A few days after my daughter turned eight months old, I let her eat peanuts. It wasn't an accident. I opened the jar of peanut butter, spread it thinly on a sliver of toast and handed it over to my smiling baby girl. I did it because my family doctor told me to. She said I could forget the old rules I'd heard about delaying introducing peanuts, shellfish, dairy and other potential allergy-causing foods until as late as three or four years old.
Her advice was based on recommendations published in May 2011 by the Ontario Society of Nutrition Professionals in Public health (OSNPPH), which advises that when children reach six months of age, parents can introduce what health professionals refer to as "highly allergenic" foods, even if there is a family history of allergies. As of October 2012, the Canadian Paediatric Society agrees. Their website tells parents that there is no reason to delay the introduction of common allergens like peanuts, tree nuts, shellfish and eggs.
Dianne Oickle, a registered dietitian and member of the OSNPPH, says these new recommendations are the result of a review of the most current evidence-based research, which clearly shows there is no benefit to delaying the introduction of any specific foods to prevent food allergies. As soon as infants are six months old, Oickle says, "everything is on the buffet" - with the exceptions of junk food, choking hazards and honey (due to the risk of botulism). If this conflicts with other advice you've been hearing, or with the guidelines you followed with your older children, don't worry: Many Canadian doctors are still telling parents to delay certain foods until well into the toddler years.
"This is largely an issue of health professionals not being aware of the most up-to-date research," says Edmond Chan, a paediatric allergist at BC Children's Hospital in Vancouver. This new advice from the Canadian Paediatric Society is in line with a 2008 position statement from the American Academy of Pediatrics and recommendations from health professionals in Australia and Europe. Parents should introduce one new solid food every few days, to avoid any confusion if a reaction does occur. It is important to remember that the likelihood of a child having a severe food allergy is relatively low: An estimated six to eight percent of Canadian children have some form of diagnosed food allergy, and only about one percent of children have a confirmed peanut allergy.
When introducing a potentially risky food, doctors recommend parents watch closely in the first few minutes for any signs of anaphylaxis, including hives, swelling, difficulty breathing, loss of consciousness or vomiting. If there is no reaction, make the new food a regular part of their diet. "Just giving them peanut butter once and then never again isn't going to help anything. It has to be consistent," says Chan.
When I gave peanut butter to my daughter for the first time, I like to think I played it pretty cool. But as she sucked on her gooey piece of toast, I felt my heart speed up a little as I scanned her skin and listened to her breathing, ready to leap into 911-mode at any moment. Thankfully, she didn't react at all. In the end, our only real problem with peanut butter has been figuring out how to get it out of her hair.
Did you know? There is a difference between food allergies and food intolerances, even though some symptoms, like diarrhea and vomiting, occur with both. Intolerances are caused by enzymatic deficiencies and result in indigestion, gas and bloating. Food allergies may manifest as hives, swelling or difficulty breathing.
This article appeared in our January 2013 issue with the headline "News about nuts," p.48.
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