With childhood allergies now more common
it's good to have evidence-based information to go by.
The number of children becoming allergic to foods has risen sharply in recent years in Western countries. Finding out what we are doing wrong has been the aim of recent and current research in several parts of the world, including Australia.
Reducing the risk of allergies
For many years we thought we knew how to reduce the risk of allergy, that is, delay allergenic foods, such as cows’ milk, nuts, wheat, soy, egg and fish. This approach was thought to reduce the risk of allergy to these foods by allowing the baby’s system to mature. However, population studies and some large, controlled trials carried out in the UK1 and Australia2 have disproved this, for peanuts and egg respectively.
It is now recommended:3,4
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that once solids are begun, a variety of foods should be given
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that the type and order do not matter, as long as there are some rich in iron
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to start the most allergenic foods (as mentioned above) before 12 months of age, as this is associated with a reduced risk of allergy developing
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to leave a gap of 2 to 3 days between each new food, in case there is some reaction.
No matter what age your baby starts solids, keep breastfeeding as new foods are begun. Research suggests that this may reduce the risk of your baby developing allergies.3 It used to be thought that this also applied to coeliac disease.5 However, the latest evidence is that the way a baby is fed when gluten is begun does not affect this risk.6
If your baby or child has a food allergy
If a baby or child already has a food allergy, they need to avoid those foods. In many cases, their breastfeeding mother also has to avoid those foods, but in other cases, the foods do not seem to go through the milk.
There is not enough evidence to advise pregnant women to avoid allergens to reduce the risk of allergy in the child.7 It is possible that eating allergenic foods during pregnancy could actually be protective.8,9
If your baby already has symptoms of allergy, you should seek advice from a health professional about introducing solids.
What about starting solids earlier?
There has been a push to start solids at 4 or 5 months. However, there has been no good evidence to suggest that babies of this age have a reduced chance of developing allergies than babies starting solids at 6 months.10 Also, allergy is not the only consideration in timing of solids.11 There are also nutritional issues, risk of illness, risk of the baby having too little breastmilk and the timing when each baby is ready for more than milk.
Many people think that risk of illness from formula-feeding or dirty solids is only a problem in poor countries. However, there are many studies showing that breastfeeding protects babies from illness in Western countries as well.11 This supports keeping the timing for exclusive breastfeeding to around 6 months.
Therefore, Australian recommendations in the current (2012) Australian Infant Feeding Guidelines are to introduce solids at around 6 months of age.
© Australian Breastfeeding Association April 2022
- Du Toit G, Roberts G, Sayre PH et al 2015, Randomized trial of peanut consumption in infants at risk for peanut allergy. New Engl J Med 372(9): 803–813. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416404/
- Koplin JJ, Osborne NJ, Wake M et al 2010, Can early introduction of egg prevent egg allergy in infants? A population-based study. J Allergy Clin Immunol 126(4): 807–813. https://www.jacionline.org/article/S0091-6749(10)01173-5/fulltext
- National Health and Medical Research Council 2012 (2015 revision), Infant Feeding Guidelines. Australian Government, Canberra.https://www.nhmrc.gov.au/about-us/publications/infant-feeding-guideline…
- Netting MJ, Campbell DE, Koplin JJ, Beck KM, McWilliam V, Dharmage SC, Tang MLK, Ponsonby A-L, Prescott SL, Vale S, Loh RKS, Makrides M, Allen KJ 2017, An Australian consensus in infant feeding guidelines to prevent food allergy: Outcomes from the Australian Infant Feeding Summit. J Allergy Clin Immunol Pract 5(6): 1617–1624. https://research-repository.uwa.edu.au/en/publications/an-australian-co…
- Ivarsson A, Hernell O, Stenlund H, Persson LA 2002, Breast-feeding protects against celiac disease. Am J Clin Nutr 75: 914–921. https://academic.oup.com/ajcn/article/75/5/914/4689407
- Szajewska H, Shamir R, Mearin L, Ribes-Koninckx C, Catassi C, Domellöf M, Fewtrell MS, Husby S, Papadopoulou A, Vandenplas Y, Castillejo G, Kolacek S, Koletzko S, Korponay-Szabó IR, Lionetti E, Polanco I, Troncone R 2016. Gluten introduction and the risk of coeliac disease. A position paper by the European Society for Paediatric Gastroenterology, Hepatology & Nutrition. J Paediatr Gastroenterol Nutr 62(3): 507–513.
- Kramer MS, Kakuma R 2012. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev Issue 9. Art. No.: CD000133. DOI: 10.1002/14651858.CD000133.pub3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045459/
- Frazier AL, Camargo CA, Malspeis S, Willett WC, Young MC 2014. Prospective study of peripregnancy consumption of peanuts or tree nuts by mothers and the risk of peanut or tree nut allergy in their offspring. JAMA Pediatr 168(2): 156–162. https://jamanetwork.com/journals/jamapediatrics/fullarticle/1793699
- Tuokkola J, Luukkainen P, Tapanainen H, Kaila M, Vaarala O, Kenward MG, Virta LJ, Veijola R, Simell O, Ilonen J, Knip M, Virtanen SM 2016. Maternal diet during pregnancy and lactation and cow’s milk allergy in offspring. Eur J Clin Nutr 70(5): 554–559.
- Smith HA, Becker GE 2016, Early additional food and fluids for healthy breastfed full-term infants. Cochrane Database Syst Rev. 2016(8):CD006462. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006462.pub4…
- Anderson J, Malley K, Snell R 2009, Is 6 months still the best for exclusive breastfeeding and introduction of solids? A literature review with consideration to the risk of the development of allergies. Breastfeeding Review 17(2): 23–31.
Read more about introducing solids
Evidence-led info and practical tips from our Breastfeeding Information Series
Breastfeeding: and family foods
