First foods: the great allergy debate

Posted by rosanne on Jul 6, 2009 in Developmental Milestones, Health |

Food for infants — especially the ongoing debates around breastfeeding and delaying solids — is a fraught topic. Everybody wants to do what’s best for their baby and it isn’t easy. It’s even harder when health professionals weigh in (no pun intended) with opinions about baby’s growth or lack thereof or when Mama is struggling with mastitis or other complications. On the other hand, hardliners seem to insist on adherence to ideals that are almost impossible to achieve or sometimes feel not-quite-right for baby’s particular experience. It’s important to find out the latest when dealing with allergies — the advice from the professionals has changed.

I’ve noticed I have a pattern around a lot of debates like this. I do research, find out what the scientists and peak bodies think, read the arguments from the really crunchy hippies, and then pick what feels intuitively most nurturing but still matches the science.

That how I’ve ended up a big breastfeeding advocate. The World Health Organization agrees that breast is best and further that breastfeeding should continue (accompanied by safe solids) up until baby is two years of age and may continue beyond that for best health outcomes. It suggests exclusive breastfeeding until six months. The American Academy of Pediatrics issued a revised policy in 2005 that also called for exclusive breastfeeding until six months. It’s important to note the wording though: it says juice, water, solid food etc is “generally unnecessary” for children under six months.

This has meant that some people seem to say, “Baby is six months old today! Solid food for you!”. That doesn’t make a lot of sense to me. I want to know what it is that’s magically happening “around six months” that leads to this readiness for food.

The attachment parenting guru, Dr Sears, gives some reasons: baby’s ‘tongue thrust reflex’ (medically known as the extrusion reflex) is gone and the gut has started to go through ‘closure’. Gut closure refers to the lining of the gut which stops microscopic antigens entering the blood stream (my favourite quote on this was that it “is the process by which the epithelial surfaces of the intestine become impermeable to antigens”). A very quick search suggested that in most humans, gut closure starts before birth, because premature babies have more issue with macro antigens entering the blood stream whether they are breastfed or not. Fascinatingly, though, breastfeeding, and especially colostrum, that fabulous early milk, may actually trigger gut closure which is why breastfed babies may have fewer allergies. It’s chock full of secretory IgA hormone which helps stimulate the baby’s enzymes. Where does this four-to-eight month thing come in then? What’s this six month magic marker?

Interestingly, it seems possible that gut closure completion  is triggered by the introduction of solid food. I don’t have a link for this just yet, as the article that suggested it is behind locked walls and I haven’t had time to read the full reference, but that would suggest we’re looking for other physical signs, then we introduce the solid food, and then the gut realises what’s going on and does its thing. Certainly, in other animals, gut closure is triggered by weaning.

My darling daughter is now five-and-a-half months old. We have a lot of allergies in our family. Between my sisters, nieces and nephews, we have soy, dairy and wheat allergies and my partner is allergic to anything with fur or feathers (skin sensitivity), allergic to arrowroot (as a food and as a skin irritant) and lactose intolerant. She’s sitting up unaided, watching us eat with rivetted attention and most importantly, grabbing at food. Naturally, I’m hesitant to introduce solids if my darling is going to have allergic reactions. The “common knowledge” about this is that you shouldn’t introduce things like egg and peanuts until baby is at least a year old. Based on the latest research, though, the common knowledge is wrong. The Infant Feeding Advice from the Australasian Society of Clinical Immunology and Allergy says there is insufficient evidence that delaying allergenic foods helps prevent allergies and acknowledges that there is some suggestion recently that delaying such foods can increase allergies. (Who knows how, given the whole gut closure discussion…)

So, with yet another lots of conflicting advice whirling through poor mama’s head, where does that leave us? I think it leaves us as follows:

  • Keep on breastfeeding, as it’s the best source of vitamins and minerals for her and the World Health Organization says it has all the nutrients she needs for survival.
  • She’s showing all the signs that she’s ready to start eating, even though she doesn’t need food yet. Start giving her tiny pieces of low allergen foods (carrot, potato, rice, pumpkin) to trigger the completion of gut closure.
  • Introduce each food as a food on its own, in the morning, as recommended by Dr Sears, and watch carefully for allergic reactions. If none are seen, that food goes onto the list of foods okay to combine with other foods.
  • Continue with baby-led weaning. (Note that this is weaning onto solid foods and not off breastmilk.) She’s already licked a few foods — cucumber, carrot — but we’ll follow her lead with how much she wants.
  • After she hits six months, but not necessarily on the day, offer her an actual meal of solid food, with selections of items she’s not allergic to, and see how she goes.
  • Delay those allergenic foods to eight months, just to give that gut closure a chance to happen but not worry too much about delaying further, based on ASCIA’s recommendation.

Your baby will have her or his own individual signs that he or she is ready to eat. Pay attention to them. Some babies don’t sit up unaided until almost nine months. If yours is one of them, and he or she is NOT reaching for food, there may be no need to start him or her on it yet. And remember that information changes as research occurs. This information is current as of July 2009. If you’re reading this more than a year down the track and we haven’t updated it, check our sources for up-to-date information or hassle us to find out the latest.

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6 Comments

Kate Devitt
Jul 6, 2009 at 4:54 pm

Great post. Really interesting. Thank you. I think the ‘baby-led’ idea is the best advice. Babies are tougher than people think. I imagine they’ll stop eating something they don’t like pretty quickly if it’s an exploratory food rather than one forced in or the only option.


 
Beth W.
Jul 6, 2009 at 5:29 pm

Thanks for this. We’re hoping to put it off a while — but let her choose. Our pediatrician said today that watching us eat and/or grabbing for food may not be the indicator that she’s ready for solids, although he added that she’s likely to do it anyway. I’m going to be cautious with the wheat/gluten scenario, but a woman who grilled a celiac expert about this suggested to introduce crumbs of bread while still in the breastfeeding phase — he seemed to think the combo of breast milk & potential allergens was key to not developing an allergy. Nobody knows for sure how allergies happen, though…


 
rosanne
Jul 6, 2009 at 7:30 pm

Everything I’ve read suggests that breastfeeding while introducing allergens is the way to go too. Part of that is again the IgA: the idea is that it should help the baby’s body treat the food as something to digest, not something to reject.


 
paula
Jul 7, 2009 at 9:15 pm

My beliefs in this matter are so colored by my own children’s experiences. I’ve been a member of an online breastfeeding community for a few years now, where the dominant view is that you just *don’t* start solids until after 6 months. So I was skeptical when my Maternal & Child Health nurse talked about “readiness signs” and bigger babies (my first bub was 90th percentile at that point) wanting solids earlier. So I ignored readiness signs for a few weeks, and finally cracked when at exactly 5 months of age he rolled away from a full breast, crying with hunger, looked me in the eye insistently and said “um, yum, yum!!!”

In other breastfeeding news, I want to add a link to the ABA’s new Swine Flu fact sheet.
– keep breastfeeding (yes, even if mother has the H1N1)
– increase breastfeeding frequency if necessary
– breastfeeding may help limit the severity of respiratory symptoms in infants
– anti-viral medication is compatible with breastfeeding


 
Tiffiny
Aug 26, 2009 at 11:44 am

Hi! I maintain a BLW community on LJ and I am really fascinated by this part of your post: “Interestingly, it seems possible that gut closure completion is triggered by the introduction of solid food. I don’t have a link for this just yet, as the article that suggested it is behind locked walls and I haven’t had time to read the full reference, but that would suggest we’re looking for other physical signs, then we introduce the solid food, and then the gut realises what’s going on and does its thing. Certainly, in other animals, gut closure is triggered by weaning.”

Do you happen to have a link yet for this info? Or at very least, do you have a citation I can look up on my own and perhaps purchase the article for myself? Thanks!


 
admin
Aug 31, 2009 at 5:24 am

Hi Tiffiny,

One of the articles was this one (Food Antigen Handing by the Gut, http://tropej.oxfordjournals.org/cgi/pdf_extract/27/1/1-a). And you can find lots of references to weaning triggering gut closure in animals. Of course, I can no longer find the article I originally found. Sigh. I’ll keep looking though…


 

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