lead to this happening."
A food allergy develops when the body's immune system goes on the attack against a certain food as a foreign invader, he said. Food allergies typically begin in the first or second year of life, unlike environmental allergies, which appear much later.
A young, working mother when her first child was born 13 years ago, Tracey Becker, of Plainfield, said she followed her pediatrician's recommendations exactly and doesn't remember being instructed to hold back any foods.
When her second child was born three years later, she received conflicting recommendations, and by the time her third child was born six years ago, Becker said, she chose to do what she felt was right.
"I finally realized at that point that medicine is not an exact science, and if you don't like one doctor's opinion, you can find another one that you do," said Becker, whose kids did not develop food allergies. "Once I realized that, I realized that I already had my own opinions."
Becker is not suggesting that parents forgo the advice of medical professionals. Rather, she suggests supplementing it with advice from a mentor, such as your own mother, as a way to combat the onslaught of information available to new, often overwhelmed, parents.
"Relax!" she said. "People have been raising babies for thousands of years."
Some of the confusion might come from the dissemination of new knowledge from researchers to pediatricians to parents, Bhatia said.
"One of the frustrations at the academy level is that we don't always see change at the trench level," Bhatia said. "My own nutritionist went to her pediatrician, and she was given a piece of paper that was probably 15 years old — 'This Is How You Introduce Foods.'"
Joyce Cunningham, of Schererville, Ind., followed advice from "the older, wiser women" in her life as she began to make dietary decisions for her six children, who range in age from 20 years to two months.
For the most part she introduced solid food to her children as she felt they were ready, often earlier than the recommendations provided at the time. Although doctors suggested avoiding nuts, citrus fruits and spices, Cunningham operated on the assumption that babies had taste buds, too, and could join in on the family's dinner if bits were mashed up.
"I'm a foodie. I love to cook, love to eat, love all different kinds of food, and I want my kids to have no allergies and be open to any kind of food that's good," she said. None of Cunningham's children has developed food allergies.
Dr. Krystal Revai, clinical chief of general pediatrics and adolescent medicine at Children's Hospital University of Illinois in Chicago, tells breast-feeding parents to start babies on solid food at six months by beginning with a fruit, adding a vegetable and then a meat or bean, and continuing in no specific order.
"The reason why I do a fruit and then a vegetable and then a meat is because a lot of babies won't take the meats straight out," Revai said. "Sometimes you have to mix in a little bit of fruit to sweeten up the meat a little bit."
Regardless of the order, and even if food allergies are hard to avoid, Bhatia said the introduction of solid foods is still the best time to help a baby develop healthy eating habits.
"This is a window of opportunity for a parent to (instill) healthy eating habits because at this time the mother is still the provider," he said. "If you restrict salt and excess sugars, your baby is not going to, hopefully, develop a taste for too salty and too sugary foods. That becomes a lifelong habit."
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