Early weaning, from 4 months old, for babies with eczema or food allergies

Did you know that if your baby has eczema or already has a food allergy, it is advised to start weaning them early? With the specific aim of introducing egg and peanuts early into their diet.

Research now shows that starting egg and peanuts earlier, from 4 months, can help prevent them developing an allergy to egg and peanuts later in life (1).

The general advice in the UK is to ideally exclusively breastfeed for the first 6 months of life and around 6 months old to start weaning your baby onto solids, alongside continued breastfeeding.

However, the advice around when to start weaning has changed for babies who are at higher risk of developing a food allergy.

Who is at higher risk of developing a food allergy?

1. Babies who have eczema, especially if it started within the first 3 months of life or it is classified as moderate -severe, i.e. their eczema is very bad and needing steroid creams.
2. Babies who already have a food allergy, the most common being cow’s milk protein allergy (CMPA).

These babies are unfortunately at higher risk of developing a food allergy to egg and peanuts (1).

But if this is your baby, they will also benefit the most from an early introduction of egg and peanuts into their diet, as it may prevent an allergy from developing if these are well tolerated.

Why is early weaning recommended for babies with eczema or a food allergy?

Recent research has consistently showed that when you introduce allergens earlier into your baby’s diet, it can help prevent them from developing an allergy to that specific food. With the most significant results seen in the prevention of egg and peanut allergy.  

Two key studies contributing to the change in allergy prevention weaning advice have come from the UK: 

1. The EAT Study (Enquiring about tolerance Study)

2. The LEAP Study (Learning early about peanut allergy Study)

These studies and others show that introducing egg and peanuts alongside other weaning foods earlier, or at least by 12 months of age, may help prevent your baby from developing an allergy to that food.

And specifically, for babies with eczema or those who already have a food allergy, early introduction, from 4 month’s old may prevent your baby from developing an egg or peanut allergy.

For babies who don’t have eczema or a food allergy, it is advised to wean at around 6 months old, introducing allergens with other foods as weaning progresses. Aiming for food allergens to be introduced by the time your baby is 12 months’ old (1).

Remember, if your baby already has a food allergy, then please follow the advice of your health care professionals and allergy team.

What are allergens?

An allergen is a usually harmless substance that can cause an allergic reaction in some people. They include pollen, house dust mite, and foods.

The most common food allergens are:

• Egg
• Peanut
• Nut (for example almond, cashew nut and hazelnut)
• Milk and dairy products
• Soya
• Wheat and gluten
• Fish
• Crustaceans (crab, lobster, prawn, and scampi)
• Molluscs (mussels, land snails, squid, and whelks)
• Mustard
• Sesame seed
• Lupin
• Celery (1&2)

If my baby has a sibling or family member with a food allergy, when should I introduce allergens?

If someone in your baby’s family has a food allergy, including their mum, dad, or a sibling, this alone doesn’t increase their risk of developing a food allergy. 

It is therefore still advised to start weaning around 6 months old, as per normal UK weaning guidelines. Once weaning has started, egg and then peanuts should be introduced, followed by other allergenic foods, as listed above. 

The most important thing to do if your baby has a family member with a food allergy, is not to delay the introduction of allergens into your baby’s diet, including those any family members are allergic too. As it is the delayed introduction that is more likely to result in your baby developing an allergy, rather than an allergic family history (1).

Which foods are the most important to introduce early?

Research has shown that the early introduction of egg and peanuts has the most beneficial effects in allergy prevention.

Therefore, these two foods are the focus of early introduction.   

It is important to note that some babies will already be allergic to egg or peanuts before they eat them for the first time. This is more likely in babies with severe eczema. If your baby has severe eczema, speak to your healthcare professional before introducing egg and peanuts for the first time.

Should my baby have an allergy test before they have egg and peanut for the first time?

Ideally, all babies at higher risk of developing a food allergy would first have an allergy test taken before introducing allergens, to help identify their individual risk.

Reliable tests include:

1. A blood test looking at specific IgE’s to food allergens. Immunoglobulin E or IgE is an antibody produced by the immune system in response to an allergen. If the IgE level for a specific food is high, it may indicate an allergy.
2. Skin prick tests to specific foods.

If this is an option for you under the NHS or privately, then you may want to consider it before introducing allergens.

However, for most babies the risk of waiting to be referred to an allergy clinic and have an allergy test taken would mean that weaning may be delayed and they may have missed the early introduction window (1).

Therefore, it is advised to consider introducing allergens early, even without an allergy test, due to the potential benefits of allergy prevention.

If you have any concerns about this, please discuss it with your GP, Consultant, or a Paediatric Dietitian.

How do I know if my baby is ready to wean at 4 months?

The following are 3 common developmental signs that your baby is ready to start weaning:

1. They have good head control and can stay in a sitting position, relatively unaided. If they need some extra support, like a cushion tucked in next to them to help keep them upright that’s ok.
2. They have the co-ordination to look at an object, pick it up and bring it to their mouths by themselves. You will probably have noticed them doing this with toys.
3. When you give your baby food, they can swallow it rather than push it back out with their tongues. This is an absence of what we call the tongue thrust reflex that babies are born with (3, 4 & 5).

Many babies will only be doing all 3 of these closer to when they are 6 months old.

However, due to the above-mentioned benefits, if your baby is classified as higher risk and has good head control, I would suggest considering starting early.

Having good head control and sitting upright is very important as it helps reduce the risk of choking.  

How to introduce egg and peanut early into your baby’s diet

If your baby is at higher risk of developing a food allergy, and ready to start weaning, you can start any time after they are 4 months old.

When you first introduce egg, peanuts, and other allergenic foods, monitor your baby for any allergic reactions.

If your baby reacts to a food stop that food immediately and seek medical advice.

1. Start by offering a small amount of pureed vegetables and/or fruit once a day.

2. After 5-10 days, once your baby is eating small amounts of these,

Introduce cooked egg:

• Always give your baby cooked egg, never raw.
• Use both the egg white and the yolk.
• If you are using British Lion stamped eggs – you can give scrambled egg, soft- or hard-boiled egg.
• If you are not using British Lion-stamped eggs, only give well-cooked or hard-boiled eggs.
• Mix ¼ – ½ teaspoon (tsp) cooked egg into some puree vegetables and give it to your baby.
• If well tolerated, slowly increase the amount of egg given over the next few days, by ¼ – ½ tsp per day.
• Aim for your baby to eat at least 1 small cooked egg per week.
• To help maintain tolerance, continue giving your baby at least 1 small cooked egg (or more) per week going forwards.

3. After about 7 days of giving your baby egg,

Introduce peanuts:

• Give your baby smooth peanut butter or grind whole peanuts into a fine powder.
• Mix with pureed fruits, vegetables or baby porridge using the following recipe:

1 tsp smooth peanut butter or finely ground whole nuts

 + 1 tablespoon (tbsp.) pureed fruit, vegetables, or baby porridge.

• Give 1-2 tsp of the above peanut and puree mixture to your baby.
• If well tolerated, slowly increase the amount given over the next few days.
• Aiming for 2 x 4 tsp of the above recipe to be eaten per week or 2 tsp of smooth peanut butter/finely ground peanuts per week.

Remember not to give whole nuts to children under 5 years of age, as they can be a choking hazard.

4. Introduce foods high in protein next, and especially those high in iron.
5. You can now introduce other allergenic foods (see list above), slowly one at a time (1).

If you are breastfeeding, continue breastfeeding while introducing solids as this may support your baby’s tolerance of new foods.

Food must always be given in an age-appropriate form to your baby to help avoid the risk of choking. For example, smooth peanut butter and cooked egg, mashed or pureed with vegetables or in a finger food if your child is 6 months or older.

Remember – never feed your baby something they are already allergic food without first speaking to your Consultant, Dietitian or GP.

If you would like specialised help for introducing allergens or weaning, please send me a message, I’d love to help you.