Top weaning tips for an allergic baby:
- start weaning early, from 4 months (once you’ve had the go-ahead from your pediatrician)
- allergy testing may not be helpful if your baby has the delayed non-IgE type of allergy as it is often falsely negative
- it may take several days to see symptoms of the delayed type allergy
- food diary is very useful as it is often in retrospect, days/week later that you make an association with particular foods
- childhood conditions like colds, teething, vaccination, can all cause ‘flare ups’ without an allergen being present. So if in doubt, re-trial foods again when your baby is better.
- introduce ‘texture’ early
(more details on these points below)
Here’s my journey with weaning Sarah (4-9 months):
When Sarah was 4 months I started weaning her on the advice of her dietician who told me that allergic kids have a tendency to have heightened ‘sensory processing’ so they may be more sensitive to texture (lumpy foods) and tastes. I was advised to get her exposed to different tastes and textures as much and early as possible so she didn’t grow up to be a picky eater, as there is a window of opportunity between 6-12 months when kids are more receptive to new foods. Also, as shown by the LEAP study (see my article on peanut allergy prevention) it would make sense to introduce as many foods into her diet as possible to ‘prevent’ future allergies (although 8 years ago we didn’t know this definitively). The dietician was just way ahead of her time.
Unfortunately, weaning was very slow… because Sarah’s allergies were not the immediate (IgE) type but rather, the delayed (non-IgE) type.
I talked about this in ‘How do I know my child has a food allergy‘, but briefly, here is a list of differences:
- symptoms usually within 1-2 hours of food ingestion with obvious symptoms like hives, vomiting, rash, wheezing, lip swelling etc.
- blood IgE and skin prick testing usually positive
- symptoms occur later, usually around 2-24 hours but may take up to 72 hours
- symptoms may be insidious and sometimes attributed to another cause, and commonly affects the gut e.g.abdominal pain, constipation, food aversion.
- blood IgE and skin prick testing usually negative
As you can see, it can be very difficult to monitor and wean children with the delayed type of allergic reactions because there is no test that can tell you definitively what they are allergic to (especially when they can’t speak and tell you their symptoms), most of the time I just found myself second guessing and stabbing in the dark. This was extremely uncomfortable for the perfectionist in me who wanted everything black or white.
Sarah’s skin prick testing at 6 months was only positive to egg and peanut, but she definitely 100% was allergic to milk (yet she tested negative with both skin prick or blood tests). So the only way I could monitor if she was allergic to anything else was by keeping a food diary and observing her symptoms. This meant that:
- I could only introduce one new food at a time
- I had to give the same food 3 consecutive days and watch for a reaction.
The symptoms I looked out for were: abdominal pains, reduced appetite, and change in bowel habit. How vague is that! And a recipe for neurotic mom right?? Even without allergies an average child will experience these symptoms from time to time, but throw allergies into the mix and even as a doctor, I found it extremely hard to interpret her symptoms. The main problem is that the time lag between symptoms and food ingestion could be 2-3 days! So it is difficult to make that association. In fact, I probably over-interpreted ANY symptom and should have just been more relaxed. What a lot of people don’t realize is that you don’t have to have eaten an allergen to have a flare up – Sarah could get a flare up if she was teething, had vaccinations, or a cold. So imagine the scenario of me trying a new food e.g. carrots. 2 days in, Sarah gets a cold. She starts to refuse food and had abdominal pains – I think – oh she must be allergic to carrots when in fact she is ok with carrots but just had a cold that flared up her symptoms. And hey, a baby always seems to be forever teething right? teething is blamed for everything! So you can see what a confusing period of time it was when I tried to wean her. (Weaning Thomas was different thought, as he mainly had IgE-mediated allergies).
I didn’t get a full night’s sleep until Sarah was 18 months old – and spent many nights rubbing her tummy, patting her and rocking her every 2-3 hours when she suffered from abdominal pains in reaction to food/or a flare up due to teething and the abundant other upsets a baby endures.
Even if you think your child may be allergic to a food – unless the symptoms were clear cut, and you were sure, it is worth retesting that food again because their symptoms might have been caused by another concurrent factor e.g. a cold, teething (and I am only talking about the delayed type reaction here because the immediate type is usually obvious and you should be consulting a doctor rather than re-testing it at home).
A food diary, although tedious, is so important if you do ‘re-test’ a food, because you can look back on symptoms that occurred the first time and confirm/refute your suspicions.
Another important aspect of weaning is texture. Moving from smooth pureed food (unless you do baby-led weaning) to more lumpy food can be a real challenge. Sarah gagged every time I tried to introduce texture; she could not eat chopped up lumpy food properly until she was 14 months, and swallowing cut up pieces of meat was a challenge for her until she was 3 years!! She would often hold the pieces of meat on the inside of her cheek and accumulate it there. I found that if I gave her a small spoonful of rice WITH the meat (or another food she likes with a soft texture) she was then able to swallow the meat a lot easier. Don’t know why! So between the ages of 1-3 years, it would not be unusual for her to be seen eating a bite of lamb whilst popping a blueberry at the same time…
It is also important to be patient and keep re-trying foods they reject. Sarah kept spitting out broccoli the first few times but eventually she liked it and now it is one of her favorite foods!!