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Friday, April 25, 2008

Infant Diets: New Feeding Regimen for Infants

The New Infant Feeding Regimen - No More Egg-less Meatballs:

In January of 2008, the American Academy of Pediatrics (AAP), released a policy statement regarding the introduction of solid foods, including eggs, fish and peanuts into an infant’s diet. This policy statement replaced the statement released in 2000 that had advised delaying the introduction of highly allergic foods until 1-3 years of age.

The delay of the introduction of certain solid foods has become the mainstay for many infant-feeding regimens. The standard feeding regimen for infants had been breast milk or formula, exclusively, for the first 4-6 months, followed by the introduction of rice cereal, then vegetables and fruit, followed by meat, with eggs being introduced after 2 years of age, and fish and nuts after 3 years. However, according to a new policy statement released by the AAP, these restrictions are no longer thought to be necessary.

The new statement still recommends exclusive breastfeeding for 4-6 months, however, there are no longer recommended delays for the introduction of solid foods after this time, including removing the previous recommended delays for eggs, fish and nuts. It is important to understand what the statement says. Previously, it had been thought that some atopic diseases, which include eczema, allergic rhinitis, asthma and food allergies, could be prevented or lessened in severity by delaying the introduction of highly allergic foods into the infant’s diet. The new statement concludes that, after 4-6 months of age, the timing of introduction of solid and highly allergic foods does not change the outcome. That is to say, if a child is going to be allergic to a food or have an atopic reaction (eczema, allergic rhinitis or asthma) to the food, then delaying the introduction of that food does not lessen this chance. The child will still have the reaction when the offensive food is introduced, whether that is at 7 months of age or 2 years. Thus, a certain percentage of infants will have these reactions to a food regardless of when the food is introduced. For these reasons, it is still prudent to only introduce one food at a time and watch for allergies. When introducing eggs, it is still wise to start with just the cooked yolk and if that is well tolerated move on to the whites a week or so later.

These new recommendations should be discussed with your child’s pediatrician. For infants that have already had an atopic reaction or who have a strong family history of eczema, allergic rhinitis, asthma or food allergies, parents and pediatricians may still opt to wait on introducing solids or highly allergic foods as these children are more likely to have reactions. The full statement release by the AAP can be found at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;121/1/183.

Update: AAP Q&A - first foods as of Sept. '08