Reducing Risk of Food Allergy in Your Baby

This resource includes steps to reduce a baby’s risk of developing food allergy. It is intended for babies at increased risk.

What is food allergy?

Food allergy occurs when the immune system mistakes a specific protein (an allergen) in a food as harmful. Once a person has a food allergy, an allergic reaction occurs every time they eat that food.

About 7% of babies and young children have food allergy. Children can outgrow some food allergies.

The foods that cause food allergy most often are called common food allergens. They include:

• Milk (and milk products)
• Egg
• Peanut
• Tree nuts (e.g. almonds, cashews, and walnuts)
• Soy
• Seafood (fish, shellfish, and crustaceans)
• Wheat
• Sesame

What are some possible symptoms of an allergic reaction?

Symptoms of an allergic reaction to a food can range from mild to severe. Reactions often appear within minutes after exposure to the food. Examples include:

• Hives, swelling, redness, or rash
• Stuffy or runny nose with itchy watery eyes
• Vomiting
• Cough

Although less common, vomiting, sometimes together with diarrhea, can also occur hours later.

Severe symptoms of an allergic reaction require immediate attention. Examples include:

• Swelling of the mouth, tongue or throat
• Hives that are spreading
• Any difficulty breathing, repetitive coughing, or wheezing
• Difficulty swallowing or hoarse voice or cry
• Pale or blue colour of the face or lips
• Faintness, weakness or passing out

Call 9-1-1 or the local emergency number right away if signs of a severe allergic reaction occur.

If you think a food is causing an allergic reaction, stop giving the food to your baby and talk to your baby's doctor. You can continue to offer other new foods.

Is my baby at increased risk of developing food allergy?

A baby is at increased risk of developing food allergy if:

• A parent, sister or brother has been diagnosed with an allergic condition like food allergy, eczema, asthma, or hay fever. Allergic conditions tend to run in families.
• They have a diagnosed allergy condition, like another food allergy or eczema.

Talk to your baby’s health care provider to find out if they are at increased risk of developing food allergy.

Steps you can take

What can I do to reduce my baby’s risk of developing food allergy?

If your baby is at increased risk of developing food allergy, there are some steps that you can take to help reduce your baby’s risk.

1. Keep your baby’s eczema under good control. If your baby has eczema, try to keep it well controlled. If you need help to control your baby’s eczema, talk to your baby’s doctor or nurse practitioner. They can refer your baby to a pediatric allergist or pediatric dermatologist, if needed.
2. If you can, breastfeed your baby. Breastfeeding your baby may help prevent the development of food allergy. Since breastfeeding is linked to many other health benefits, Health Canada recommends breastfeeding until 2 years of age and beyond.

3. Introduce the common food allergens when your baby has shown they are ready for solid foods. For most babies this is at about 6 months of age. Your baby is ready for solid foods when they can:
   • hold their head up
   • sit up and lean forward
   • let you know if they are full (for example turns head away)
   • pick up food and bring it to their mouth.

Do not introduce solids before 4 months of age. Your baby will not be ready. It will not help reduce your baby’s risk of developing food allergy.

After you have introduced a few other solid foods, offer the common food allergens one at a time. There is no research to show that you need to wait a certain number of days between them.

You can start with the common food allergens your family eats. You do not have to introduce the foods your family does not eat, such as fish if your family is vegetarian.

4. Offer tolerated common food allergens regularly. Offer the common food allergens your baby tolerates several times a week, or more often if you like. This will help your baby maintain tolerance to these foods (prevent a food allergy from developing).

If you have questions about allergies, the common food allergens and feeding your baby, contact your baby’s doctor, nurse practitioner or a dietitian.

How should I offer the common food allergens when I try them for the first time?

• Offer textures that are safe for your baby. At about 6 months you can offer foods with a semi-solid texture such as lumpy, tender-cooked and finely minced, pureed, or ground.
• Blend some of the common allergen into prepared infant cereal or fruit puree. See the recipes below for details.
• Offer your baby a small taste of the recipe (about a quarter of a baby spoonful).
• Wait about 10 to 15 minutes before offering more.
• During this time, watch your baby to see if they show symptoms of an allergic reaction. You can offer other foods to your baby while you wait.
• If after 10 to 15 minutes your baby hasn't shown any symptoms of an allergic reaction, you can offer more of the common allergen along with other foods.

How should I prepare peanut, tree nuts, and egg to give to my baby?

The recipes are suggestions of how to prepare peanut, tree nuts, and egg for your baby, when your baby is ready for solid foods.

Peanut, almond, cashew and hazelnut butters	Blend 15 mL (1 tablespoon) of breast milk or warm water to 15 mL of smooth peanut butter. Blend until smooth and no lumps. Stir into 30 mL (2 tablespoons) of infant cereal prepared according to package instructions. You can also stir the blended peanut or tree nut butter into 30 mL (2 tablespoons) of fruit puree, such as banana or apple.
Hard-boiled egg	Blend or mash a hard-boiled egg with a fork. Add a few teaspoons of breast milk or water to moisten as needed.

The recipes below are suggestions for preparing peanut, tree nuts, and egg when your baby is older and ready for more textures. Avoid offering whole peanuts and tree nuts or globs of peanut and tree nut butters. They are choking hazards for children until about 4 years of age.

Peanut butter and tree nut butter on toast	Spread 15 mL (1 tablespoon) of smooth peanut or tree nut butter thinly on a piece of toast. Cut into strips.
Scrambled egg	Beat together an egg and a small amount of water. Scramble in an oiled pan, until egg is completely cooked. Mash larger pieces of scrambled egg with a fork before offering to your baby.
French toast	Beat together an egg, 30 mL (2 tablespoons) of milk and some cinnamon. Soak a slice of bread in the egg mixture. Fry each side of the bread in an oiled pan until the egg is completely cooked. Cut into cubes.

What other foods should I offer my baby?

In addition to the common food allergens, offer your baby other foods, especially foods rich in iron. Offer iron rich foods 2 or more times each day. Examples include:

• Well-cooked meat, poultry, and fish
• Cooked egg, lentils, beans, and tofu
• Iron-fortified infant cereal

Some common food allergens are also sources of iron. These include peanut, tree nut, and sesame seed butters.

Yogurt and cheese are recommended for your baby starting at 6 months of age. You can offer pasteurized whole cow milk (3.25% milk fat) to drink when your baby is 9 to 12 months of age and is eating a variety of foods that are high in iron.

Additional Resources

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©2017 Province of British Columbia. All rights reserved. May be reproduced in its entirety provided the source is acknowledged. This information is not meant to replace advice from your medical doctor or individual counselling with a health professional. It is intended for educational and informational purposes only.