What the hell… it’s been a while since I’ve done a purely medical post.
So, several years ago there was an episode of “Six Feet Under” in which Lisa (Lili Taylor) yells at Ruth (Frances Conroy) for feeding her baby peanut butter. In the midst of her freak-out, she reprimands her mother-in-law for increasing her daughter’s risk of “horrible allergies.” In a later scene, Ruth is seen musing aloud to the child about how, back when she was raising her own kids, nobody seemed worried about feeding their kids peanut butter. (It’s all a metaphor, you see, for Ruth’s feelings of alienation and loss as the world changes around her.)
Score one for Ruth Fisher.
[OK, so I said I was going to do a purely medical post, but apparently I can’t stop myself from talking about something else. Wanna know a show that hasn’t aged well? “Six Feet Under.” The first time I watched it, at least the first season or two, I loved it. Then the Better Half and I got the complete series DVD and watched them all a couple of years ago, and I found it a lot less enjoyable. The later seasons in particular just get nutty, and characters who were complicated but ultimately sympathetic simply become awful and unwatchable. The plot spins out in all kinds of rococo twists and turns that collapse under their own weight. The performances remain top-notch, but the writing falls to pieces.]
Where was I? Oh, yes. Peanut butter.
If you have been responsible for the nourishment of small children anytime within the past decade or so, chances are you’ve been told to avoid certain foods. The reasons you have been told to avoid certain foods were probably several. Some foods are choking hazards, for example, and should be avoided until children are old enough to chew and swallow them appropriately. (Among them is the treacherous hot dog, a food so dangerous some of my colleagues have proposed a total redesign. Because parents are apparently incapable of halving them lengthwise.) Honey should be avoided until after age 1, to prevent a fleetingly rare form of botulism. If you’re parenting a small child, you should keep following those particular recommendations.
However, for the better part of the past dozen years or so, it’s been recommended that parents avoid feeding their kids certain highly allergenic foods. Specifically, the recommendation has been to avoid cow’s milk products until age 1, egg until age 2, and fish, peanuts and tree nuts until age 3. The thinking was that delaying the age of first exposure would lower the risk of developing allergies to these foods.
The problem with this is that there have never been data to support these recommendations. And wouldn’t you know, the prevalence of allergies to these foods hasn’t dropped since these recommendations became the standard. In fact, it’s risen. A lot.
Take it away, American Academy of Allergy, Asthma and Immunology:
Previous AAP recommendations published in 2000 advised delayed introduction of the following highly allergenic foods in infants at high risk for allergic disease to prevent the development of future allergy: cow’s milk until age 1 year; egg until age 2 years; and peanuts, tree nuts, and fish until age 3 years.88 However, over the next decade, the incidence and prevalence of food allergy and allergic diseases in general have increased substantially, leading to the re-evaluation of the 2000 recommendations. After careful review of the current literature, the AAP’s Committee on Nutrition and Section on Allergy and Immunology published an updated Clinical Report in January 20081 that determined there was no convincing evidence for delaying the introduction of specific highly allergenic foods…
I first came across the AAAAI’s new feeding guidelines a few months ago thanks to Dr. David Hill’s blog Needles. (I like reading another blog written by a pediatrician who enjoys awards shows and making fun of pop culture.) Truth be told, I’ve never been sold on the recommendations to avoid certain foods until the early preschool years and have always found the data lacking. While it’s always a bit unsettling when a set of guidelines is given a 180-degree flip, at least they’re now flipping in the direction I wanted. From the new set:
•Most pediatric guidelines suggest first introducing single-ingredient foods between 4 and 6 months of age, at a rate not faster than one new food every 3 to 5 days.71•Complementary foods in the United States are typically rice or oat cereal, yellow/orange vegetables (eg, sweet potato, squash, and carrots), fruits (eg, apples, pears, and bananas), green vegetables, and then age-appropriate staged foods with meats.92[snip]•We do not suggest introducing one of the highly allergenic foods as one of the first complementary foods; however, once a few typical complementary foods (see above bullet) are tolerated, highly allergenic foods may be introduced as complementary foods.
What that means in real-world-speak is that once your kids have had a few solid foods introduced sometime between 4 and 6 months of age and have tolerated them well, there’s no reason you can’t give them a small amount of peanut butter or eggs or other previously-verboten foods. While there is a bit of nuance to the guidelines and a few exceptions, the ban on shellfish and fish and nut butters is essentially lifted. (Certain exceptions apply, such as if there is a family history of severe food allergies or poorly-controlled, moderate-to-severe eczema. If you have questions about your own kid, probably best to ask a doctor who actually knows him or her rather than trusting some schmoe on the Internet.)
However, this particular schmoe took the cue from the AAAI and has been gleefully feeding his infant daughter peanut butter for weeks. Kids can be hard enough to feed as it is. Removing unnecessary restrictions on the foods they can eat will only make the job easier, and I’m happy to have the new guidelines in hand both as a pediatrician and as a parent.