Taking a brief hiatus to venture into the wild!

May 24, 2010 personal news

It’s going to be quiet around here for the next 8 days or so.  We’re leaving for a much needed vacation into the wild!  No phones, no internet and no TV.  How wierd is that?   My twins think that no TV means no cable - LOL and that we can at least bring a mini dvd player to hook up – not!  Ok, I have to admit that I was thinking that too because really, where have you gone lately where there was not a television set?   They will miss their wild animal shows but we’ll find lots of real wild creatures.  Totally looking forward to it! 

I hope that your week is full of fun and rest too!

Baby Foods to Avoid – Are Forbidden Foods Still Relevant?

Jun 9, 2009 Allergies, Dangerous Food Items, Food Safety Tips, Forbidden Foods, Friendly Baby Food Advice, Nutrition, Solids and Weaning, Uncategorized, personal news

We received an email this evening regarding delaying the introduction of foods listed on our Forbidden Foods chart. Sandra wrote the following:

Your list of “forbidden” foods is very poorly outdated. The AAP revised their very old policy about withholding peanuts and other “no nos” a very long time ago.

The new recommendation is that any child six months or older (starting solids) can eat anything, including strawberries, peanut proteins, etc., providing there is not a family history of allergies. It makes it very difficult to take anything else on your site seriously when your information is so very outdated.

We sent her our reply however the email address was not valid. I am hoping that Sandra might see this post and that others will share their thoughts as well. About 15 months ago, the results of a clinical study came out in the Journal Pediatrics (PEDIATRICS Vol. 121 No. 1 January 2008, pp. 183-191). This clinical report revised a policy issued in 2000 that focused on the use of Hypoallergenic Infant Formulas. We noted the following directly below our Forbidden Foods chart:

Is this chart really relevant since the AAP report from 2008 came out?

In 2008, the AAP released a clinical report entitled Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas

There are many who believe that due to this clinical report, there is no longer a need to delay any foods, of any kind, when beginning to introduce solid foods to babies. The report notes the following:

“Although solid foods should not be introduced before 4 to 6 months of age, there is no current convincing evidence that delaying their introduction beyond this period has a significant protective effect on the development of atopic disease regardless of whether infants are fed cow milk protein formula or human milk. This includes delaying the introduction of foods that are considered to be highly allergic, such as fish, eggs, and foods containing peanut protein.”

It is important to note that the AAP states in its clinical report that:

“In summary, the evidence from these conflicting studies, in balance, does not allow one to conclude that there is a strong relationship between the timing of the introduction of complementary foods and development of atopic disease. This raises serious questions about the benefit of delaying the introduction of solid foods that are thought to be highly allergic (cow milk, fish, eggs, and peanut-containing foods) beyond 4 to 6 months of age; additional studies are needed.”

In the press release, the AAP notes that:

“Current evidence is insufficient to document a significant protective effect of maternal dietary restrictions during pregnancy or lactation. Nor is there sufficient evidence that any dietary intervention after 4-6 months of age prevents allergic disease. This includes delaying the introduction of complementary foods.”

At this time, there has not been an AAP Policy Statement firmly declaring that it is safe for (non-allergic) infants to be introduced to all foods, allergenic or not, after 6 months of age. The report makes changes to the policy of using Hypoallergenic Infant Formulas. The Clinical Report states that more studies are needed and that the report itself is not definitive.

The bottom line is that peanuts and eggs have not been proven safe for infants prior to 12 months or older; nor have these items in particular been proven unsafe. It is most important that you discuss introducing possible allergenic foods with your baby’s pediatrician.  As the Journal of Allergy and Clinical Immunology, notes (see full response/report below) Although the AAP report describes a lack of evidence on the topic of delaying introducing peanut beyond age 6 months, we caution that this is not tantamount to advising introducing peanut at that age as a weaning food!

Our forbidden food chart will remain on our site until there is a major consensus policy issued by the AAP and other pediatric nutrition authorities. Several of the recommendations for delaying the introduction of certain foods are not due to possible allergic reactions rather, they are due to other possible health risks. As we mentioned prior, many foods listed should not be given until a certain age due to possible health issues:

• Honey for example, could prompt infant botulism due to the immaturity of a baby’s intestinal tract.
• Whole milk should not be introduced as a replacement for breast milk or formula until after 12 months. The AAP maintains this stance in the January 2008 clinical report. This recommendation is due to the fact that whole cow milk cannot properly sustain a growing infant. It simply does not have all the nutritional components needed for healthy growth and development. There is also a bit of difficulty in the digestion of whole milk proteins. Yogurt and cheese are cultured and thus tend to be more easily digested.
• Citrus is very acidic and many infants under the age of 12 months old suffer rashes and tummy upsets due to the acidity. This has nothing to do with allergies.
• Strawberries and Shell Fish, and even Peanuts, can prompt severe, life threatening allergic reactions. The recommendation continues to be one of caution and delay.
• We would also like to point to a few other examples of why it might be prudent to delay the introduction of certain foods. Broccoli for example is known to cause gas in many people. Offering broccoli to an infant who is 6 months of age is really not a good idea. You would not want offer a 6 month old baby Beans either, as these too may cause painful gas.

In speaking with our personal pediatrician and a few others, all continue to recommend delaying the top 8 allergenic foods. They also say to avoid acidic foods until 10-12 months and of course if it’s a choking hazard, it’s a no-go! One pediatrician we spoke to recommends peanut butter around 2-3 years old due to it’s being so sticky that it may pose more of a choking hazard than an allergy hazard!

Please let us know your thoughts!

You should always discuss solid foods with your baby’s pediatrician as generalities may not apply to your infant.

Thanks to one of our Allergist friends for the following:

Journal of Allergy and Clinical Immunology, Volume 122, Issue 1, Pages 29-33 (July 2008)
Deciding what should be on or off the menu in 2008

We know that the revised AAP report has caused concern because it is not simply a to-do list of recommendations. The new approach is more sensitive to the notion that when evidence is unclear, physicians and patients should be aware of those caveats.
The conclusions of the report (aimed at high-risk infants without current evidence of atopic disease) are summarized as follows: approaches that are generally effective are
(1) breast-feeding for the first 4 to 6 months of life;
(2) if not breast-feeding, or if supplementing, for the first 4 to 6 months, using an extensively hydrolyzed casein formula (or a partially hydrolyzed whey formula, though it may be less effective), instead of a cow’s milk or soy formula; and
(3) delaying introduction of solid foods until 4 to 6 months of age.

Approaches that have been tried but remain unproven are
(1) dietary allergen restriction during pregnancy,
(2) dietary allergen restriction during lactation (there is some evidence that this approach may reduce eczema), and
(3) avoidance of allergenic foods for months and years beyond 6 months of age.

An educated consumer should be aware of the limitations of the available data. For example, different studies target different risk groups, and it may be that stricter or more comprehensive prevention programs may have different effects depending on the level of risk. A family in which both parents have multiple severe atopic diseases may be more motivated and may benefit more (although this is an assumption) from interventions compared to one in which the risk of atopy is lower.

More studies must carefully consider whether primary allergen avoidance delays, permanently prevents, or simply masks atopic manifestations that would have been transiently evoked.

We must remain aware that most of our conclusions are drawn from observational studies and that reverse causation may play a role in affecting results. That is, a family may alter the diet on the basis of observing signs of disease or on the basis of their level of risk, which could lead to dilution of prevention effects (breast-feeding longer if disease is appearing) and erroneous conclusions (waiting longer to give egg appears to be associated with more allergies).

We are also becoming aware of additional subtle influences of diet that raise concerns about suggestions to make changes on a limited evidence base. For example, lipids, antioxidants, and vitamins may influence atopy outcomes.5, 33 The influence of allergens in the diet during pregnancy or lactation remains controversial.33, 34 Noningestion (skin contact, inhalation) exposure may be a means of sensitization.14, 33 Regarding the question of maternal exclusion diets during pregnancy, Rowe et al35 followed T-cell and humoral responses in high-risk infants and could not document evidence for prenatal priming. Liem et al36 evaluated a 1995 Manitoba birth cohort (n = 13,980) by using an administrative database and could not find an increase in food allergy diagnosis among low-birth-weight or premature infants who might have been considered at risk for early dietary allergen exposures. Oral tolerance presumably requires oral exposure and is affected by dose, timing of exposure, and other factors. Elimination diets could theoretically result in bypassing oral tolerance induction, whereas exposures through sensitizing routes (skin, respiratory) could be sensitizing.14 Of additional concern, the literature includes cases in which dietary elimination of previously tolerated foods results in new onset of allergy on re-exposure.37, 38 We are becoming more interested in oral and sublingual immunotherapy to treat food allergy,39 which runs counter to advice to avoid allergens for long periods. These observations create a tenuous situation if one is to advise general prolonged elimination of allergens as a “do no harm” approach.

The situation is especially sticky regarding peanut. Green et al40 recently documented an earlier age of presentation of children with peanut allergy to a referral center, compared with previous years. However, the timing between introduction and symptoms has not changed, and the authors could not conclude there was a relationship of early introduction as a risk for inducing peanut allergy. Sicherer and Sampson41 recently reviewed the complex situation of there being multiple potential risks for peanut allergy, including how peanut is processed (roasting/emulsification), genetic disposition, timing of introduction, and dose. Lack et al14 have reported a concern that lack of early oral exposure/increased skin exposure may increase the risk of peanut allergy and are studying whether early ingestion influences outcomes in the Learning Early About Peanut allergy study.

Although the AAP report describes a lack of evidence on the topic of delaying introducing peanut beyond age 6 months, we caution that this is not tantamount to advising introducing peanut at that age as a weaning food!

Regarding the approaches that have been tried but remain unproven, we typically discuss the available data with our patients and try to help them make informed decisions. Families may already be avoiding certain allergens because of an allergic sibling and find it easy to continue to avoid, for example, peanut. We do not discourage this. For infants at risk, we may provide general advice to begin solids with single-ingredient infant foods such as fruits, vegetables, and cereal grains, gradually and in progression, which typically results in the more allergenic foods not being introduced until nearer the first birthday, and only if there have not been signs of atopic disease. Regarding peanut, the sibling history may influence our advice because there is a 7% risk of peanut allergy among siblings42; we may delay peanut until testing is performed.

We view the AAP report as aimed to primary prevention; if an infant has signs of atopic dermatitis or food allergy, we may consider testing and longer periods of avoidance.

The updated AAP report underscores the need for additional research on prevention and treatment. It does not preclude following any of a variety of reasonable approaches but does behoove us to present information to our patients in the context of the limitations of our current evidence base.

Tags: Allergies, allergy, honey, strawberries

We’re back! Is it Christmas yet? Has Christmas really passed us by?

Dec 29, 2008 Uncategorized, personal news

Wow-Weeeee! We were without power for 10 days! Yep, 10 days. From 11 December to 21 December at 10:00pm we were in the dark, without modern heat, hot water or refrigeration. When the power came on, we realized that there were only 3 shopping days left until Christmas. Wholy Schmoly!!!!!!! I was unable to do any shopping during the power outage as the twins believe in Santa and also, they would have told their Dad and brother what we bought. Boy do I have a new respect for those that have their Christmas shopping done by July! I think this will be my plan from now on.

So how was it without power? First of all, it was very strange as we became adapted to “non-electrical’ time. Within 4 days or so, our bodies began to get sleepy by 6:00pm as we began to wake with the sun and then find bedtime was calling soon after sunset.

How did we cook? We used our woodstove top to boil water, cook noodles and soups etc. We used the grill outside to cook and we ate out a lot. Thank goodness for the French (coffee) Press – we were still able to have a good hot cup of coffee. Paper plates replaced the winter snowmen china.

How did we store the food? By the time we realized we were going to be in the dark for the long haul, I grabbed the frozen food from the spare freezer and put it into crates. I managed to save a bit but everything in the upstairs fridge/freezer had to be thrown away. The crates I then buried in the snow outside on our deck. A grapevine reindeer stood guard in case our resident raccoon tried to elnow in on our foods. The milk and orange juice, cheese and butter sat outside on the deck table and remained cold – a quick shake every now and then prevented freezing.

How did we clean ourselves? Well of course we drove over to SIL’s house to shower and also did quick washes with a pot of boiling water and a washcloth. The downfall here is in the washing of your hair. You see, it’s wonderful once you have washed your hair with warm water but then it hits you – you don’t have a hair dryer and man-o-man is your head freezing. Sitting down by the wood stove for an hour dries you hair nice enough but forget a perfectly coiffed look!

How did my twins (now 6yrs old) take it? They had no complaints really. They are used to reading, doing crafts, playing with their toys and their imaginations, drawing and playing outside in the snow. They don’t watch a lot of t.v. nor do they play video games so there was no whining or withdrawl for them. More than ever, we are thankful for the decision to try and raise them with limited t.v. and video games!

So now we are happy to have the power back on but still feeling off kilter. We had just arrived back home from a 14 day trip on the 3rd Dec. and finally had things caught up. We were gearing up for the Christmas shopping and planning to do most shopping online. Christmas came and went so fast that we feel like we missed it. It was so hurried and rushed and the twins did cry a bit when they realized we weren’t going to be making Christmas cookies as we traditionally do. Santa was left Goldfish and milk!

Now, all the laundry is finally done and things are almost back to normal. We’re getting back to updating the Blog and our website. We have so many beautiful babies to get posted – seeing your beautiful little ones really is the highlight of running this site for us!

We all hope you had a magical and wonderful Christmas/Holiday celebration with good food, love of family and friends and comfort and joy!