Introducing Solid Foods and Breastfeeding with Infants

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Atopic dermatitis (AD) is a chronic, itchy skin condition most commonly diagnosed in infants and young children, with 90% of all cases beginning before age 5. While the exact cause of AD isn’t fully understood, experts have determined that the development of AD occurs due to a combination of factors, including genetic predisposition, environmental factors, and dysfunctions in the skin barrier and the immune system.1,2

Children with AD frequently develop a progression of allergies – the word “atopy” means a genetic disposition to develop an allergic reaction – and have described this progression as the “atopic march.”3 Much research has focused on the potential benefits of breastfeeding, as well as the use of formula and the timing of introducing foods that are common food allergies to infants, to determine how these environmental factors impact the development of AD.

Breastfeeding and atopic dermatitis

Breastfeeding has many benefits for infants. Breastfeeding provides nutritional benefits, boosts the child’s immune system, and has psychological advantages as it promotes bonding between the mother and child. While research has demonstrated that breastfeeding can reduce the risk of many conditions, including ear infections, respiratory infections, and sudden infant death syndrome (SIDS), research on breastfeeding and AD are inconclusive.

Some studies have found that breastfeeding may reduce the risk of the child developing AD, while others have found no such benefit. In assessing the benefits of breastfeeding on AD, researchers have looked at the duration of exclusive breastfeeding as well. While some studies have found exclusive breastfeeding for 3 months provides a benefit in reducing the risk of AD, other studies have found that a combination of breastfeeding and formula feeding for the first 6 months had no difference in the reduction of AD.4-7

Although there is inconclusive data on breastfeeding and AD, there is conclusive research that proves the benefits of breastfeeding, including reducing the risk of allergies and asthma, two conditions that are common in children with AD. Both the American Academy of Pediatrics and the American Academy of Family Physicians recommend that women should breastfeed exclusively for the first 6 months and continue to breastfeed through the first year with complementary foods.6,7

Choosing an infant formula

Although breastfeeding provides the best nutrition as well as other health benefits for infants, it is not always possible. For infants who are fed with formula, either as a supplement to breastfeeding or instead of breastfeeding, hydrolyzed formulas may have a preventive effect on the development of AD. The American Academy of Allergy, Asthma & Immunology (AAAAI) recommends that infants who are at an increased risk of developing AD (those with a first-degree relative with AD) and who are fed with formula should formulas such as:

The American Academy of Allergy, Asthma & Immunology (AAAAI) recommends that infants who are at an increased risk of developing AD (those with a first-degree relative with AD) and who are fed with formula should formulas such as:

  • Partially hydrolyzed whey (Gerber Good Start Gentle)
  • Partially hydrolyzed casein/whey (Enfamil Gentlease)
  • Extensively hydrolyzed casein (Enfamil Nutramigen, Enfamil Pregestimil, or Similac Expert Care Alimentum)3

Introducing common allergenic foods

Because there is a higher risk of developing food allergies in children with AD, researchers have also looked at the effect of when common allergenic foods are introduced to an infant’s diet and AD. Most guidelines from pediatricians suggest that solid foods are introduced at 4 or 6 months of age, when the infant can sit with support and has sufficient neck control. To assess the child’s reaction to a new food, doctors recommend introducing one new food every 3 to 5 days. In this way, if an allergic reaction does occur, it will be easier to identify the allergenic food.3

Foods that are commonly highly allergenic include cow’s milk, eggs, fish, peanuts, soy, tree nuts, and wheat. New research suggests that delaying the introduction of these highly allergenic foods may actually increase the risk of food allergy or eczema, like AD, while early introduction of the highly allergenic foods may prevent food allergy in children. The AAAAI recommends introducing the highly allergenic foods one at a time after a few typical complementary foods have already been introduced. However, whole cow’s milk as an infant’s main beverage should be avoided until the child is one year of age, although cow’s milk in yogurt or cheese can be introduced sooner. In addition, whole nuts are generally discouraged due to a potential choking hazard, although peanut butter or other tree nut butters can be introduced.3

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view references
  1. Lyons JJ, Milner JD, Stone KD. Atopic dermatitis in children: clinical features, pathophysiology, and treatment. Immunol Allergy Clin North Am. 2015;35:161-183.
  2. Tollefson MM, Bruckner AL. Atopic dermatitis: skin-directed management. Am Acad Pediatrics. 2014 Dec;134(6):e1735-1744. doi: 10.1542/peds.2014-2812.
  3. American Academy of Allergy, Asthma & Immunology. Accessed online on 5/16/17 at https://www.aaaai.org.
  4. Yang YW, Tsai CL, Lu CY. Exclusive breastfeeding and incident atopic dermatitis in childhood: a systematic review and meta-analysis of prospective cohort studies. The British Journal of Dermatology. 2009;161(2):373-383. Accessed online on 5/16/17 at http://www.medscape.com/viewarticle/708328.
  5. Blattner CM, Murase JE. A practice gap in pediatric dermatology: does breast-feeding prevent the development of infantile atopic dermatitis? Journal of the American Academy of Dermatology. 2014;71(2):405-406.
  6. American Academy of Pediatrics. Accessed online on 5/16/17 at https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/aap-reaffirms-breastfeeding-guidelines.aspx.
  7. American Academy of Family Physicians. Accessed online on 5/16/17 at http://www.aafp.org/afp/2015/0101/p56.html.
View Written By | Review Date
Emily Downward | June 2017
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