Dear Nikki I am doing a study on breastfeeding, allergy and introducing solids. Which AAP Policy are you referring to? I am very interested. Do you have a link for me. I have the following articles from AAP The first one is revised. Below the old one you will find the most recent one. Clinical Report I extracted the recommendations. Old policy: from August 2000, from the Committee of Nutrition. Hypoallergenic Infant Formulas http://aappolicy.aappublications.org/cgi/reprint/pediatrics;106/2/346.pdf RECOMMENDATIONS 1. Breast milk is an optimal source of nutrition for infants through the first year of life or longer. Those breastfeeding infants who develop symptoms of food allergy may benefit from: a) maternal restriction of cow’s milk, egg, fish, peanuts and tree nuts and if this is unsuccessful, b) use of a hypoallergenic (extensively hydrolyzed or if allergic symptoms persist, a free amino acid-based formula) as an alternative to breastfeeding. Those infants with IgE-associated symptoms of allergy may benefit from a soy formula, either as the initial treatment or instituted after 6 months of age after the use of a hypoallergenic formula. The prevalence of concomitant is not as great between soy and cow’s milk in these infants compared with those with non–IgE-associated syndromes such as enterocolitis, proctocolitis, malabsorption syndrome, or esophagitis. Benefits should be seen within 2 to 4 weeks and the formula continued until the infant is 1 year of age or older. 2. Formula-fed infants with confirmed cow’s milk allergy may benefit from the use of a hypoallergenic or soy formula as described for the breastfed infant. 3. Infants at high risk for developing allergy, identified by a strong (biparental; parent, and sibling) family history of allergy may benefit from exclusive breastfeeding or a hypoallergenic formula or possibly a partial hydrolysate formula. Conclusive studies are not yet available to permit definitive recommendations. However, the following recommendations seem reasonable at this time: a) Breastfeeding mothers should continue breastfeeding for the first year of life or longer. During this time, for infants at risk, hypoallergenic formulas can be used to supplement breastfeeding. Mothers should eliminate peanuts and tree nuts (eg, almonds, walnuts, etc) and consider eliminating eggs, cow’s milk, fish, and perhaps other foods from their diets while nursing. Solid foods should not be introduced into the diet of high-risk infants until 6 months of age, with dairy products delayed until 1 year, eggs until 2 years, and peanuts, nuts, and fish until 3 years of age. b) No maternal dietary restrictions during pregnancy are necessary with the possible exception of excluding peanuts; 4. Breastfeeding mothers on a restricted diet should consider the use of supplemental minerals (calcium) and vitamins. I found that the vision of the AAP has changed. http://aappolicy.aappublications.org/cgi/content/abstract/pediatrics;121/1/183 Effects of Early Nutritional Interventions of the Development of Atopic Diseas in INfants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introductieonof Complementary Foods, and Hydrolyzed Formulas. January 2008 Abstract his clinical report reviews the nutritional options during pregnancy, lactation, and the first year of life that may affect the development of atopic disease (atopic dermatitis, asthma, food allergy) in early life. It replaces an earlier policy statement from the American Academy of Pediatrics that addressed the use of hypoallergenic infant formulas and included provisional recommendations for dietary management for the prevention of atopic disease. The documented benefits of nutritional intervention that may prevent or delay the onset of atopic disease are largely limited to infants at high risk of developing allergy (ie, infants withat least 1 first-degree relative [parent or sibling] with allergic disease). Current evidence does not support a major role for maternal dietary restrictions during pregnancy or lactation. There is evidence that breastfeeding for at least 4 months, compared with feeding formula made with intact cow milk protein, prevents or delays the occurrence of atopic dermatitis, cow milk allergy, and wheezing in early childhood. In studies of infants at high risk of atopy and who are not exclusively breastfed for 4 to 6 months, there is modest evidence that the onset of atopic disease may be delayed or prevented by the use of hydrolyzed formulas compared with formula made with intact cow milk protein, particularly for atopic dermatitis. Comparative studies of the various hydrolyzed formulas also indicate that not all formulas have the same protective benefit. There is also little evidence that delaying the timing of the introduction of complementary foods beyond 4 to 6 months of age prevents the occurrence of atopic disease. At present, there are insufficient data to document a protective effect of any dietary intervention beyond 4 to 6 months of age for the development of atopic disease. *Key Words:* atopy • food allergies • breastfeeding • complementary foods • hydrolyzed formula • atopic dermatitis • asthma 1. At the present time, there is lack of evidence that maternal dietary restrictions during pregnancy play a significant role in the prevention of atopic disease in infants. Similarly, antigen avoidance during lactation does not prevent atopic disease, with the possible exception of atopic eczema, although more data are needed to substantiate this conclusion. 2. For infants at high risk of developing atopic disease, there is evidence that exclusive breastfeeding for at least 4 months compared with feeding intact cow milk protein formula decreases the cumulative incidence of atopic dermatitis and cow milk allergy in the first 2 years of life. 3. There is evidence that exclusive breastfeeding for at least 3 months protects against wheezing in early life. However, in infants at risk of developing atopic disease, the current evidence that exclusive breastfeeding protects against allergic asthma occurring beyond 6 years of age is not convincing. 4. In studies of infants at high risk of developing atopic disease who are not breastfed exclusively for 4 to 6 months or are formula fed, there is modest evidence that atopic dermatitis may be delayed or prevented by the use of extensively or partially hydrolyzed formulas, compared with cow milk formula, in early childhood. Comparative studies of the various hydrolyzed formulas have also indicated that not all formulas have the same protective benefit. Extensively hydrolyzed formulas may be more effective than partially hydrolyzed in the prevention of atopic disease. In addition, more research is needed to determine whether these benefits extend into late childhood and adolescence. The higher cost of the hydrolyzed formulas must be considered in any decision-making process for their use. To date, the use of amino acid–based formulas for atopy prevention has not been studied. 5. There is no convincing evidence for the use of soy-based infant formula for the purpose of allergy prevention. 6. 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. 7. For infants after 4 to 6 months of age, there are insufficient data to support a protective effect of any dietary intervention for the development of atopic disease. 8. Additional studies are needed to document the long-term effect of dietary interventions in infancy to prevent atopic disease, especially in children older than 4 years and in adults. 9. This document describes means to prevent or delay atopic diseases through dietary changes. For a child who has developed an atopic disease that may be precipitated or exacerbated by ingested proteins (via human milk, infant formula, or specific complementary foods), treatment may require specific identification and restriction of causal food proteins. This topic was not reviewed in this document." 2010/2/11 Nikki Lee <[log in to unmask]> > Dear Friends: > > A comment was made in the last digest about expecting infants to terminate > exclusive breastfeeding at 6 months. > > The AAP policy says "about 6 months"......some babies are ready for solids > sooner, and some later. > > warmly, > > -- > Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI > craniosacral therapy practitioner > www.breastfeedingalwaysbest.com > > *********************************************** > > Archives: http://community.lsoft.com/archives/LACTNET.html > To reach list owners: [log in to unmask] > Mail all list management commands to: [log in to unmask] > COMMANDS: > 1. To temporarily stop your subscription write in the body of an email: set > lactnet nomail > 2. To start it again: set lactnet mail > 3. To unsubscribe: unsubscribe lactnet > 4. To get a comprehensive list of rules and directions: get lactnet welcome > -- Lactatiekundig en Voedingskundig Advies Ir. Marijke Frings Laurenburg 229 6006 GR Weert Mobiel: 06 4086 5578 e-mail: [log in to unmask] *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome