Delayed Introduction of Solid Foods: The Introduction of Allergenic Foods and the Development of Reported Wheezing and Eczema in Childhood: The Generation R Study

Here’s the summary of a nice study that shows what I’ve been saying for a while.  Delaying foods doesn’t affect whether or not your child will have allergies.

Delayed Introduction of Solid Foods: The Introduction of Allergenic Foods and the Development of Reported Wheezing and Eczema in Childhood: The Generation R Study. (I’ve copied the full text at the bottom of this article)

What I find interesting from this Dutch study, is how high of a percentage (over 30%) of 2 year olds had wheezing or eczema.  Even more surprising is that nearly half had a parent with a “history of atopic disease” (that is allergies, asthma, eczema, hives, etc).  So what else is in our environment causing all these symptoms?  Since there is a lower percentage in older kids maybe it’s the diapers?  That doesn’t explain what is happening in the parents though.  Maybe the diapers from their youth, or other exposures were even more toxic?
One study I often tell parents about showed that kids raised in the country, who are exposed to more dirt, animal gunk, and nature in general, have less allergy symptoms.
Please comment, why do you think there are more allergic symptoms seen in our modern world?

Here’s a copy of the summary from Medscape:
The Introduction of Allergenic Foods and the Development of Reported Wheezing and Eczema in Childhood: The Generation R Study

Tromp II, Kiefte-de Jong JC, Lebon A, et al.
Arch Pediatr Adolesc Med. 2011;165: 933-938
Study Summary

Background. Parents give many reasons for delaying the introduction of complementary foods to a diet of breast milk or infant formula, including concerns about increased risk for early excessive weight gain, development of allergic sensitivity to the foods, and autoimmune diseases such as diabetes or celiac disease. Pediatric professional organizations generally recommend delaying the introduction of solid foods until the child is at least 4 months of age, with some recommending delaying these foods until the child is 6 months of age. Data about whether the early introduction of solid foods elevates the risk for allergies or other food sensitivities are conflicting.

Methods. This study evaluated the results of a generational cohort study from The Netherlands that followed more than 7000 infants and mothers who delivered their infants between 2002 and 2006. The goal was to determine whether the timing of introduction of allergenic foods such as cow’s milk, eggs, peanuts, tree nuts, soy, and gluten was associated with eczema and wheezing through the fourth year of life. The investigators also conducted subgroup analysis looking at children with and without a history of allergy to cow’s milk demonstrated during the first year of life and subgroup analysis comparing children with and without a parental history of atopic disease. The outcomes were assessed when the children were ages 2, 3, and 4 years, using questionnaires completed by their parents.

Approximately two thirds of the cohort parents responded at each of the survey points. Data on food introduction was obtained during visits when the child was between 6 and 12 months old, again collected by parental report on a questionnaire. Parents were asked about the age when they first introduced each of the allergenic foods. When children were between 6 and 12 months of age, parents again completed a short food frequency questionnaire.

The analyses controlled for appropriate covariates including gender, gestational age, maternal sociodemographic factors, and family history of allergic diseases. The investigators were also able to control for illnesses experienced by the child. Finally, breastfeeding was divided into 6 different categories ranging from children who were “never” breastfed to children who were “exclusively breastfed” through at least 4 months of age. Data were obtained on whether the child had ever been seen by a physician for cow’s milk allergy. The 2 main outcomes of interest were whether the child experienced eczema or wheezing, and the authors created prediction models for children experiencing either of those at age 2, 3, or 4 years.

Findings. The investigators stratified analyses by both cow’s milk allergy and parental history of allergic disease. There were 6905 children in the analysis cohort. At 2 years of age, 31% of the children had experienced wheezing and 38% had experienced eczema. At 3 years of age, 14% of the children reported wheezing and 20% reported eczema. At 4 years of age, 14% of the children had experienced wheezing and 18% had experienced eczema. Almost half (47%) of the children had a parent with a history of atopic disease. With respect to breastfeeding, 11% of the children had never been breastfed, whereas approximately 24% had been exclusively breastfed to at least 4 months. No respiratory illnesses at 12-24 months of life were reported by 48%. Three quarters of the children were in daycare during the second year of life.

When looking at the outcomes of wheezing and eczema, the introduction of allergenic foods at ≤ 6 months of age was not associated with the likelihood of wheezing or experiencing eczema at either 2, 3, or 4 years of life. Wheezing and eczema were both more likely in children who experienced cow’s milk allergy or who had a parental history of atopic disease, but introduction of allergenic foods before 6 months of life was not associated with either outcome in the stratified analyses. The investigators concluded that their data do not support delayed introduction of allergenic foods until after 6 months of age for the prevention of either wheezing or eczema.
Viewpoint

The discussion section of this article reviews additional cohort studies that had very similar findings. It appears that the bulk of evidence suggests that delayed introduction of allergenic foods, even among those felt to be atopic prone, does not provide protection against the development of atopic illness. It will be interesting to see how long it takes for general practice to evolve, but the building data suggest that we should reconsider feeding recommendations, at least as they pertain to allergy.

 

 

 

 

Sleeping on the Road

We are trying out traveling with him internationally. Yes we are brave. So much for routines. One good thing is he recognizes his bedtime cues. We brought a favorite blanket (even though it’s 90 degrees and humid!), a favorite bedtime book-The Very Busy Spider, and the portable playpen from grandma’s house. So after the days adventures, he is getting to sleep ok, albeit initially in our bed. I’m sure we could get him down in his own playpen after a bit of protest, but the hotel neighbors aren’t enjoying the protest.
We are hoping everything will be back to normal when we get back to home. If he can get off schedule that quickly, he should be able to get on schedule quickly too. (I will comment below when we get back to follow up.) As a rule of thumb, for medical problems, I tell parents, anything that makes them sick quickly tends to heal just as quickly. Unfortunately, things with a slow onset tend to take awhile to cure as well. I think that will pan out for behavioral issues as well.
Anyway, it’s time to get back to preparing my lecture (We are traveling so I can do some volunteer medical teaching in Nicaragua. If you want to learn more about our “teach a man to fish” efforts, check out Health Volunteers at www.HVOusa.org )

How to Clean your House, and Kill Pests without Killing Your Child

Want to know how to keep pests out of your house without exposing your child to toxins?  Here are some handy hints http://www.environmentalhealth.org/EHC_Misc_Archive/fs-homeclean.html from the Environmental Health Coalition of San Diego. 

It’s nice because they are not trying to sell you their latest greatest version of a natural product. It also has lots of great ideas, that are mostly common sense, on preventing insects in the first place.

I liked the hint to avoid ants around dog bowls by making a soapy moat, even though my wife says she invented that for her 5th grade science project (any Intellectual Property lawyers reading my blog?).

A good rule of thumb:If you don’t like the fumes, it’s probably not good for your child.

Attitude of Gratitude Happy Thanksgiving

Gratitude Attitude

This week, my bosses ex died suddenly at home with his kids there.  My mother, who has been scared to drive her Prius, switched to driving her husband’s larger car to be safer.  She was the front of a 3car pile up on the freeway.  Fortunately, my mother and sister who was also in the car, are overall okay.

It may be cliche, but Thanksgiving is a time to remember, you never know what life may bring, so make the most of it.  Most of all appreciate what you do have.  I avoid wasting energy worrying about the bad and I focus on the good.  It’s my Attitude of Gratitude.  

Every country has holidays celebrating various victories, and independence.  This day, the  United States of America commemorates finding common ground with Native Americans, where we learned to share a land we all appreciated.  We commemorate it, and title it, as a day of giving thanks for all we have.  I am grateful for those moments when our opposing political parties find common ground and we progress as a nation.

On Thanksgiving, my amazing partner and I were also married.  Our lives together, have built on this attitude of Gratitude that we will instill in our son.
Every night before going to sleep, we say something we are grateful for.  We go to bed grateful and happy.  
When I was a kid, on Thanksgiving my family did “Thankfuls”.  I thought they were weird.  Now every day it is easy for me to seek what is wonderful about my day, my friends, my family, the world, and acknowledge it.  I can’t wait to instill this attitude of gratitude every day in my children.

Happy Thanksgiving.  I am grateful you are interested in what I have to say.  What are you grateful for?

Funny Hospital Story

Some of you may not know about my other blog, and are always asking me about funny hospital stories.
I thought this story about undesirables in the hospital belonged there, since no child was involved.

My only thought as Daddy Dr. is, I will have to remember what parents just went through in the waiting room, just to get to see me in the ER. The Hospital Chapel in the little story is just around the corner from the ER in that hospital.

Where do babies come from? (Wanna’ Screw?)

Pre-schoolers come up with some very funny things to say, and are a constant source of entertainment.

Recently I saw an adorable little 3 year old girl in the pediatric urgent care who had swallowed a small screw.
These are her xrays (I have a signed consent on file to publish her story and the image, Mr. HIPAA Policeman).

Swallowed Baby Screw

Where Baby's Come From

Why did she swallow the screw? The child explained “Mommy, it’s a baby screw and babies have to go in your tummy!” Mom is pregnant, and has been preparing her for the new sibling.

Swallowed screw

Inverted image of screw in belly

 

Isn’t that adorable? How do you argue with that?

Well you have to argue with that, before she swallows any more babies! I am excited about (and fearing) what my creative new little guy is going to come up with. …And with what he is going to swallow.

Happy Father’s Day

I thought I would get to sleep in as a special father’s day gift. Nope. I have now discovered the new joy of waking up to your child in your bed, and he’s not even a year old. He’s not doing the “Daddy, Daddy, Daddy!” yet. He does stick his little hand out and pat me on the back to get my attention while he’s laying between us nursing. And then he smiles so big when I open my eyes from a deep sleep and look at him finally.
That is a joy that anyone who’s had a child can understand, but once you are a father…wow.
When I look at my son, I think about the joy my dad must have had looking at me. I still catch him looking at me that way.
So Happy Father’s Day to all the daddies out there.

What fond memories do you have of your father?

Good News!

I just finished a rant on the benefit of immunizations. So I thought it was time for something more upbeat.

My life is better by surrounding myself with positivity and avoiding the negativity. My family does not watch the sensationalized, negativity saturated news. Don’t let your children watch the news! The world is not the evil, dangerous place they make it out to be.

Instead check this out: http://www.happynews.com/

Boy’s Will Be Boys

So Daddy is back from a week long work trip on the pediatric ward up North in Central California.  It has been a nice 5 long weeks since I’ve had to travel.  We figured out, that besides when he was born and I was home 7 weeks, that’s a record since we’ve been together!

After starting Pediatric training over 15 years ago, I learned one thing about naked baby boys.  They will aim and fire at will.  (I’m not sure if that ends at babyhood!).   I’ve been exceptional in my Pediatric career at not getting hit by baby pee.  Although parents always amusingly (and proudly?)  share with me that their sons “Peed all over the scale” as my wife did after my son’s first pediatric visit.  They smile even wider when their son “Peed all over the nurse”.

Yet I’ve once again learned, years of knowledge, do not replace experience.  Right after a shower, when I stopped to send a nice pic to Mommy…he shot the cannon.  Twice.  The second to last pic is the look of shock on his face after he’s peed on it.  The last one is his amusement at my amusement.  Who wouldn’t be amused to see pee all over their (freshly showered) son’s face?!

The life of the patient

I write this blog, because I am now the patient’s family.  I write it to help physician’s remember medical advice, is just that, advice.  When it comes to actually executing all that wonderful advice, I’m finding, it’s much easier said than is done.

My other aim is to now give that advice, as a parent, in a different way then I gave it, when I didn’t get to actually try these things out.

As a friend said, empathy has given way to sympathy now.

I am writing today’s entry after watching a friend’s video about a day in her life.  She is about to turn 50.  What makes her life relevant here is that she is surviving a “childhood” illness, cystic fibrosis.  When I started my residency, the average lifespan of people with CF was just getting into the early 20′s.  Now with modern advancements in caring for this disease, the average age is 35!   She is an inspiration that fights hard to beat the odds.  Every day.  Every minute.

Here is her video she made in celebration of her birthday.  It shows some of the reality of living with this disease.  When I prescribe this treatment and that treatment, this med and that med, I will remember watching this and what it’s like to execute medical regimens. 

Heck, I even have a hard time putting sun screen on my baby!  If I put it on his hands, he’ll eat it.   I never thought about that!