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Choosing an Alternative Vaccine Schedule | Prenatal Vitamins- The Importance

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By Dr. Richard Visser

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Toddler- Food Precautions, Foods To Avoid

Foods to avoid — Certain foods should not be given to any child under 12 months - including cow's milk and hard, round foods that can cause a child to choke (i.e., nuts, grapes, raw carrots, candy, and honey). Cow's milk is not recommended because it does not contain adequate iron; honey is not recommended due to the potential risk of exposure to a harmful bacterial toxin known as botulism (botulism poisoning, see "Botulism").

Food allergy concerns — An infant is said to be at "high risk" for developing allergic disease if there is at least one first degree relative (parent or sibling) with an allergic condition, including a documented food allergy, asthma, allergic rhinitis, or atopic dermatitis (eczema). (See "Patient information: Food allergy symptoms and diagnosis" and see "Patient information: Dermatitis").

Previously, parents were told to delay giving highly allergenic foods, such as eggs, peanuts, tree nuts, fish, and shellfish, for months or years longer than other foods. However, studies do not show enough evidence in support of waiting to introduce these foods [3,4]. Experts now recommend that high-risk infants be introduced to traditional supplemental foods between four and six months of age (see "Puréed foods" below).

If the infant has no signs of allergy (including eczema) with the initial foods, additional foods can be introduced gradually, including the highly allergenic foods such as eggs, peanuts, tree nuts, (although not whole nuts because of the choking risk) fish, and shellfish. Cow's milk should not be given to any child until after age 12 months. (See "Foods to avoid" above).

The safest way to introduce highly allergenic foods has not been studied. It is possible for an allergic reaction to occur the first time the child eats a particular food. We recommend giving highly allergenic foods like cow's milk, eggs, peanut butter, fish, and shellfish to high-risk children in the following manner:

1. The child should be given a first taste of one of these foods at home (rather than at a day care center or restaurant). Have an oral antihistamine (i.e., diphenhydramine/Benadryl® or cetirizine/Zyrtec®) available in case of an allergic reaction.

2. If the child does not develop any signs or symptoms of food allergy (skin rash, vomiting, diarrhea) over the next few days, the food can be offered again in increasing amounts over several days.

3. If the child has signs or symptoms of an allergic reaction or develops a skin rash after eating a food, the parent should consult with the child's healthcare provider and/or allergist before other new foods are offered, especially the highly allergenic foods. (See "Patient information: Food allergy symptoms and diagnosis").

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