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
>
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