…In the American Academy of Pediatrics that is. Am I the only one who thinks we (doctors)may have it all wrong? I found my baby book, which my mother filled in faithfully in a way reserved for the first born child. My first response when I read the feeding page was shock. MOM! You fed me cereal when I was 5 days old, formula when I was a week old, egg at 4 months, ice cream at 6 months! Were you crazy!! My mom just shrugged and said “that’s what we were told to do…and there were a lot less food allergies back then.”
Losing my faith…
Up until a year ago, the AAP feeding mantra went like this ” Exclusively breastfeed for 6 months, then introduce solids slowly, continue nursing until a year, wait until then to introduce eggs and cow’s milk, no nuts or fish until age 3.” Now, the AAP seems as confused as anyone else and retracting all the promises that delayed solids could prevent food allergy.
The dark questions in my mind are, “Has all this advice on delaying solids actually caused the epidemic of food allergy we are now seeing? Has the advice for allergic kids to religiously avoid allergens led to the observation that this generation is outgrowing their food allergies later than previous generations? “
Anecdotally, it makes sense to me. The “good” parents who follow all the “feeding rules”, end out with the rashy and allergic kids. The parents who just wing it, feeding solids way early, little tastes of table food here and there…tend to do fine. The “good” parents faithfully avoid milk after a positive skin test shows their child’s eczema is due to milk allergy… then much later, their previously non-anaphylactic kid anaphylaxes from an accidental exposure. The “bad” parents get the same diagnosis for the same rashy kid, but don’t fully remove milk from the diet. The kid stays a bit rashy, but doesn’t ever anaphylax with accidental exposures.
For now, I keep repeating the AAP feeding mantra to the new parents…but with a lot less conviction. For now, when a RAST test on a rashy kid comes back positive, I recommend avoidance. But I wish I could say “keep feeding the allergen and we’ll just treat the eczema” , or better yet, I try to talk parents out of testing altogether so we can just treat the skin without stressing about the cause. All the exciting research in food allergy seems to be focusing on prevention through early introduction of allergens or in the arena of tolerance through increased exposure. In the next few years, I would not be surprised to see my mom’s feeding regimen vindicated by science.
Camille says
It's tough, isn't it? So much information that no one really knows anything about.
As one of my friends likes to say, that's why we call it the "practice" of medicine.
Libby says
If it makes you feel any better, my son had his first anaphylactic reaction at 4 months. I wasn't producing enough breast milk for him to gain weight, so we supplemented with the "pre-digested" milk formula he'd been given in the NICU. When our (awesome) ped said to give him regular formula, we did. That was our first trip to the ER. Also, I never cut any allergens out of my diet, even though I nursed until 16 months. He's never had skin problems, either. So I guess I'm a little leery of any generalizations. (But meat sticks? Really?) Libby
Speedbump Kitchen says
My favorite is the slot for the nutritional milestone of "bacon"! In my case, my oldest was born a bit early and tolerated a few early bottles of milk formula without a problem while I figured out the nursing-thing. I followed the "rules" until 6 months, and then started rice cereal. She wasn't too interested, so I mixed some of that same can of milk formula with the rice cereal and she broke out in hives around her mouth where the formula touched her skin. Then after following the allergist's "rules" of strict avoidance for another 5 years, she had an accidental exposure with 2 sips of the wrong milk and she anaphylaxed. I have to wonder if a little milk protein exposure all along would have prevented such a dramatic immune response at age 5.
Amber says
Oh dear! Your post really hit home. I'm not a doctor, but an amateur allergist by fate. I so often wonder the same thing about my 3.5 yr old. Maybe I should never have been this careful. What if I've made things worse? My son's RAST numbers were quite high and he was clearly reacting, but the reactions were nothing scary. Chronic eczema and runny noses for a while after ingestion. He never had straight egg and didn't really like pancakes, but nothing terrible happened when he tried them.
This issue is agonizing. All the research seems to be going against all the advice I got. And to think I used to feel like a better, more well-informed mother when I ran into the cavalier allergy moms.
E Lohroff says
This Treehugger post reminded me of your post here.
http://www.treehugger.com/files/2009/05/asthma-research-closes-in-on-more-potential-causal-factors.php
Haylee says
Hello. I'm a mom of two – both with severe food allergies (dairy, egg and nut). My husband was born allergic to milk and egg, but grew out of both by his toddler years. I have the peanut allergy. Back then, parents "winged it". I remember my mom forgetting to order my hotfudge sundae at McDonalds without nuts and just scraping them off and giving it to me. And amazingly, I haven't had an anaphylaxic reaction since I was 2. I often have foods with a little peanut oil in them and don't have a major reaction. The same with my husband. His parents didn't know to completely avoid all contact with egg and dairy and he grew out of both at such a young age. I can't help but think that I'm hurting my kids by depriving them completely of all foods with these elements in it. I wish I knew the best thing to do.
Holly says
Very interesting. I wonder the same. I too am in the medical profession (hospital clinical pharmacist). My son is milk and egg allergic. He had his first anaphylactic reaction to milk when he was 4mo. I had breastfed until he was 3mo, and then he was on soy formula. I was slowly feeding him solids starting with veggies, and we had just graduated him to stage 2 foods. I gave him some creamed spinach and he had some slight redness around his mouth, but it went away quickly. I tried again 2 days later and, voila anaphylaxis. The RAST testing showed milk, egg, and peanut. So we were advised to avoid all three. We complied, and last year he had an anaphylactic reaction to egg after an accidental exposure. What if we had not found out about the egg, and he had just eaten things that "contained" egg. Would he have ended up with ana? Who knows, but in light of the recent peanut desensitization study, it makes me wonder if small amouts of allergen on a regular basis may do its own desensitization. We have been desensitizing patients to drug allergies for years, I am glad that they are trying it with foods. I think only time and more reasearch will tell.
Claire says
You know, part of me tends to think that if a kid is allergic, he's gonna be allergic no matter when he's introduced to the food. Of course, then there's the phenomenon of "developing" an allergy after multiple exposures (I did this with penicillin…loved amoxil growing up and then had a different form for strep throat and broke out). I guess the answer is that we really don't know!
I must say that some of those milestones are HILARIOUS! I mean, baked custard? Today's books probably say fried chicken, ribs, and french fries. BTW, we had a mom feeding her two month old who was in the hospital for meningitis french fries…OH MY!
J says
Do you have any advice for a me? I am having a hard time dealing with this milk allergy diagnosis.
The toughest part of this journey so far is that we live in a very small city in Oregon. There is not even a local allergist but one that travels here once a week to service patients in this city. The resources here are so limited!
I think sometimes you just have to go by motherly instinct anyway – but it is so beneficial to get info. from professionals!
I don't want to do any challenge without first getting a negative test. The allergist says my son should be okay to eat baked foods that have milk in them – but again – I'm not buying it! Do you have any knowledge about cooking milk and it being safe?
At the skin prick appointment they also tested my son for shellfish, peanuts, cantaloupe, soy, wheat and eggs. He did not seem to have any reaction to these – so from your experience should this really mean that he is not allergic? I had very little shellfish and peanuts and no cantaloupe while I was breastfeeding – so it's hard for me to know if he really was exposed to these or not and if not is the test accurate???
I I am only asking for your experience in hopes to understand this better and feel better prepared to ask my doc's questions.
I appreciate your time
Speedbump Kitchen says
Hi NoMilkMama! So sorry about the lack of good allergists in your area, your situation is quite common. It is very hard to find good pediatric allergists. Since you visit them rather rarely, I think it is worth finding a good one who deals with kids primarily and make a drive. We drive 2 hours to see ours at the Big University, and it is worth it. The local allergists here are terrible, they test kids to everything under the sun, and then send them out with 20 foods to avoid. As far as baked milk and/or egg proteins, there is some research out there to support that high heat makes the proteins 'less allergenic", which is why some kids with those allergies are able to tolerate small amounts in baked goods. I guess the advice to give baked milk has to be interpreted in light of your son's previous reactions and how far out you are from those reactions. If you are nervous about a food challenge at home, ask to have one in the office!
Brittany says
I COULDN'T AGREE MORE!
This very topic has come up many, many times lately! Is it better to give them a little bit and deal with eczema? Or total avoidance? BIG DEBATE! Like you said, our parents gave us cereal early and bites of all kinds of food – and there were NO FOOD ALLERGIES! Today, we go by the AAP's strict guidelines and now there is an epidemic! I nursed for 14 months, gave him his first cereal at 6 months and first vegie at 7 months…..and no bites of anything off the table!!!!!!!! He STILL has food allergies! Ironic?!
I have a friend that gives her baby a "1/2" birthday cake at 6 months and let's them EAT THE CAKE! But guess what, her kiddos don't have any allergies!!!
It makes me want to scream!
Thanks for posting!!!!!!
youngmarriedmom says
I just found your blog–I’m not even sure what led me here–but I am so grateful! My son has the same allergies your site caters to (plus fish, I’ve been told), and I am so happy to find a new safe haven. Thank you for doing what you do!
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