Introducing your baby to their first solids is a fun, exciting journey for all parents. Worrying about allergens is a journey as well, one that can seem overwhelming if it’s something you haven’t planned for. Michael Wieder, the co-founder of Lalo, is joined by Kim Grenawitzke, feeding specialist at Solid Starts, to talk about allergens, a very serious topic when you’re thinking of first foods for your baby. Parents have a lot of anxiety around allergens and we want your baby’s first food experience to be really positive. If you have concerns regarding allergens, please speak to your pediatrician. This is a conversation about allergens, but by no means is it medical advice.
Allergens, what are the most important ones for toddlers?
Michael: Can you walk us through what the allergens are? How do we think about even approaching allergens? What is the process about working that into starting solids?
Kim: In the United States, there are 9 common allergens, and depending on what country you're in, this list actually may change a little bit, but I'm going to cover the 9 top that are in the United States.
They are: egg, peanut, and dairy, which are the big 3! Plus tree nuts, tinned fish, shellfish, wheat, soy, and sesame.
Those are the nine common allergens that are most likely to cause an allergic reaction. When it comes to introducing them, the research tells us that the three that you want to really make sure that you get in the first year of life are eggs, peanut, and dairy.
How to introduce allergens:
Kim: The key to introducing an allergen is that you want to start small, and you want to introduce it across 3 subsequent introductions. Most people like to do it over 3 days, so you start with an eighth or a quarter of a teaspoon of, say, yogurt, if you want to do dairy.
The next day, you're going to go up a little bit, so you'll do a quarter or a half of a teaspoon of that yogurt, and the following day after that, you maybe will do a full teaspoon of yogurt.
Generally, if they've had 3 exposures of progressively larger amounts without any signs of allergic reactions, you can say that your baby is most likely tolerant of that allergen.
Now, allergies technically can pop up at any time, but the research tells us this is the way that we can lower the risk the most for our kids. The research says that keeping the allergens in the diet around two times a week up until age five is the key to getting the most protection. So say you introduce that yogurt in week two of starting solids, you still want to keep offering yogurt once or twice a week to make sure that that dairy stays in the diet.
Introducing allergens separately:
Kim: The other key about allergens is that you don't want to introduce two allergens at the same time. So if you're introducing yogurt, for example, you're not going to mix peanut butter in that for the first exposures. You want to do the allergens separately. Once they've both been offered a few times, and you've ruled out the allergy, then you can mix those two together, because that's an easy way to keep those allergens in the diet, but when you're first introducing them, you keep them separate.
You can, on the other hand, pair them with a non-allergenic food. So if you give your kid a little bit of yogurt, and then you're waiting 15-20 minutes to see if your baby has a reaction, go ahead and give them a mango pit. Give them something else to eat and play with at the table. It's completely fine to put a non-allergen with an allergen. Just not two allergens together.
What does an allergic reaction look like?
Kim: So the thing about allergic reactions that I think makes some parents feel a little bit better, is that it's very black and white. It's either mild or severe. There's no in-between. Our allergist tells families to think about the systems that are involved.
So we have skin, we have breathing, and we have GI (tummy). When most of us think about allergic reactions, we think about skin, we think about hives, we think about rashes. A small patch of a rash, or hives, would be considered a mild reaction. If your baby has more than one symptom together, so say they have hives and breathing problems or they have a rash and their lips are swelling up, that would be automatically considered severe because we have two reactions.
The other thing you're going to see is that within 15 to 20 minutes of giving the allergen- while there are some reactions that can be delayed- almost all of the time, it's going to happen pretty soon after giving it.
One thing that we may see that's a more delayed reaction is a GI-related reaction, where the baby has the food, and then typically they go to sleep because it's at night, or they're going down for their nap, and then they're vomiting or having diarrhea and that can be a reaction called FPIs. That’s very rare, and it does need to have very close monitoring by an allergist, but if your baby has food a couple times in a row, and then they have these GI symptoms pretty consistently afterward, it's worth bringing it up to your doctor.
Introducing allergens naked:
Kim: One little trick for introducing allergens is to do it naked, because I can't tell you how many times babies will have no rash on their face, but the onesie comes off and they have hives on their body. It's helpful to do it naked, just so you can see their whole body.
To make everybody feel a little bit better- allergic reactions are very rare. I believe it's only 8% of children generally who will have an allergic reaction, and the amount of babies is even less than that. So while I know a lot of people would want to introduce allergens at their pediatrician's office or in the parking lot of the hospital (as a precaution), our allergist says that you don't need to have an EpiPen at home. Most kids are not going to have a reaction, and reactions are dose-dependent. You're starting with a little tiny bit, a little taste of these foods. And if there is a reaction, it's most likely not going to be super scary the first time.
Eggs and dairy allergens:
Michael: Let’s address eggs and dairy which are separate allergens.
Kim: Eggs are not dairy. So, please remember, those are two separate things. You gotta get them both separately. And the thing about eggs, too, that we hear a lot is that there was old advice to separate egg white and egg yolk. The new advice is, unless you have been advised differently by your doctor, is to do them together. So you would scramble eggs and then you mash a little bit to give to your baby as a taste.
This is not medical advice, speak to your pediatrician with any questions or concerns regarding starting solids.
