For many years, the nutrition and allergy experts of the American Academy of Pediatrics (AAP) have given parents advice about how and when they should introduce their tots to certain foods, aiming to reduce kids' risk of food allergies, asthma, and allergic rashes. Based on a recent review of existing research data on the subject, the AAP has issued new guidelines changing some of those currently accepted recommendations.

The long and short of the report: Avoiding certain food allergens from the get-go has been proven to help only those babies with a high risk of food allergies (that is, those with a parent or sibling with allergies). But for everyone else, avoiding known allergens — during pregnancy, breastfeeding, and when introducing foods in the infant and toddler years — hasn't been shown to have much effect on preventing allergies.

The recent, headline-grabbing recommendations are establishing new AAP policy that may confuse parents who've gotten used to following the organization's old dietary do's and don'ts, which most pediatricians have been endorsing for years.

But it's important to note that the AAP isn't just tossing out its old policies. Although the new report does advise changes in some of the guidelines, the AAP's allergy and nutrition expert panels stress that, although current evidence doesn't provide adequate scientific support of some of the existing recommendations, they aren't ready to say those policies have been disproved altogether until they have more reliable research in hand.

Key Points From the Report

The new policy lists the things that current research indicates do seem to work to keep food allergies, asthma, and atopic dermatitis (eczema) at bay — and things that don't.

According to the best available research, feeding only breast milk or certain hydrolyzed formulas (in which the proteins have been broken down to make them less allergenic) for at least 4 months can help prevent or put off atopic dermatitis, cow's milk allergy, and wheezing in early childhood for high-risk kids.

However, a lack of "current convincing evidence" shows that some old recommendations do not seem to help in certain areas:

• Women do not need to avoid eating any potential allergens (like peanuts) during pregnancy or breastfeeding. But the study points out that although more research is needed, there is some evidence that avoiding certain foods while nursing could possibly help prevent eczema.
• Exclusive breastfeeding does not seem to protect against allergic asthma that starts beyond early childhood (after 6 years of age).
• Feeding soy-based infant formulas does not seem to help prevent allergies.
• From an allergy prevention standpoint, there's no reason to wait beyond 4 to 6 months of age to start babies on solid foods.

What This Means to You

If you're still perplexed about the new recommendations, consider these standard dietary tidbits that can help you start your tiny tot off on the right nutritional foot:

• Talk to your doctor about your immediate family's history of allergies or asthma, whether you're expecting, breastfeeding, or introducing foods.
• Still continue to avoid certain foods during pregnancy that could harm your baby:
  • soft, unpasteurized cheeses like feta, goat, Brie, Camembert, and blue
  • unpasteurized milk, juices, and apple cider
  • raw eggs or foods containing raw eggs, including mousse and tiramisu
  • raw or undercooked meats, fish, or shellfish
  • processed meats like hot dogs and deli meats (unless they're well-cooked)
  • fish that are high in mercury, including shark, swordfish, king mackeral, or tilefish
• Breastfeed. Health experts the world over agree that breast milk is the ideal form of nutrition for babies. And exclusively breastfeeding for at least 4 months gives infants an excellent start in life for many reasons other than allergy prevention.
• Continue to eat a well-balanced diet while nursing, full of plenty of fruits, vegetables, whole grains, calcium, protein sources, water, and added calories (up to 500 more a day).
• Let your doctor know if your breastfed baby seems to have an allergic or sensitivity reaction to anything you've eaten — consistent spitting up or vomiting, belly pain (lots of gas and/or pulling up the knees in pain), or bloody and/or mucousy stools (poop).
• Give iron-fortified infant formula (if you can't or choose not to nurse), which still contains all of the nutrients your baby needs to thrive and grow.
• Still wait until your baby's first birthday to introduce honey (which can cause infant botulism, a potentially serious disease).
• Talk to your doctor before starting your baby on any solids and, later, before introducing finger or table foods.
• Immediately stop giving a food — and call your doctor — if your child seems to have an allergic reaction to it.

It's also important to remember that these new AAP guidelines apply only to the role of diet in preventing or delaying allergies — not to dietary changes for children who already have a food-sensitive allergy.

Be sure to have a discussion with the doctor about what the recent and old AAP advice specifically means for you and your little one. Find out what's the best diet for you — if you're pregnant or breastfeeding — and your child, based on your own personal needs and medical history.

Reviewed by: Steven Dowshen, MD
Date reviewed: January 2008

Source: "Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas," AAP clinical report, Pediatrics, January 2008.