Eat this, not that: Pediatricians adjust to new science on introducing food to kids

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    Lara Manogg

    Lara Manogg

    Food allergies among children increased approximately 50 percent between the late 90s and now, according to the Centers for Disease Control.  How did we get there?

    Recent research on introducing food to babies may put some on the blame on advice given by pediatricians.

    “For a very long time, pediatricians told people ‘don’t start food for six months, and then you have to start with rice cereal, and then fruits and then vegetables, and no eggs and no peanuts until age one,'” said pediatrician Alexis Lieberman of Fairmount Pediatrics in Philadelphia. “I have said this so many times, it comes out of my mouth very comfortably and happily.”

    But it turns out – all that advice was based on opinions and theories. “Expert opinions, which is the way we like to say – ‘this is what we think,’ we call it expert opinion,” said Jonathan Spergel – the chief of the allergy section at the Children’s Hospital of Philadelphia.

    “The idea was to avoid, avoid, avoid, so you would avoid the food, so you wouldn’t get a food allergy,” he added.

    And now – the advice has changed. “Well, it’s just the opposite of what we used to say,” admitted Lieberman. “Earlier is better, the advice we gave 10 years ago was wrong,” added Spergel.

    Communicating a big change

    Lieberman is very open about this big change with her patient families.

    “When the studies actually got done, it turns out we were dead wrong, and it’s possible that a lot of the peanut allergy epidemic is because of doctors telling people to delay peanuts, which is a shame,” she explained to Lisa and Micah Reyes who came in for a check-up with their four-month-old daughter Naomi.

    Lieberman explained the new marching orders to them – which are when your kid is four months old, keep on breastfeeding, if possible, but bring on the food.

    “Whatever you’re eating, dip your pinkie in it, and touch her tongue, if you eat potato, smoosh it and touch her tongue, if you bite an apple, she can have a lick,” Lieberman explained to Lisa and Micah Reyes.

    Even foods previously considered an absolute no-no are OK. 

    “Let’s say you made yourself African squash peanut stew – puree some of that, that’s a great way to give her the peanuts for example,” said Lieberman.

    Lisa Reyes looked very surprised. She actually has some food allergies – which means her baby girl is more at risk for allergies. Still – Lieberman said, go ahead, and test it out.

    “Put a dot on the lip, wait the next day, put a dot on the tongue,” she said. “Keep your Benadril on hand just in case, and that way if she has a reaction it will be a fat lip, not a big allergic reaction – but delaying the foods does not prevent the food allergies.”

    Lieberman joked with the mom that she looked rather terrified mulling over these approaches, but reassured her to try it anyway. “You’re going to increase the baby’s risk by waiting, it’s not just this one new article that’s come out.”

    Lieberman was referring to a study published in the New England Journal of Medicine which found that introducing peanut products early helps children avoid peanut allergies.

    “I had heard the recommendation for breastfed babies was no food until six months of age,” said Lisa Reyes. “This makes sense and I am concerned about allergies, but we will do it, we’ll get over our nervousness, and try some of these approaches.” 

    New kid, new rules 

    For parents who have more than one kid – the new advice has meant a totally different approach to feeding with kid one and kid two. Lara Manogg’s first son, Jagger is five years old now.

    “We were told to start off with rice cereal, and then other foods to start off with pureed and then we weren’t supposed to introduce regular people foods closer to a year.” 

    Jagger is now clearly a fan of “regular people foods.”

    “I gobble up all the pizzas and meatballs,” he said.

    Manogg’s baby boy Jethro got to eat everything much sooner – which has been a game changer. “He can sit and have dinner with us, I can just put some meatballs and spaghetti on his tray, and we can eat our spaghetti and meatballs on our plates, so that part is a lot more fun.”

    Jethor also didn’t have to wait to try foods, one at a time: Parents are no longer told to introduce one food a week – because an allergic reaction happens within hours. 

    What about the trust factor? 

    Lieberman doesn’t think the recent complete change in food advice has shaken up trust between parents and pediatricians. “I think that my style is to share information and not to just tell people what to do,” she said. “Because of that I don’t feel like trust issues come up a lot in my practice, because I rarely say ‘you have to do this,’ I’m much more likely to say ‘I posted these articles and here’s what I’ve learned.'”

    CHOP pediatric allergist Jonathan Spergel thinks it has caused a lot of confusion though.

    “Everybody is very confused, ‘what do I give, when do I give it,’ and now you really want to give peanut butter at six months.”

    Asked whether the advice might change once again, he said parents should ask their pediatricians what their advice is based on. Is it opinion, is it research – how much research is there?

    The American Academy of Pediatrics is working on finalizing the new guidelines on introducing foods, Spergel says they are tweaking a few things. He is even involved with an effort to come up with global guidelines and says that process has been very messy so far.

    And – there’s one more wrinkle to all of this: Spergel says even though this information has been around for a while – many pediatricians are not aware of it, and still preach the gospel of avoidance.

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