Eat and don’t worry

The American Academy of Pediatrics recently published a revised policy statement, retracting earlier recommendations that mothers of infants with a family history of allergies avoid fish, peanuts, tree nuts, eggs and cow’s milk while breastfeeding. Experts now say there isn’t enough evidence to show that avoiding certain foods makes a difference.

“We tell people to do these things, but really, even before these new recommendations, we didn’t have firm evidence to support it,” says Dr. Annie Khuntia, a clinical associate professor in the section of pediatric allergy and immunology at the University of Chicago. She says that in pediatrics, it’s often the case that recommendations come out of a‘cover-all-the-bases’ strategy, since comprehensive research can be difficult to complete with infants and young children.

“The bottom line with this new information is that nothing has really changed,” she says."We don’t have enough strong evidence to support our previous recommendations, but we don’t have strong evidence against them, either. We need more controlled studies to know if there’s a benefit—or not—to waiting on certain foods.”

The one piece of the new recommendations that Khuntia says does have stronger evidence is that exclusive breastfeeding for the first four months provides protection against wheezing in babies. However, it’s unclear whether the protection extends to asthma in older children.

“Breastmilk has an antibody in it called Secretory IgA—babies produce it on their own, but not as much of it at first, so that may make a difference,” Khuntia says. She also suggests another possible explanation for the benefits offered by exclusive breastfeeding—that the contents making up human milk have already been broken down by the time they get to the baby, so perhaps they’re less allergenic by that time.

So what should you know now?

Remember that even the earlier recommendations were for high-risk individuals—those with a family history of allergies or asthma—and you still need to be careful and consult your doctor.

Khuntia says the important take-away from the new recommendations is that you should breastfeed exclusively for the first four months. If you can’t, you should use a partially or extensively hydrolyzed (in which chemical compounds in the contents have been decomposed) formula. Examples are Nestle’s Good Start (partially hydrolyzed) and Nutramigen (extensively hydrolyzed) formulas.

“With the previous recommendations, many parents whose children developed allergies placed blame on themselves—if the mother ate peanuts while pregnant, if the parents introduced one food or another,” says Khuntia."There isn’t anything currently that says that at all. These things may influence development of allergies or they may not. Right now there isn’t enough that says they do.”

Recent research out of the University of Michigan found that 40 percent of children between 6 and 11 whose parents described them as"about the right weight” were actually obese. A quarter of the children whose parents were polled were classified as overweight or obese.

Less than 10 percent of the more than 2,000 parents surveyed for the study said they were"very concerned” about their child’s weight.

The findings of this research call attention to a startling discrepancy between awareness of the public health issue of childhood obesity and the ability to objectively recognize it in one’s own children.

“I think that it is imperative for parents to appreciate how big a problem obesity is and they need to take it on themselves to ask their physicians if their child is growing and gaining well, and ask specifically how to control weight gain issues,” says Dr. Joel Schwab, an associate professor of pediatrics and director of medical education in the department of pediatrics at the University of Chicago’s Pritzker School of Medicine.

Obesity is based on an individual’s body mass index (BMI). When a child’s BMI is above the 95th percentile for children of the same age and gender, the child is obese.

According to research, parents’ lack of concern or awareness of their child’s weight can have additional health implications beyond the obvious roadblocks to a healthy life.

While it can be difficult to hear, some of the responsibility should fall on the doctor"to point out that the child is not perfect and discuss eating habits, diet, nutrition, physical activity and television watching,” Schwab says.

But Schwab insists parents have to take it on themselves to request information, too.

“They should ask that the physician demonstrate that they’re plotting their child’s progress on a growth chart,” he says.

The greatest red flag, Schwab warns, is a family history of obesity-related health issues, such as obesity itself, hypertension, diabetes and cardiac disease.

“This is a huge problem without many working solutions at this time,” Schwab says.

As many parents themselves know, overcoming unhealthy weight is a long and difficult process."We have to be able to communicate about it and we cannot ignore it,” Schwab says.