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Introducing new foods: what, when and how

Current guidance

Although a number of guidelines have been published on the management of CMA,1–3 there is a scarcity of data on weaning food-allergic infants. Publications from expert bodies on weaning healthy infants and those at high risk of developing allergy4–9 are used to provide guidance on weaning infants with CMA.

  • There is no evidence that delaying introduction of complementary foods beyond 6 months has a protective effect against allergy10
  • Therefore, in line with WHO guidelines for healthy children, infants with CMA should ideally be weaned at 6 months of age (prior to which they should ideally be exclusively breastfed)4,5
  • If weaning is started sooner, it should not commence before age 4 months6–8,11

The role of breast milk and/or hypoallergenic formula in maintaining key nutrients

Breast milk and/or hypoallergenic formula continue to play important roles as major sources of nutrients during weaning.

An eHF such as Nutramigen LIPIL remains the first-line choice for formula-fed infants with mild-to-moderate CMA, whereas an AAF such as Nutramigen PURAMINO should be used for severe CMA and multiple food allergies.1,3 Learn more

  • Although a baby’s intake of breast milk and/or hypoallergenic formula may decrease during weaning, formula-fed infants should ideally receive 500–600 ml (17–20 oz) per day.12
  • Follow-on formulas suitable from 6 months, such as Nutramigen LIPIL 2, are tailored to meet the needs of older babies, with more calcium and other nutrients to complement a weaning diet.


When should potentially allergenic foods be introduced?


Aside from cow’s milk, the foods that most commonly evoke an allergic reaction include egg, soy, wheat, fish, ground nuts and tree nuts.13

  • The most recent recommendations state that there is no convincing evidence that delaying introduction of these foods has a protective effect against allergy.6–8

  • Therefore, the introduction of potentially allergenic foods should start as for healthy children, at 6 months of age (but not before),12,14 though they should be introduced with caution. Learn more

Show references
  1. Du Toit G, Meyer R, Shah N et al. Identifying and managing cow's milk protein allergy. Arch Dis Child Educ Pract Ed 2010;95:134-44.

  2. Fiocchi A, Brozek J, Schunemann H et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines. World Allergy Organization Journal 2010;3:57-161.

  3. Vandenplas Y, Koletzko S, Isolauri E et al. Guidelines for the diagnosis and management of cow's milk protein allergy in infants. Arch Dis Child 2007;92:902-8.

  4. World Health Organization. Guiding principles for complementary feeding of the breastfed child. 2003.

  5. World Health Organization. Guiding principles for feeding non-breastfed children 6-24 months of age. 2005.

  6. Agostoni C, Decsi T, Fewtrell M et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2008;46:99-110.

  7. Greer FR, Sicherer SH, Burks AW. 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. Pediatrics 2008;121:183-91.

  8. Host A, Halken S, Muraro A et al. Dietary prevention of allergic diseases in infants and small children. Pediatr Allergy Immunol 2008;19:1-4.

  9. Muraro A, Dreborg S, Halken S et al. Dietary prevention of allergic diseases in infants and small children. Part II. Evaluation of methods in allergy prevention studies and sensitization markers. Definitions and diagnostic criteria of allergic diseases. Pediatr Allergy Immunol 2004;15:196-205.

  10. Thygarajan A, Burks AW. American Academy of Pediatrics recommendations on the effects of early nutritional interventions on the development of atopic disease. Curr Opin Pediatr 2008;20:698-702.

  11. British Dietetic Association Paediatric Group. Position statement: Weaning infants onto solid foods. 2011.

  12. Department of Health. Weaning booklet: Starting solid food. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4117080 [Last accessed October 2012].

  13. Venter C, Pereira B, Voigt K et al. Prevalence and cumulative incidence of food hypersensitivity in the first 3 years of life. Allergy 2008;63:354-9.

  14. NHS. Information book: Birth to Five. 2009.

  15. Food Standards Agency. Peanuts during pregnancy, breastfeeding and early childhood. http://www.food.gov.uk/safereating/allergyintol/peanutspregnancy [Last accessed August 2012].