Safely introducing food to an infant for the first time can be daunting for caregivers. What can they eat? What if they choke? Will they like it? Throw allergens into the mix, and it’s a recipe for major anxiety.
May is Food Allergy Awareness Month in Canada, so we spoke with Brock Williams, a registered dietitian and PhD candidate in UBC’s faculty of land and food systems. This fall, he will be exploring the challenges caregivers face when feeding babies allergenic foods as part of a postdoctoral fellowship with UBC medicine professor Dr. Edmond Chan at B.C. Children’s Hospital.
When should common allergens be introduced to infants?
Brock Williams: Early, often and safely.
In 2019, the Canadian Pediatric Society introduced new recommendations on preventing food allergies in babies: Common allergenic foods such as peanuts, tree nuts, eggs, sesame, shellfish, fish and wheat can be introduced into the diet of children who are at higher risk of developing a food allergy at around six months, but not before four months. Those considered to be at higher risk include those with a personal history, or a parent or sibling with allergic disease such as eczema, food allergy, asthma or allergic rhinitis.
For babies at a low or no risk for food allergy, common allergenic foods can be introduced into the diet after solids, at around six months. This was a significant change from advice in the early 2000s, which was to delay the introduction of common allergens to children until later in life—up to two years of age.
How should common allergens be introduced?
BW: It’s important to ensure that a baby is developmentally ready when introducing solids. They should have good head and neck control, and be able to sit upright when supported.
Foods also need to be prepared safely to reduce the risk of choking, like diluting and mixing peanut butter into breast milk, infant formula or a previously tolerated puree.
When allergenic foods are introduced safely, especially to infants at higher-risk of developing a food allergy, early and regular ingestion of commonly allergenic foods has been shown to reduce risk of developing a food allergy. For peanuts, this is roughly two teaspoons of peanut butter, two to three times per week. For eggs, it’s roughly one-third of a well-cooked egg, two to three times per week as tolerated.
The other commonly allergenic foods do not have the same quality of evidence, but should be incorporated into a healthy, well-balanced and diverse diet by offering a variety of healthy whole foods, such as fruits, vegetables, grains, meats and meat alternatives such as nuts and seeds, prepared in ways that are safe for infants.
What will your study focus on?
BW: For my postdoctoral work, our research will focus on identifying the challenges and barriers that caregivers experience in introducing and regularly feeding babies commonly allergenic foods.
Research conducted in England has found that the main obstacles often revolve around convenience. This includes challenges related to the caregiver’s lifestyle, such as managing time and finding ways to provide allergenic foods when travelling or returning to work. Another issue is food preparation—specifically finding safe and appealing ways to include recommended foods in a consistent and safe form.
With the research team at B.C. Children’s Hospital, I will be working closely with Canadian families to identify their issues, develop unique strategies to overcome them, and promote frequent intake to maintain tolerance to food allergens.
Why is it important to share new scientific information with caregivers?
BW: Parents of children with food allergies have expressed to us that they wished this information was accessible to them when they started introducing solid foods to their infants, and that accurate, evidence-based guidance on social media would have been so helpful. I think it’s important for us to have a holistic approach to disseminating information to caregivers, through healthcare providers, traditional media and social media, so we meet caregivers where they are.