by Amy Spangler
January 10, 2008

The incidence of atopic diseases such as asthma, eczema, and food allergies has increased dramatically the last 10 years. Among children under the age of 4 years, asthma rates have increased 160 percent, while rates of peanut allergy have doubled. Although parents can’t change their child’s genes, they can modify the environment—the question is how.

In an effort to address allergy prevention as it relates to infant and young child feeding, the American Academy of Pediatrics (AAP) recently released a policy statement on the subject. Published in the January issue of Pediatrics, the revised guidelines target pregnant and breastfeeding women, infants, and young children. The guidelines focus on what to feed, what not to feed, and when to feed it—a summary follows:

• Breastfeed exclusively for at least four months—While the Committee on Nutrition recommends exclusive breastfeeding for four months, the Section on Breastfeeding recommends a period of six months.

• High-risk infants (those with a family history of allergic disease) gain the greatest protection from exclusive breastfeeding. If formula feeding is necessary, hydrolyzed formula is a better choice than cow’s milk or soy formula. There is no evidence that use of soy formula prevents allergic disease.

• There is little evidence that exclusive breastfeeding provides protection from allergic disease beyond six years.

• There is no evidence to support restricting the diet of pregnant or breastfeeding mothers in order to prevent allergic disease in their high-risk children.

• Solid foods are not recommended until an infant is 4 to 6 months of age.

• There is no evidence to support delaying the introduction of solid foods beyond 4 to 6 months. This includes foods known to cause allergies in young children such as eggs, fish, or peanut butter.

The earlier guidelines recommended delaying the introduction of eggs until age 2, and tree nuts, peanuts, and fish until age 3. “We just do not have the studies to back this up. If a child is going to be allergic to peanuts or eggs, it doesn’t seem to matter [after 4 to 6 months] when you introduce these foods,” says study co-author Frank Greer, MD.

Moms who think they caused their child’s food allergy by introducing certain foods too soon can blame it instead on his or her genes.

Exclusive breastfeeding is the one intervention for which there is sufficient evidence.

“If there is a family history of allergy problems, it is clear that moms should breastfeed exclusively for at least four months,” says study co-author Scott H. Sicherer, MD. “If that isn’t possible and formula is needed, don’t pick a typical soy formula.”

The new guidelines apply only to babies with a high risk of developing allergic disease, not those who already have asthma, food allergies, or eczema.

Also, more research is needed before the long-term effects of dietary interventions in infancy on the development of allergic disease in later childhood can be determined.