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Early Introduction of Complementary Foods Might Prevent Allergic Disease

Duration of total breast-feeding is more important than exclusive breast-feeding for prevention of asthma and allergies.

The timing of the introduction of complementary foods in infants is confusing for parents and clinicians alike. Older guidelines recommended avoidance of dairy until age 1 year; eggs until age 2 years; and peanuts, nuts, and seafood until age 3 years. Currently, the American Academy of Pediatrics recommends exclusive breast-feeding until age 4 to 6 months, followed by introduction of complementary foods without providing a timeline for when to introduce specific foods. Investigators followed 3781 Finnish children for 5 years to examine the association between duration of breast-feeding and timing of introduction of complementary foods (based on parent report) and the development of allergic disease and specific IgE (sIgE) sensitization to foods and inhalants.

Introduction of wheat, rye, oats, and barley before age 5.5 months, fish before age 9 months, and egg before age 11 months was associated with lower rates of asthma, allergic rhinitis, and sIgE sensitization. Total breast-feeding duration of 9.5 months or more was associated with lower risk for nonatopic asthma, and the benefit seemed to correlate with the duration of total breast-feeding rather than exclusive breast-feeding.

Comment: By telling parents for years to delay the introduction of allergenic complementary foods, we might have caused more harm than good. On the basis of these results and recent guidelines (J Allergy Clin Immunol: In Practice 2013;1:29), I recommend exclusive breast-feeding for only 4 months followed by continued breast-feeding with complementary foods until age 12 months. Grains should be started at age 4 months, followed by all other foods during the first year. A recent randomized trial showed similar growth rates and better iron status in breast-fed infants when complementary grains were started at 4 versus 6 months of age. (JW Pediatr Adolesc Med Jan 9 2013)

— David J. Amrol, MD

Dr. Amrol is an Associate Professor of Clinical Internal Medicine and Director of the Division of Allergy and Immunology at the University of South Carolina School of Medicine in Columbia.

Published in Journal Watch Pediatrics and Adolescent Medicine January 30, 2013

Citation(s):

Nwaru BI et al. Timing of infant feeding in relation to childhood asthma and allergic diseases. J Allergy Clin Immunol 2013 Jan; 131:78. (http://dx.doi.org/10.1016/j.jaci.2012.10.028)

Reader Remarks:

Review and add to remarks on this article

• Early Introduction of Complementary Foods Might Prevent Allergic Disease
  Lucio Piermarini, 31 Jan 2013 1:27 PM EST
  Specialty: Pediatrics
  People keep blindly proposing an age of weaning or another, always with good reasons, and always never asking the infants... [more]
• Change in sensitization with age
  James Thompson, AAOL, 5 Feb 2013 4:26 PM EST
  Specialty: Allergy & Immunology
  I was looking over some of my molecular allergy results and realized that toddlers and infants are far more likely... [more]
• Early Introduction of Complementary Foods Might Prevent Allergic Disease
  Neal Devitt, 19 Feb 2013 1:04 PM EST
  Specialty: Family Medicine
  It is premature, reckless and possibly dangerous to recommend changes in the time to introduce solid foods on the basis... [more]
• Starting Grains vs Meats between 4-6 months of age
  Marc A. Tanenbaum, Atlanta, 12 Mar 2013 12:34 PM EST
  Specialty: Pediatrics
  Dr. Amrol,
  
  Could you comment on the pros & cons of starting individual puréed meats vs infant cereals as first... [more]

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