Ok here is some links to canadas guidelines......first one is from canadas pediatric and our number 1 recommended site to parents from our pedi and the hospital
http://www.caringforkids.cps.ca/handouts/feeding_your_baby_in_the_first_year
http://www.actionagainstallergy.co.uk/index.php?option=com_content&view=article&id=145:infant-food-allergies&catid=3:newsflash&Itemid=525
Introducing Solid Foods
The first consensus document on the introduction of solid foods for the food-allergic infant was published in July 2006 by the Adverse Reactions to Foods Committee of the American College of Allergy, Asthma and Immunology . They recommended that introduction of the multiple allergens in solid foods to the allergic infant is preferably delayed until after six months of age. Until this age the authors suggest that the infant's immature digestive tract and immune system may increase the risk of sensitization and development of allergy. Furthermore, it was recommended that the most highly allergenic foods should not be introduced until after one year of age or later. Specific times of introduction were suggested as: cow’s milk at 12 months; egg at 24 months; peanut, tree nut and fish at three years. Most Western countries, including the UK, followed these recommendations.
However, more recent research has demonstrated that these recommendations were neither supported by evidence-based research nor were they effective in practice. Newer position papers reflect this change in approach. The AAP paper, published in 20087 states, “..the evidence…does not allow one to conclude that there is a strong relationship between the timing of the introduction of complementary foods and development of atopic disease”.
According to the current published guidelines of all paediatric societies and consensus committees, solid foods should be introduced individually and gradually, starting at about four to six months of age. Each food should be introduced, ideally over a four-day period, with careful monitoring of the baby for the development of signs of allergy. Some studies suggest that foods, especially gluten-containing grains, should be introduced at about six months of age while breast-feeding for optimum tolerance development . Early introduction (e.g. before one year of age) of even highly allergenic foods such as peanut is likely to lead to tolerance rather than sensitisation .
There is no evidence to suggest that any food should be delayed after six months of age, nor guidelines to suggest any particular order of introduction of solid foods. No mixed foods should be given until each food in the mixture has been given to the baby and is tolerated. Current research is indicating that there may be a “window of opportunity” when the child’s immune system is most likely to tolerate the food, and that if this is missed there may be an increased likelihood of sensitization. Future research will undoubtedly reveal the ideal times for introduction of specific foods.
Summary of Dietary Guidelines for the High Risk for Allergy Baby during Pregnancy, Lactation, and Early Infant Feeding
• A high risk for allergy is defined as a baby with one first degree relative (parent or sibling) with a diagnosed allergy
• There should be no dietary restriction during pregnancy except:
o Mother must avoid her own allergenic foods to avoid any allergic reactions
It is essential that mother should obtain complete balanced nutrition appropriate for pregnancy, and eat as wide a range of foods as possible
The allergic mother must ensure that she is consuming equivalent nutrients in the alternative foods she is eating as substitutes for her allergens
• Mother should not restrict her own diet while breast-feeding except:
o Mother must avoid her own allergenic foods
o Mother must avoid any foods to which her baby has been diagnosed as allergic
• Exclusive breast-feeding should be continued for 4 – 6 months.
• For the breast-fed baby the introduction of solid foods or infant formula (complementary foods) should be delayed until at least 4-6 moths
• If breast-feeding is not possible, hydrolyzed infant formula can be used as a measure to prevent food allergy. Extensively hydrolyzed formulas are thought to be more effective than partially hydrolyzed formulas in allergy prevention
• Soy-based formulae and other milk-based formulas (e.g. goat’s milk) are not recommended for reducing the risk of food allergy
• If the child is allergic to cow’s milk, extensively hydrolyzed casein based formulae or amino acid based formulae should be used if breast-feeding is not possible
• If the baby is not allergic to cow’s milk, a normal cow’s milk formula can be introduced as complementary food at 4-6 months
• There is no benefit in delaying the introduction of solid foods beyond 6 months of age
• There are no recommendations regarding the sequence in which complementary foods are introduced. Even highly allergenic foods can be introduced early (e.g. before 1 year) in order to maximise the development of tolerance
• Each food should be introduced separately and mixed foods introduced only after each food in the mixture has been introduced and tolerated
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