CHA Family Medicine Residency

Tufts family medicine residents have "the best of both worlds"


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Let them eat cake!

Randomized Trial of Introduction of Allergenic Foods in Breast-Fed Infants – n engl j med 374;18 nejm.org May 5, 2016

The plot thickens. I can’t imagine how difficult it must have been to try to cram all that stuff into a 3-4 month old! The four we had would have spit out at least 75%. I compute the NNT to be around 66 overall, and 20 in the “per protocol” analysis. – even though the P value was high (need to figure out how to reduce unnecessary variance in babies!).

Bottom line for me is that it’s ok to ask babies if they want to try some interesting foods, starting at around 4 months of age, including those who might be at high risk for food allergy. Most of the stuff on the web, powered by AAP and USDA, says start introduction of solids between 4 and 6 months. WIC starts handing out baby food at 6 months, but they ok introducing solids between 4 and 6 months. Unclear whether these recent studies are going to change those eminence-based recommendations.

http://www.fns.usda.gov/sites/default/files/feedinginfants-ch7.pdf

  • Introduce foods to a baby that have been previously introduced,with no problems, by the baby’s parents;
  • Introduce new foods one at a time;
  • Introduce new foods gradually, for example, wait at least 1 week(7 days) between each new food;
  • Introduce a small amount (e.g., about 1 to 2 teaspoons) of a new food at first (this allows a baby to adapt to a food’s flavor and texture);
  • Use single-ingredient foods at first to easily see how the baby reacts to each new food. Caregivers who are preparing foods at home for a baby and older children should separate the baby’s portion before adding other ingredients; and
  • Observe the baby closely for reactions after feeding a new food
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