Make Every Bite Count – Information & Resources for Healthcare Professionals to Share with New Parents

M Pulse 1125x1125

Make Every Bite Count:

Information & Resources for Healthcare Professionals to Share with New Parents

Katie Hayes, RDN

Eggs Across the Lifespan

Nutritious Dietary Patterns

At the Egg Nutrition Center, we commend Healthcare Professionals (HCPs) and their unwavering commitment to science as they make practical recommendations to their patients and clients. Staying abreast of current evidence is critical as HCPs craft their guidance and education. 

In order to help HCPs offer their patients and clients comprehensive information on eggs as a first food for growth and development, allergy risk reduction, and feeding tips, we created “Make Every Bite Count” booklets (download here) and a poster (download here) that can be printed and shared. Why is this information important to share with parents and caregivers? Keep reading! 

The newly released 2020-2025 Dietary Guidelines for Americans include recommendations for birth to 24 months old, and specifically recommend eggs as an important first food for infants and toddlers, as well as for pregnant women and lactating moms.1 This historic recommendation, coupled with the evolving evidence about infant feeding and allergen guidance from the American Academy of Pediatrics, arms practitioners with a clear message, “Parents can make every bite count by feeding eggs as a fundamental first food.”

In 2019, the American Academy of Pediatrics (AAP) updated their policy on the introduction of potentially allergenic complementary foods. Feeding common food allergens, such as eggs, when a baby is developmentally ready (between 4-6 months) may actually reduce the chances of developing an allergy to that food.2

Additionally, in their 2018 policy statement advocating for improving nutrition in the first 1,000 days, the AAP stated: “Although all nutrients are necessary for brain growth, key nutrients that support neurodevelopment include protein; zinc; iron; choline; folate; iodine; vitamins A, D, B6, and B12; and long-chain polyunsaturated fatty acids. Failure to provide key nutrients during this critical period of brain development may result in lifelong deficits in brain function despite subsequent nutrient repletion.”3

Eggs are affordable, accessible, and versatile. Eggs contain various amounts of all the nutrients listed by the AAP as essential for brain growth, including being an excellent source of choline, which plays a vital role in neurocognition during the first 1,000 days of life. With 90% of brain growth happening before kindergarten, eggs help make every bite count, especially when babies are just being introduced to solid foods. These recommendations confirm what the science has shown: eggs provide critical nutritional support for brain health, and they play a crucial role in infant development and prenatal health. Just one large egg provides the daily choline needs for babies and toddlers, and two large eggs provide more than half of daily choline needs for lactating moms.

Eggs are a nutrient-dense powerhouse. They provide an excellent source of vitamin B12, biotin, iodine, selenium, and choline; a good source of high-quality protein, riboflavin, and pantothenic acid; as well as the carotenoids lutein and zeaxanthin.4

For more information and shareable handouts, videos, and more visit our materials page

  1. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2020-2025 Dietary Guidelines for Americans. 9th Edition. December 2020. 
  2. Greer, F.R., S.H. Sicherer, and A.W. Burks, The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods. Pediatrics, 2019. 143(4).
  3. Schwarzenberg SJ, Georgieff MK. Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Pediatrics, 2018. 141(2)
  4. U.S. Department of Agriculture and Agricultural Research Service. FoodData Central. 2019; Available from: https://fdc.nal.usda.gov/index.html. 

More Articles You’ll Love

Free Webinar: Every Bite Counts – Nutrition During Pregnancy and Birth to 24 Months

D Every Bite Counts Webinar 2098x963

Mickey Rubin, PhD

Nutrients in Eggs

Nutritious Dietary Patterns

To view the recorded webinar click here.

Continuing education certificate can be found here.

The 2020 Dietary Guidelines Advisory Committee Scientific Report includes for the first time dietary guidance for women who are pregnant and infants and toddlers from birth to 24 months of age, highlighting the importance of optimal nutrition during these life stages. Health professionals play a critical role in educating expectant mothers and the parents, guardians and caregivers that help shape dietary intake during for the first few years of life. This webinar will equip health professionals with clear and practical guidance for educating these groups on the latest research and key dietary recommendations from the Scientific Report.

After attending this webinar, the attendee will be able to:

  • Identify important nutrients and foods during pregnancy and birth to 24 months
  • Explain the importance of introducing potentially allergenic foods early and often
  • Describe practical ways to close nutrient gaps during pregnancy and birth to 24 months

This webinar has been approved by CDR for:
1.0 CEU

More Articles You’ll Love

Early Introduction of Eggs May Reduce the Risk of Developing an Egg Allergy

PB Oatmeal 12

Early Introduction of Eggs May Reduce the Risk of Developing an Egg Allergy

Jen Houchins, PhD

Allergies

Previous recommendations for infant feeding included guidance to avoid early introduction of eggs and allergenic foods in the diet for both the infant1 and mother.2 However, science has advanced, and early life feeding recommendations are rapidly changing.  The 2020 Dietary Guidelines Advisory Committee (DGAC) evaluated evidence for complementary feeding, and allergy experts chimed in with the latest scientific evidence.3 The Advisory Committee affirmed that current research indicates that introducing peanut and egg, in an age-appropriate form, in the first year of life (>4 months) may reduce the risk of allergy to peanut and eggs. For other type of potentially allergenic foods, the DGAC reported there is no evidence that avoiding such foods in the first year of life is beneficial.


LATEST RECOMMENDATIONS FOR EARLY INTRODUCTION

The Advisory Committee recommends that caregivers provide a variety of animal-source foods (meat, poultry, seafood, eggs, and dairy), fruits, and vegetables, nuts and seeds, and whole grain products, beginning at ages 6 to 12 months in order to provide essential nutrients, develop acceptance of nutrient-rich foods, and help build lifelong dietary habits.  Additionally, early introduction of peanuts and eggs has the potential to favorably influence risk of allergy to these foods.

According to a recent systematic review conducted for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 months project, “…there is evidence to suggest that introducing allergenic foods in the first year of life (>4 months) does not increase risk of food allergy or atopic dermatitis but may prevent peanut and egg allergy…Moderate evidence suggests that introducing egg in the first year of life (>4 months) may reduce the risk of food allergy to egg.”4 This conclusion aligns with the American Academy of Pediatrics’ Clinical Report on early nutritional interventions, which states, “There is no evidence that delaying the introduction of allergenic foods, including peanuts, eggs, and fish, beyond 4 to 6 months prevents atopic disease.”5 A recent analysis of the Enquiring About Tolerance (EAT) randomized controlled trial found “early introduction was effective in preventing the development of food allergy in specific groups of infants at high risk of developing food allergy…Of equal importance was that early introduction of allergenic foods into the diets of the non-high-risk infants was not associated with any increased risk of food allergy.”6   High risk infants in this study were identified as those with visible eczema at enrollment and infants with food sensitization (IgE antibodies present to one or more of the six allergenic foods).  In this secondary analysis, early introduction of egg reduced the risk of allergy for both infants sensitized to egg and for those who had moderate to severe eczema at enrollment.  Food Allegy Research and Education (FARE) has also commented on this new study, and suggests, “Guidance on early egg introduction is likely to evolve as more evidence becomes available.”


BAKED EGGS ARE TOLERATED BY MANY CHILDREN WITH EGG ALLERGY

In the U.S., approximately 1% of all children, and about 12% of children with food allergies are allergic to eggs.7  Egg allergies are considered to have a high rate of resolution in childhood, with approximately 50% of children with egg allergy reaching tolerance between the ages of 2-9 years.8,9

Of significant interest, it has been observed that approximately 70% of children with egg allergy can tolerate extensively baked egg in foods like muffins or cakes (as opposed to lightly cooked eggs like scrambled or French toast).9-11 Several studies have suggested that introduction of baked egg in the diet of children who can tolerate these foods may help hasten resolution of allergy,9-11  with some data showing frequent ingestion increases the likelihood of tolerance compared to infrequent ingestion.12

Although these are promising observations, many of these recent studies lack adequate control groups, limiting conclusions of the impact of extensively baked egg on allergy progression or development of tolerance.11 So, while more research is needed to better understand the role of baked eggs to potentially alter the course of egg allergy, “…inclusion of egg and milk in its baked form may also have other benefits.  It is reasonable to expect that liberation of the diet may boost nutrition, improve the child and family’s quality of life and reduce family anxiety, however, no studies have specifically investigated this.”11 Importantly, caregivers of children with egg allergy should consult the child’s physician before introducing extensively baked egg into the child’s diet.


ADDITIONAL BENEFITS OF EARLY INTRODUCTION

Early introduction of eggs into an infant’s diet has the added benefit that eggs provide various amounts of all nutrients listed by the American Academy of Pediatrics as essential for brain growth.13 Eggs additionally provide 252 mcg of lutein + zeaxanthin, carotenoids with emerging evidence linking to brain development and health.14,15  As a nutrient-rich food that is a good or excellent source of eight essential nutrients, including choline – a nutrient essential for brain development and health, incorporation of eggs into the diet early may not only reduce the risk of food allergy to egg, but also serve as an important food to support brain development. 

Interested in more information?  

Check out these recipes for infants and toddlers:

  1. Zeiger, R.S., Food allergen avoidance in the prevention of food allergy in infants and children. Pediatrics, 2003. 111(6 Pt 3): p. 1662-71.

  2. American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics, 2000. 106(2 Pt 1): p. 346-9.

  3. Spergel, J.M., et al. Public comments to the 2020-2025 Dietary Guidelines Advisory Committee. 2020  1-July-2020]; Available from: https://www.regulations.gov/document?D=FNS-2019-0001-17765.

  4. Obbagy, J.E., et al., Complementary feeding and food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis: a systematic review. Am J Clin Nutr, 2019. 109(Supplement_7): p. 890s-934s.

  5. Greer, F.R., S.H. Sicherer, and A.W. Burks, The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods. Pediatrics, 2019. 143(4).

  6. Perkin, M.R., et al., Efficacy of the Enquiring About Tolerance (EAT) study among infants at high risk of developing food allergy. J Allergy Clin Immunol, 2019. 144(6): p. 1606-1614.e2.

  7. Gupta, R.S., et al., The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States. Pediatrics, 2018.

  8. Sicherer, S.H. and H.A. Sampson, Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol, 2018. 141(1): p. 41-58.

  9. Savage, J., S. Sicherer, and R. Wood, The Natural History of Food Allergy. J Allergy Clin Immunol Pract, 2016. 4(2): p. 196-203; quiz 204.

  10. Nowak-Wegrzyn, A. and A. Fiocchi, Rare, medium, or well done? The effect of heating and food matrix on food protein allergenicity. Curr Opin Allergy Clin Immunol, 2009. 9(3): p. 234-7.

  11. Dang, T.D., R.L. Peters, and K.J. Allen, Debates in allergy medicine: baked egg and milk do not accelerate tolerance to egg and milk. World Allergy Organ J, 2016. 9: p. 2.
  12. Peters, R.L., et al., The natural history and clinical predictors of egg allergy in the first 2 years of life: a prospective, population-based cohort study. J Allergy Clin Immunol, 2014. 133(2): p. 485-91.
  13. Schwarzenberg, S.J. and M.K. Georgieff, Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Pediatrics, 2018. 141(2).
  14. U.S. Department of Agriculture and Agricultural Research Service. FoodData Central. 2019; Available from: https://fdc.nal.usda.gov/index.html.
  15. Johnson, E.J., Role of lutein and zeaxanthin in visual and cognitive function throughout the lifespan. Nutr Rev, 2014. 72(9): p. 605-12.

More Articles You’ll Love

Eggs: An Essential Complementary Food

Jessica Ivey Feeding Baby Article

Eggs: An Essential Complementary Food

Jessica Ivey, RDN, LDN

Egg Allergies

Eggs Across the Lifespan

The Egg Nutrition Center partnered with Jessica Ivey, RDN, LDN to write this blog post.

Some parents are excited to introduce their baby to solid foods, while others find the process nerve-wracking. No matter where they fall on the spectrum, this is an important milestone for baby and can be a fun family experience.

Most babies are ready for complementary foods around 6 months of age. According to the American Academy of Pediatrics, there is not enough information to suggest which foods should be introduced first and in what order, but rather, it’s best to introduce a wide variety of single ingredient foods in any order.1 Different foods contain different nutrients, so a more varied diet will be more nutritionally complete. Also, food and flavor preferences are established early, so exposing infants to many different textures and flavors from an early age can help establish lifelong healthy eating patterns.

Previously parents were told to wait to introduce allergenic foods to their infants, especially if there was a family history of food allergies. But groundbreaking research2,3 has found that early introduction of potential allergens, including eggs, to an infant around 6 months of age helps to reduce the likelihood of developing an allergy to that food.

When considering first foods, parents should choose nutrient-rich foods with essential nutrients for growth and development. Eggs are a good or excellent source of eight essential nutrients, including choline and lutein, nutrients that are important for brain development, learning, and memory. Plus, eggs have all of the nutrients that the American Academy of Pediatrics lists as key nutrients that support neurodevelopment – which are protein, zinc, iron, choline, folate, iodine, vitamins A, D, B6 and B12, and long-chain polyunsaturated fatty acids.4

There are several ways to incorporate eggs into an infant’s diet. Here are some ideas to consider:

If parents are having trouble getting their child to try new foods, remember that many babies and toddlers need to be exposed to the same foods multiple times before accepting them. Encourage parents to keep offering nutrient-dense foods, like eggs, and eat nutritious foods themselves! Babies and toddlers are more likely to try foods that they see their peers, siblings, and parents eating.

More Articles You’ll Love

Free Webinar: Leaping Past Food Allergies

M Webinar Food Allergies 1125x1125

Free Webinar: LEAPing Past Food Allergies

How and When to Introduce Potential Allergens

Mickey Rubin, PhD

Egg Allergies

To view the recorded webinar click here.

Continuing education credits can be claimed by completing the evaluation which can be accessed here. Continuing education certificates can be found at the end of the survey.

Reported food allergies have been on the rise for the last decade. Groundbreaking findings from research led to new guidelines recommending early introduction of peanut foods in infancy to reduce the risk of peanut allergies. But what about other allergens such as egg, milk, and fish? Join internationally recognized researcher and pediatric allergist, Dr. Gideon Lack, and food allergy expert, Sherry Coleman Collins, MS, RDN, to review the latest science and feeding recommendations for reducing the risk of food allergies.

After attending this webinar, the attendee will be able to:

• Describe the latest science and feeding recommendations for reducing the risk of food allergies.
• Utilize the latest research to guide patients and clients on when and how to introduce common allergens, including peanuts, eggs, and others.
• Incorporate the latest National Institute of Allergy and Infectious Disease (NIAID) and American Academy of Pediatrics (AAP) guidelines on infant feeding practice into their patient and client education and counseling.

This webinar has been approved for:
1.0 CEU
1.0 AAPA Category 1 CME*

*This activity has been reviewed by the AAPA Review Panel and is compliant with AAPA CME Criteria. This activity is designated for 1 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation

More Articles You’ll Love

Baby-Led Weaning: A Fresh Approach to Starting Solids

M Baby Led Weaning A Fresh Approach 1125x1125

Baby-Led Weaning: A Fresh Approach to Starting Solids

Diana K. Rice, RD, LD

Egg Allergies

Featured article in the Fall 2018 Issue of Nutrition Close-Up; written by Diana K. Rice, RD, LD

What infants eat in their first few months of life is critical.

Around six months old, breast milk and formula are no longer sufficient to meet an infant’s increasing nutritional needs. In particular, the nutrients needed for cognitive development including iron, zinc, choline and docosahexaenoic acid (DHA) must start to come from solid foods.We also now know that early exposure to common allergens including eggs and peanuts can actually help decrease the development of problematic food allergies.2

Although pediatricians once recommended starting with infant cereal at four months old, the World Health Organization and the American Academy of Pediatrics now recommend introducing complimentary foods around six months old. And that infant cereal has fallen out of fashion, too. A method of starting solids called baby-led weaning, in which infants are encouraged to self-feed pieces of whole foods, is rapidly rising in popularity.

The term “baby-led weaning” was coined by British author Gill Rapley, who published a book about letting infants self-feed titled “Baby-Led Weaning” in 2008. The feeding method quickly became popular in Europe and is now catching on in the United States. Parents are drawn to the approach because it prioritizes the consumption of freshly prepared, nutritious foods, encourages autonomy and is convenient.

Still, some worry that foregoing that iron-fortified infant cereal in favor of whole foods like scrambled eggs, avocados and sweet potatoes could result in nutrient deficiencies, or that allowing infants to self-feed could increase their risk of choking. A 2017 study, called The Baby-Led Introduction to SolidS (BLISS) trial, examined these concerns. It found that so long as parents were advised to frequently offer high-iron foods such as meat and egg yolks, the baby-led approach did not increase the risk of either iron or zinc deficiency.3,4 Reassuringly, the study also found that infants in the baby-led group consumed a similar amount of total energy and were no more likely to exhibit growth faltering or experience choking episodes.5

When the right foods are offered, the baby-led approach can easily lead to a more nutritious diet than the traditional spoon feeding method. Commercially prepared baby purees often contain produce and meat, but rarely feature eggs, fish and nuts. Another 2017 study showed that infants given eggs starting at six months old had higher blood concentrations of choline and DHA.6 Waiting to regularly incorporate eggs and other nutritious whole foods into a baby’s diet until he or she is beyond the puree stage could impact the child’s cognitive development and lead to missing a critical window for early allergen exposure. Certainly, parents can prepare their own purees featuring eggs and other nutritious foods, but as the growing popularity and demonstrated safety of baby-led weaning suggests, why bother?

The BLISS study also found that infants in the baby-led group exhibited less food fussiness at age two, which builds on past research demonstrating that regularly providing children with tactile food experiences helps them accept and enjoy new foods.5 So while a puree made with avocado, carrots and egg yolks may be nutritious, it is not a food that a baby is likely to encounter later in life. Offering babies recognizable, nutritious foods in their whole forms early on encourages food acceptance and, importantly, is also convenient for caregivers.

The current research on baby-led weaning shows that the method is indeed safe and effective, but parents and infants will benefit from expert guidance about the process. For instance, parents should be advised to minimize the amount of sodium in the foods they offer and that the first foods should be large and soft so they are easy for the infant to grasp and chew. Perfect examples are slices of a simply prepared omelet, cooked vegetables, ripe fruit and soft meat and fish. To promote iron absorption, parents should also know that iron-rich foods should be offered with a source of vitamin C, which can be as simple as meatballs served in tomato sauce or cooked egg yolks offered alongside kiwi slices.

With baby-led weaning only growing in popularity, healthcare practitioners need to be informed about the method so they can point interested parents toward credible resources, including Rapley’s pioneering book and “Born to Eat” by dietitians Leslie Shilling and Wendy Jo Peterson. Parents will also certainly benefit from a referral to a local practitioner trained in baby-led weaning instruction, such as a member of the International Network of Baby-Led Weaning Dietitians founded by dietitian Jessica Coll (jessicacoll.com/BLW_network.html).

And as for suggestions of the ideal food to start with? Look no further than the nutritious, convenient, soft and squishy little egg.

Diana K. Rice, RD, LD, is known as The Baby Steps Dietitian and is the founder of Diana K. Rice Nutrition, LLC, where she works with families to eat well and reduce the stress surrounding their food choices. She specializes in pre- and postnatal nutrition as well as feeding young children and is a strong advocate for cooking with kids, family meals, and body positivity.

  1. Prado E, et al. Nutrition and brain development in early life. Nutr Rev. 2016;267-284.

  2. Ierodiakonou D, et al. Timing of allergenic food introduction to the infant diet and risk of allergic or autoimmune disease: A systematic review and meta-analysis. JAMA. 2016;316(11).

  3. Daniels L, et al. Impact of a modified version of baby-led weaning on iron intake and status: a randomised controlled trial. BMJ Open. 2018;8(6).

  4. Daniels L, et al. Modified version of baby-led weaning does not result in lower zinc intake or status in infants: A randomized controlled trial. J Acad Nutr Diet. 2018;118(6).

  5. D’Auria E. et al. Baby-led weaning: what a systematic review of the literature adds on. Italian Journal of Pediatrics. 2018Mar;44(1).

  6. Iannotti LL, et al. Eggs early in complementary feeding increase choline pathway biomarkers and DHA: a randomized controlled trial in Ecuador. Am J Clin Nutr. 2017Jan;106(6):1482–9.

More Articles You’ll Love