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Table 7 Empiric guidelines for selecting weaning foods in infants with FPIES [1]

From: Food protein-induced enterocolitis syndrome: a review of the new guidelines

Ages and Stages

Lower risk foodsc

Moderate risk foodsc

Higher risk foodsc

4–6 months (as per AAP, CoN)

If developmentally appropriate and safe and nutritious foods are available.

 ➢ Begin with smooth, thin, purees and progress to thicker purees

 ➢ Choose foods that are high in iron

 ➢ Add vegetables and fruits

Vegetables

Broccoli, cauliflower, parsnip, turnip, pumpkin

Squash, carrot, white potato, green bean (legume)

Sweet potato, green pea (legume)

6 months (as per WHO)

Complementary feeding should begin no later than 6 months of age.

 ➢ In the breast fed infant, high iron foods or supplemental iron (1 mg/kg/day) is suggested by 6 months of age.

 ➢ Continue to expand variety of fruits, vegetables, legumes, grains, meats and other foods as tolerated.

Fruits

Blueberries, strawberries, plum, watermelon, peach, avocado

Apple, pear, orange

Banana

8 months of age or when developmentally appropriate.

 ➢ Offer soft-cooked and bite-and-dissolve textures from around 8 months of age or as tolerated by infant.

High iron foods

Lamb, fortified quinoa cereal, millet

Beef, fortified grits and corn cereal, wheat (whole wheat and fortified), fortified barley cereal

Higher iron foods:

Fortified, infant rice and oat cereals.

12 months of age or when developmentally appropriate.

 ➢ Offer modified tolerated foods from the family table-chopped meats, soft cooked vegetables, grains and fruits.

Other

Tree nuts and seed buttersc (sesame, sunflower, etc.)

cThinned with water or infant puree for appropriate infant texture and to prevent choking

Peanut, other legumes (other than green pea)

Milk, soy, poultry, egg, fish

  1. This table should be considered in the context of the following notes:
  2. aExclusive breast feeding until 4–6 months of age and continuing breast feeding through the first year of life or longer as long as mutually desired by both mother and child [17]
  3. bIf an infant tolerates a variety of early foods, subsequent introduction may be more liberal. Additionally, tolerance to one food in a food group (green pea) is considered as a favorable prognostic indicator for tolerance of other foods from the same group (legumes) [18]
  4. AAP, CoN American Academy of Pediatrics, Committee on Nutrition, WHO World Health Organization
  5. cRisk assessment is based on the clinical experience and the published reports of FPIES triggers
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World Allergy Organization Journal

ISSN: 1939-4551

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