Filling the Nutritional Gaps for Babies With Food Allergies

When your baby has a food allergy or digestive condition that means cutting certain foods out of their diet, they may get fewer of certain nutrients they need for proper growth and development as a result. But with the right monitoring and intentional nutritional replacements, your food-restricted baby can continue to thrive.

Signs of Deficiencies

The best way to know if your baby is getting the nutrition they need is by keeping up with regular checkups with your pediatrician, who looks for all the markers of proper development.

“Growth parameters are routinely recorded and tracked by your health care team using growth curves for weight, length, and head circumference,” says Michael Pistiner, MD, director of food allergy advocacy, education and prevention at MassGeneral Hospital for Children.

If your pediatrician suspects any delays in your baby’s progress, they can make dietary suggestions to help bump up any shortages they suspect. They may also recommend you work with more nutritional support, like a registered dietitian. 

“The first year is an important time for neurodevelopment and growth,” says Pistiner, who’s also a spokesperson and member of the Medical Scientific Council of the Asthma and Allergy Foundation of America (AAFA). “Poor growth, including poor weight gain, can be a sign of poor nutrition.”

Your doctor may also order blood tests to look for levels of certain nutrients. You may see physical changes from low levels in certain nutrients, he says.

“Iron and B12 deficiency can cause anemia that presents as paleness and irritability,” he says. “Vitamin D deficiency causes rickets that presents as bone abnormalities like bowing of legs, frontal bossing, and poor growth; and calcium deficiency can cause issues with bone health called osteomalacia, potentially causing bone pain and increasing the chance of fractures.” 

Without enough zinc, your baby’s body will have a harder time healing wounds. Low vitamin A levels can cause cloudy corneas. 

Before Solids

The American Academy of Pediatrics recommends starting babies on solid foods around 6 months old. That means in the first half-year of your baby’s life, all their nutrition will come from breast milk or formula (or both). 

It’s extremely rare for a baby to be allergic to or be unable to drink their mother’s milk. If your baby has a reaction from breastfeeding, it’s most likely due to small proteins that have passed into the breast milk from the mother’s diet. Eliminating the food or food group from the mom’s diet can often take care of the problem and your baby can continue to breastfeed. 

Of course, breastfeeding isn’t possible for every mom and baby pair. For babies with a milk allergy or digestion issue, this means using special hypoallergenic formulas with the milk proteins already broken down so the baby’s system doesn’t recognize them as an allergen and can digest them easier. These formulas are either extensively hydrolyzed or elemental, which is the gentlest form of formula with proteins broken all the way into amino acids.

Hypoallergenic formulas meet all the American Academy of Pediatrics requirements for nutrients for infants. Your baby should be getting all the nutrition for proper growth and development if they’re on them. 

“Extensively hydrolyzed formulas and elemental formulas offer comparable nutrient profiles, and most are supplemented with micronutrients including choline, an important micronutrient also found in breast milk, and others,” says Pistiner.

Common Allergens and Their Nutrients

Babies older than 6 months who start solids may start having allergies to other food groups. In addition to milk, the most likely culprits include:

EggsPeanutsTree nutsSoyWheatFish/shellfish

All of these food groups provide specific dietary needs. If you’re cutting one or more out, your pediatrician or pediatric dietitian can help you make certain substitutes to up your baby’s levels of the nutrition they’re missing.

Dairy. Dairy foods give your baby stores of protein, calcium, riboflavin, phosphorus, and vitamins A, D, and B12. Foods that can fill in for these nutrients include protein sources such as:

MeatFishPoultryLegumesEggs

And to bump up missed calcium, try:

Leafy greens Calcium-fortified foods

Until your baby turns 1, Pistiner says you should skip the alternative milks. 

“Plant-based milk alternatives like almond, rice, coconut milk should not be used as a beverage in the first year of life,” he says. Also, be aware that 50% of infants with cow’s milk allergies are also allergic to soy, so use caution in dairy-allergic kids over 1.

Other allergen-likely foods provide these nutrients:

Eggs. Protein, iron, biotin, folacin, riboflavin, and vitamins A, D, E, and B12.

Nutritional substitutes: Meats, fish, poultry, legumes, dairy, fruit, vegetables, leafy greens, enriched grains.

Soy. Protein, thiamin, riboflavin, iron, calcium, zinc, and vitamin B6.

Nutritional substitutes: Meats, fish, poultry, legumes, eggs, dairy, fruit, vegetables, leafy greens, enriched grains.

Wheat. B vitamins and iron.

Nutritional substitutes: Rice, corn, oats, barley, buckwheat.

Peanuts and tree nuts. Protein, vitamins, minerals

Nutritional substitutes: Meats, fish, poultry, eggs, dairy, fruit, vegetables, enriched grains.

Fish and shellfish. Protein, niacin, vitamins B6, B12, A, and E.

Nutritional substitutes: Meats, poultry, eggs, dairy, fruit, vegetables, and enriched grains.

The foods you choose to help fill in gaps in your child’s diet will depend on other allergies they have. You should always run dietary changes by your pediatrician to be sure your baby is well-nourished.

“Work with your health care team to know what it is that you need to avoid, and then work with them to otherwise keep the diet as broad as possible,” says Pistiner. “Include foods that may contain micronutrients and vitamins commonly found in the foods that need to be excluded.” 

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