Jan. 7, 2008 -- Exclusive breastfeeding for at least four months may help prevent asthma, eczema, and food allergies in high-risk babies, but there is little evidence that delaying the introduction of specific foods makes a difference, the nation's leading group of pediatricians now says.
In a newly published policy statement, the American Academy of Pediatrics (AAP) abandons a previous call for the gradual introduction of foods typically associated with allergies in high-risk children.
The earlier guidelines recommended delaying the introduction of cow's milk until after a child's first birthday, eggs until age 2, and tree nuts, peanuts, and fish until age 3.
"We just do not have the studies to back this up," study researcher author Frank R. Greer, MD, tells WebMD. "If a child is going to be allergic to peanuts or eggs, it doesn't seem to matter [after 4 to 6 months] when you introduce these foods."
There is also no convincing evidence to justify telling moms to avoid these foods during pregnancy and while they are nursing, the new report shows.
What About Formulas?
Published in the January issue of the journal Pediatrics, the report revisits and revises recommendations made seven years ago by the AAP.
Among the major findings:
- Exclusive breastfeeding for at least four months, compared with feeding regular formula made from cow's milk, appears to help protect high-risk children against milk allergy and eczema in the first two years of life, the report states.
- There is "modest evidence" that special formulas that are extensively or partially hydrolyzed may prevent eczema in infants. Formulas such as Nestle's Good Start and Mead Johnson's Enfamil Gentlease have milk proteins that are broken down, making them easier to digest.
- More study is needed to determine whether the benefits of these extensively or partially hydrolyzed formulas for allergic disease prevention extend into later childhood and adolescence.
- There is "no convincing evidence" that soy-based formulas help prevent allergic disease in high-risk children.
"If there is a family history of allergy problems, it is clear that moms should breastfeed exclusively for at least four months," study co-author Scott H. Sicherer, MD, tells WebMD. "If that isn't possible and a formula is needed, don't pick a typical soy formula."
Long-Term Impact Unknown
The authors conclude that more research is needed to document the long-term effect of dietary interventions in infancy for preventing allergic disease after early childhood.
Sicherer says doing away with the recommendation to delay the introduction of certain foods will probably have little practical impact because few parents were following them.
An associate professor of pediatrics at New York City's Mount Sinai Medical Center, Sicherer says the food restriction guideline may have even made the parents of children with allergic diseases feel responsible.