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Allergies in babies and children – updated infant feeding advice

Little boy eats a boiled egg because he does not have an egg allergyAllergic diseases are becoming more and more common among children.

In fact, in the past 25 years, allergic diseases have more than doubled in Western countries.

And according to the Australasian Society of Clinical Immunology and Allergy (ASCIA), the peak body for allergy and critical immunology in Australia, 2 in 5 children in Australia and New Zealand are affected by allergic disorders during childhood, with 1 in 5 currently having symptoms.

The most common allergies in children are food allergies, eczema, asthma and hay fever (allergic rhinitis).

The ASCIA published their guidelines for infant feeding and early onset allergy prevention in 2016, with additional guidance published in 2017 and 2018, based on emerging evidence. The guidelines were published in the Medical Journal of Australia in January 2019.

What is causing the increase in allergic diseases?

At the moment there is no clear explanation for why allergic diseases — especially in children — have increased so rapidly in recent years.

There are a number of proposed explanations but the issue is complex and research is ongoing.

Who is at risk of developing an allergy?

Any child can develop an allergy but, according to the ASCIA, there are a number of factors that appear to increase a child’s risk. These include:

  • A family history of allergic disease in a parent or sibling (and a further increased risk if it’s both parents OR a parent and a sibling).
  • Introducing cow’s milk or soy milk formula before 3-4 months of age (increases the risk for eczema and food allergies).
  • Introducing solid foods before 3-4 months of age (increases the risk for eczema and food allergies).
  • Being born in spring – a risk for seasonal allergic rhinitis (hay fever).
  • Passive exposure to cigarette smoke (increases the risk for respiratory symptoms).
READ: You can read more about starting solids in our Starting Solids Hub

What can you do to help prevent allergies?

The ASCIA updated its Infant Feeding Advice and Guidelines for Allergy Prevention in Infants in 2016, with additional guidance published in 2017 and 2018, based on emerging evidence. The guidelines were published in the Medical Journal of Australia in January 2019.

The guidelines contain advice on the mother’s diet while pregnant, early feeding (breastfeeding and infant formula) and the introduction of solid food.

Pregnancy diet and allergy prevention

  • It is not recommended that women who are pregnant (or breastfeeding) exclude any particular foods (including foods considered to be highly allergenic) from their diet. Excluding foods has not been shown to prevent allergies.
  • Up to three serves of oily fish a week may be beneficial. There is some evidence that omega-3 fatty acids in pregnancy and breastfeeding may help prevent eczema in early life.
  • There is moderate evidence that probiotics during pregnancy and breastfeeding may help prevent eczema in early life BUT more research is required (on dose levels and species of probiotics) before a specific recommendation can be made.

Infant feeding and allergy prevention

  • Breastfeeding during the period when babies are introduced to solid foods may help reduce the risk of the infant developing allergies, although evidence for this is low at the moment.
  • If breastfeeding isn’t possible, a standard cow’s milk based formula can be given. There’s no evidence that soy or goat’s milk formula reduces the risk of allergies when used in preference to cow’s milk formula.
  • Hydrolysed (partially and extensively) infant formulas are not recommended for prevention of allergic disease. There is no consistent convincing evidence that partially hydrolysed formulas (usually labelled ‘HA’ or Hypoallergenic) or extensively hydrolysed formulas helps to prevent eczema, food allergy, asthma or allergic rhinitis in babies or children.

Starting solids and allergy prevention

  • Solid foods should not be introduced before 4 months of age
  • Introduce solid food from around six months, when your baby is developmentally ready for solid food and while they are still being breastfed. This is not a strict window but rather a recommendation not to delay introducing solid foods beyond 12 months.
  • All infants should be given allergenic solid foods including peanut butter, cooked egg, dairy and wheat products in the first year of life. This includes infants at high risk of allergy. There’s evidence to say that the introduction of common allergenic foods (cooked eggs, peanuts butter, wheat, fish etc) should not be delayed. But, further evidence is needed to clarify optimal timing for each food.
  • There is good evidence that introducing peanut into the diet of babies who already have severe eczema and/or egg allergy before 12 months of age can reduce the risk of them developing a peanut allergy. If this applies to your baby, you should discuss how to introduce peanut with a doctor who has experience with food allergies.
  • There’s moderate evidence to say that introducing cooked egg into an baby’s diet before 8 months of age (where there’s a family history of allergy) can reduce the risk of the baby developing egg allergy.
  • If your child already has allergies, such as severe eczema or food allergy, you should discuss what specific measures might be useful with your doctor when starting solid food.

 

NOTE: As always, if you’re worried about any aspect of your child’s health or wellbeing you should talk to your health care provider.

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