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AAP Retracts Previous Diet Recommendations for Mothers and Children
Food for Thought: Preventing Food AllergiesBy Beth Puliti
In a move that surprised families of food-allergic children and the medical providers who care for them, the American Academy of Pediatrics (AAP) started the New Year off with new feeding guidelines that reversed prior recommendations.
Earlier restrictions on moms' and babies' diets from the 2000 AAP guidelines—namely avoiding select foods during pregnancy, using soy formula or postponing solid foods beyond six months—were revised and replaced with updated advice. In fact, the only unaffected suggestion was to continue breastfeeding, as it aids in the prevention of allergies.
As expected, the new policy statement has "generated much interest among families of food allergic children and medical providers," mainly because key areas of the policy depart from previous recommendations that offered stricter guidelines when introducing allergenic foods, said Todd D Green, M.D., assistant professor of Pediatrics, Allergy and Immunology at the Children's Hospital of Pittsburgh.
In 2000, the AAP's feeding guidelines recommended that breastfeeding mothers of infants at high risk for developing allergy should avoid cow's milk, egg, fish, peanuts and tree nuts. If they couldn't breastfeed, it was recommended they use a hypoallergenic formula as an alternative to breastfeeding. Parents were also instructed that solid foods should not be introduced into the diet of high-risk infants until 6 months of age, with dairy products deferred until 1 year, eggs until 2 years, and peanuts, nuts and fish until 3 years of age.
These recommendations from 2000 understandably triggered anxiety among pregnant and breastfeeding mothers. Parents also felt guilty when children developed allergies despite their efforts to keep risky food at bay by avoiding the recommended foods.
New Recommendations For "At-risk" ChildrenThe AAP policy released in January was written after finding that delaying the introduction of solid foods as previously recommended did not lead to fewer food allergies among children at risk for developing allergies based on family history.
"This new policy allows parents not to feel guilty because there is just not enough evidence to support avoidance as a preventive measure," explained Roger Friedman, M.D., clinical professor of Allergy, Immunology, and Pediatrics at Nationwide Children's Hospital in Columbus, Ohio. "This doesn't mean you shouldn't avoid certain foods if advised by your child's physician; it just means that there isn't a reason to recommend it universally."
The new guidelines only recommend that solid foods not be introduced before 4 to 6 months. It also suggests that there is too little evidence to support that diet manipulation among pregnant or breastfeeding moms can cause or prevent a child's allergy.
The policy addresses the following major points.
For Babies and Children with an Allergic DiseaseIt is important to note that the information in the new policy does NOT apply to babies and children who already have an atopic disease (including eczema and asthma). It is meant to provide guidelines for children who are not yet diagnosed with an atopic disorder. Therefore, the term "high risk" refers to any child with a parent or sibling who has an allergic condition, not the child himself.
For Breastfed BabiesUnfortunately, the new policy also does not address breastfeeding babies who react because they are already atopic. For those who already have an atopic child, these recommendations will apply to any future children as they would be considered high risk.
While the recommendations do not address the entire food allergy population, the current shortage of good data is understandable, Dr. Green noted.
"These are difficult studies to perform, requiring many families willing to go to great efforts over long periods of time," he explained, and underscored the strengths of the report—specifically its acknowledgement of the complication of preventing food allergies.
"It acknowledges the need for more evidence while emphasizing what we do know. And hopefully it will serve to spur more interest and research in this area," he said.
For more information on the AAP's new infant feeding guidelines, please visit: www.aap.org.
Parent Support for Breastfeeding or Formula-feedingKids With Food Allergies provides online support forums for parents to receive peer support for breastfeeding or formula feeding food allergic infants and children. Register today to join our thriving community and access a world of support!
Breastfeeding with Food Allergies Forum
Support for mothers on allergy elimination diets for food allergies and intolerances; share tips for elimination diets, total elimination diets, supplementation, "what's to eat?", and more! Find support related to nursing a food allergic infant or child.
Formula and Special Medical Foods Forum
A place for parents to discuss hypoallergenic formulas and elemental (amino-acid based) medical food formulas such as Neocate® or EleCare®. Topics range from weaning to insurance coverage for elemental formulas.
American Academy of Pediatrics, Committee on Nutrition. (2000). Hypoallergenic infant formulas. Pediatrics. 106, 346-49.
Greer, F.R., Sicherer, S.H., Burks, W.A., and the Committee on Nutrition and Section on Allergy and Immunology. (2008). Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics. 121(1), 183-91.
Sicherer, S. (2007). Food for Thought on Prevention and Treatment of Atopic Disease Through Diet. The Journal of Pediatrics. 51(4), 331-33.
Approved by KFA's Medical Advisory Team March 2008. Updated October 2009.