[Article based on a reply to a question on the SAH-AP email list. I am not a medical professional but have tried to put into plain English what I have learnt, as a person with allergies and mother of allergic children.]

With a history of allergies in my family, I was very concerned about weaning my baby. I had read that there may be an advantage in delaying the introduction of certain foods in avoiding allergies, the theory being that the later an "allergen" (allergy causing food) was introduced, the less severe that allergy might be. However, it is not a cast-iron guarantee against the child suffering allergies, eczema or asthma. I found the information on this hard to obtain, but I did get hold of a publication from the British "National Asthma Campaign", on which this advice is largely based. It works on the idea of introducing the more common allergens later, but the aim is that your child should be on a full family diet by 18 months to 2 years old. Research is still going on to see if this will really help, but the diet is pretty broad and shouldn't adversely affect your child (it is not an "exclusion diet", for instance). However, do check with your doctor if you are unsure. If necessary, they can refer you to a dietician for more detailed help.

First Foods

1. Try to maintain breastfeeding for at least a year, if at all possible, and there are benefits in continuing well into the second and third years.
2. If you are allergic to any food, or have been allergic to it in the past, you should avoid that food while pregnant or nursing. Unless there is a known allergy, there is no known advantage in the mother avoiding milk or eggs, but there may be an advantage in avoiding peanut products.
3. The baby should ideally be exclusively breast-fed for a minimum of four months, preferably at least six months, before other foods are introduced. Some severely allergic babies may benefit from very late introduction of solids, of a year old or more, but there is a risk of anaemia in these babies, so seek professional advice.
4. If breastfeeding is not possible (bearing in mind that this is rare - 95-98% of women can breastfeed, with the right support), hypoallergenic, "hydrolysate" formulas may be used. But it is best to avoid all formulas, especially in the first three months (when the baby's gut is most susceptible to food allergies). It may be possible to obtain human milk from a bank if you are unable to breastfeed temporarily.
5. Formulas that can be used, if absolutely unavoidable, include Prejomin and Pregestimil (which are only available on prescription in Britain). The baby should be observed for any allergic symptoms for a few days after beginning the formula. There is no advantage in using soya based formulas, as soya allergy is almost as common as milk-based formula allergy. After three months, soya formula are slightly less risky if you are careful to observe for any adverse reaction. Be aware that once a reaction is triggered, it may be impossible to "un-trigger" it again by avoiding that food.
6. The baby will need to be either breast-fed or a suitable formula found for at least the first year.

Introducing Mixed Feeding (Weaning)

1. Introduction of solids should usually begin around 6 months old (and definitely not before 4 months, except under medical advice). If you wish to avoid solids until very late, check with an appropiate professional.
2. The first foods tried should be very low allergy foods, such as pure "baby rice" (read the label - you want the sort that only contains rice, and no other ingredients), made up with the baby's normal milk or water (not fruit juice), root vegetables or stewed pears. Be warned that rice can be very constipating. 
3. Introduce foods one at a time leaving at least 3 or 4 days between each new food. Observe for symptoms of allergies - snuffles, wheezing, coughing, colic, unsettled behaviour or rashes. Stop the food last introduced and see if the symptoms go away. If an infection develops, stop the introducing anything new until the symptoms have gone and try again. If you are not sure if it's an infection or allergy, leave off the food for a few days, and then try again. If the same symptoms develop again, it's probably an allergy.
4. Continue to add foods one at a time until the child is on a varied diet. It may be dangerous to restrict the child's diet too much (particularly if you are not breastfeeding) once the child is on a lot of solids, so only remove a food if you have good reason to believe it's causing a problem. If lots of allergies crop up, and the child is on a lot of solids, speak to your doctor about being referred to a dietician, who can ensure your child is on a balanced diet.
5. Avoid fruit juices and fruit drinks as long as possible, and treat them as new foods when you do introduce them. They don't have any nutritional value to speak of and they play havoc with the teeth!
6. If your baby is unable to take milk (cow's or soya) after breastfeeding stops, you will have to be careful about calcium levels, so you may require the assistance of a dietitian. Calcium supplements may not be a good idea, since they can block iron absorbtion and are not well absorbed. Sheep's or goat's milk are theoretically just as allergenic as cow's milk, but many parents report that their allergic child can tolerate them.

A Basic Plan

[Please Note: the order of this plan is much more significant than the actual recommended ages, and the older the child when you introduce solids, the less critical it is]

Starting at 4 months of age as a bare minimum (preferably around 6 months of age):-

• 4-6 months:
  • Pure baby rice or ground rice, with baby's normal milk or water
  • Root vegetables - potatoes, carrots, swede, turnip
  • Pears, bananas, apricots
  • NOT citrus fruits, berry fruits or tomatoes
• 6 months:
  • Lamb and turkey. If OK, move slowly on to other meats.
  • Apples and tomatoes.
  • Green vegetables (cabbage, broccoli, spinach)
  • Pulses (peas, beans)
  • Grains other than wheat (including oats).
• 10 months:
  • Fish
  • Citrus fruit
  • Wheat products (including bread, cakes, biscuits etc.)
• 1 year:
  • Eggs, seafood, berry fruits, chocolate
  • Dairy products including cheese, butter, cow's milk, yoghurt
  • "Adult-type" soya milk, rice milk and other dairy substitutes.
• 3 years:
  • Peanuts, other nuts
• 18 years:
  • Gin and tonic

Apart from peanuts and other nuts, from a year old your baby should be moving towards the same diet as yourself, until, at 18 months to 2 years, he should be on the same food. He will continue to need at least a pint a day of either formula, cow's milk or suitable milk substitute once no longer breastfeeding.

As I said, this schedule is by no means a guarantee against food allergies but I personally felt it was worth a try. My children have to date shown no allergies at all and we hope it continues this way.

Breastfeeding Links

• La Leche League, Breastfeeding pages
• Dr Jack Newman's Breastfeeding Page
• Dr William Sears Attachment Parenting Page
• Katherine Dettwyler's Breastfeeding Page

Compiled by Anna Hayward (c) 1997.
Disclaimer: This document has not been compiled by a medical professional. Any opinions expressed are personal and should not be construed as medical advice. I am not a representative of any of the companies discussed, nor do I receive any form of commission.