About 50% of newborn babies in Hong Kong are at risk of suffering from allergies and 5% of children in the city have a food allergy. Childhood allergies are increasing worldwide and almost every parent of a young child will have had the fear of allergies drilled into them by friends, family and physicians. Allergic reactions can range from a rash to full anaphylactic shock, which may cause death. A child’s first encounter with solid foods is a scary time for parents – how will I know if my child has a food allergy? How can I prepare? Can I prevent allergies in my children?
We spoke to June Chan 陳勁芝, Senior Dietitian at the Hong Kong Sanatorium & Hospital’s Allergy Centre, to answer our pressing questions about allergies and introducing solid food.
1 – According to much of the research available, there’s a relationship between allergies and the timing of introducing solids. When should parents introduce solid food to young children?
The current medical research suggests that infants should start solid food when physiologically ready, around 4 to 6 months, and there is no benefit of delaying introduction of solid foods. The infant should have good head and neck control and be able to sit upright before introduction of solid foods. We now know that the more varieties of solid foods that an infant consumes before 12 months of age, the lower their risk of allergy. Therefore, I suggest parents aim to offer a wide variety of foods to their infants.
2 – What food do you suggest parents introduce first?
There is no particular order for introducing solid food. Parents can start with some basic foods such as iron-fortified rice cereals, fruits or vegetables as their first few solids. These solid foods should be finely pureed. Parents can also focus on introducing high iron foods such as meat, poultry, fish, eggs, beans and iron-fortified cereals. When the baby is accustomed to eating solid foods, parents can start incorporating other foods, including the common food allergens such as egg, fish, nuts, etc. When introducing solid foods, parents should start with a very small amount and observe for any symptoms for 1 to 2 days. If there is no sign of intolerance, include the food regularly as a part of the infant’s diet.
3 – What are the common allergens parents should be cautious about?
The most common food allergens in the world are milk, egg, wheat, soy, fish, shellfish, peanut and tree nuts. These eight food allergens accounted for over 90% of the food allergies around the world. Recent research found that delaying the introduction of these common food allergens, especially peanut and egg, is associated with a higher risk of developing food allergies. We think it is very important for parents to know that they should incorporate common allergens when their child is ready for solids rather than avoid them. Please be reminded that if your child has already been diagnosed with an allergy to these foods; you should not introduce these foods to them.
4 – Assuming there is not family history, for common allergens such as peanuts or eggs, how should parents go about introducing these foods to babies?
When there is no family history of allergic diseases and the infant is already eating some solid foods, parents can start introducing common allergens. As a start, parents can rub the food on the inside of the infant’s lip, and then give a small amount of the food if there is no reaction. It’s helpful to add allergens to a child’s regular food. For example, parents can start with something like 1/4 of a well-cooked egg into their usual rice cereal, add a few peanuts when boiling broth or congee or mash some fish into their usual vegetable puree. If the infant has no allergic reaction after eating, parents can gradually increase the amount and incorporate these regularly into the infant’s diet. Remember to give the right food consistency to your infants; never give foods that could make them choke. Parents should seek medical help immediately if there’s any allergic reaction. For infants who have a family history of allergy, they should talk to their pediatrician or allergist before introduction of common allergenic foods.
5 – Where can Hong Kong parents find more information about allergies?
The Hong Kong Sanatorium & Hospital’s Allergy Centre is one of the leading centers specializing in allergic diseases. Our website has additional information for parents. In Hong Kong, the Hong Kong Allergy Association (also known as Allergy HK) is a non-profit, patient-interest group providing periodic talks and newsletters for patients and their families. The Hong Kong Institute of Allergy is a very good source for up-to-date in-depth medical information about food allergies. There are also many other allergy-focused websites with trusted information such as Food Allergy Research & Education and Kids with Food Allergies.