Food Introduction in Infancy

• Exclusive breastfeeding is recommended through the first 6 months of life (WHO, ACOG, AAP, and AAFP),^3,4 and the AAP advocates that breastfeeding can be continued beyond age 2 years if both the mother and infant desire.³ (Level A; Strong Recommendation, based on clinical studies) • Complementary foods should be rich in macronutrients such as protein, fats, and carbohydrates and micronutrients such as iron, zinc, calcium, and vitamins A, B, C, and D.^3,5,7 These foods should be absent of or have minimal amounts of caffeine, added sugars, and high-sodium content.^3,5,7 (Level A; Strong Recommendation, based on clinical studies) • The LEAP study showed that introducing peanuts before age 1 year decreases the likelihood of developing a food allergy to peanuts in high-risk infants.¹³ (Level A, Strong Recommendation, based on clinical studies) • The PETIT study showed a protective effect when infants consumed cooked eggs daily between the ages of 6 and 12 months.¹² (Level A, Strong Recommendation, based on clinical studies) • There is evidence that liquid cow’s milk should not be introduced until after age 1 year for the risk of iron deficiency anemia, but families may introduce nonliquid cow’s milk prior to this age.^5,9,18,20 (Level A, Strong Recommendation, based on clinical studies) • The evidence shows low certainty on the timing of the introduction of wheat/gluten into the diet and its relationship with wheat allergy.^9,18 (Level C, based on observational studies and inconsistent study findings) An AAAAI/ACAAI/CSACI consensus report proposed that severe eczema is the highest risk factor for an infant developing a food allergy.¹² (Level B, based on clinical and observational studies) There is no evidence to support preemptive allergy testing prior to introducing allergenic foods due to the risk of getting false positives, the low-cost-effectiveness, and the low risk of a severe reaction on first exposure.²⁴ (Level C, based on observational studies and inconsistent study findings) The overall goal is regular and maintained exposure to allergenic foods throughout the years to maintain tolerance.¹