Moms: Experts Revise Infant Feeding Recommendations

Healthnotes Newswire (January 17, 2008)—The American Academy of Pediatrics (AAP) has revised its infant feeding recommendations for preventing allergic diseases in children, calling into question previously held beliefs about formula feeding and the timing of introducing solid foods.

Childhood allergies are on the rise, with increasing numbers of children affected by asthma, eczema, hay fever, and food allergies. This trend has led many investigators to explore the relationship between infant allergen exposure—from breast milk, infant formulas, solid foods, or their mother’s diet during pregnancy—and the development of allergic disease.

Restricting foods during pregnancy and lactation

The AAP previously advised pregnant women to avoid eating peanuts, and advised breast-feeding mothers of high-risk babies to avoid eating peanuts, tree nuts, and possibly eggs, cow’s milk, and fish. Infants are considered at high risk for developing allergies if they have a first-degree relative (such as a parent or sibling) with an allergic condition. Recent investigations into a possible link between maternal diet and allergic disease have failed to prove a connection, so the AAP no longer advises that these foods be avoided.


The AAP recommends exclusive breast-feeding for the first four to six months of life, at which point solid foods can be gradually introduced. They further suggest that breast-feeding be continued until the child is at least one year old, and after that “as long as is mutually desired by mother and child.” In its new statement, the AAP concluded that while breast-feeding seems to protect against eczema, cow’s milk allergy, and wheezing, it may not protect against asthma or other food allergies, as once thought.

Formula feeding

If breast-feeding isn’t an option, the AAP advises the use of extensively hydrolyzed formulas to help prevent allergic disease in babies at high risk. Hydrolyzed formulas, such as Enfamil Nutramigen Lipil and Enfamil Pregestimil, contain proteins that have been broken down into a smaller, more easily digestible size. They added, “No long-term studies have compared partially or extensively hydrolyzed formula to exclusive breast-feeding. Thus, there is no evidence that the use of these formulas is any better than human milk in the prevention of allergic disease.”

Introducing solid foods

The AAP previously recommended that cow’s milk not be introduced until a child is one year old; that children at high risk not be given eggs until age two; and that peanuts, tree nuts, and fish should not be given until age three. Evidence from new studies is conflicting, raising “serious questions about the benefit of delaying the introduction of solid foods that are thought to be highly allergenic (cow’s milk, fish, eggs, and peanut-containing foods) beyond four to six months of age,” the AAP commented, saying that more research is needed.

Matthew Baral, a naturopathic doctor and assistant professor of pediatrics at Southwest College of Naturopathic Medicine commented, “Breast-fed children are healthier overall. Besides potentially offering protection from allergies, breast-feeding decreases the risk of certain cancers and gastrointestinal disorders later in life. A decision to breast-feed should take all of this into consideration.” However, since many women are not able to breast-feed for a variety of reasons, the new study provides some comfort that hydrolyzed formulas are still a reasonable option.

At-a-glance AAP reminders

To help reduce your child’s chances of developing allergies, keep in mind these summarized findings and recommendations from the AAP:

• A mother’s diet during pregnancy and lactation does not seem to affect her child’s risk of developing allergic diseases.

• Babies who are at high risk for allergic disease are less likely to develop eczema and cow’s milk allergy if they are breast-fed for at least four months instead of given nonhydrolyzed cow’s milk formula.

• Babies who are breast-fed for at least three months are protected from wheezing early in life, but may not be protected from asthma.

• Hydrolyzed infant formulas may protect against allergic disease; these formulas are preferable to nonhydrolyzed ones when it comes to allergy prevention.

• Soy-based formulas have not been proven to help prevent allergic diseases.

• Solid foods should be introduced between four and six months of age; there is no evidence that delaying solid food introduction beyond four to six months helps prevent allergic disease.

• At present, there is no evidence to support waiting longer than six months of age to introduce allergenic foods such as cow’s milk, fish, peanuts, and eggs.

(Pediatrics 2008;121:183–91)

Kimberly Beauchamp, ND, earned her bachelor’s degree from the University of Rhode Island and her Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. She cofounded South County Naturopaths in Wakefield, RI. Dr. Beauchamp practices as a birth doula and lectures on topics including whole-foods nutrition, detoxification, and women’s health.

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