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. 2023 Oct 16;23(1):514.
doi: 10.1186/s12887-023-04262-0.

Timing of introduction to solid food, eczema and wheezing in later childhood: a longitudinal cohort study

Curtis J D'Hollander  1   2   3 , Charles D G Keown-Stoneman  3   4 , Catherine S Birken  5   6   7   8   9 , Deborah L O'Connor  1   10 , Jonathon L Maguire  11   12   13   14   15 ; TARGet Kids! collaboration
Collaborators, Affiliations

Timing of introduction to solid food, eczema and wheezing in later childhood: a longitudinal cohort study

Curtis J D'Hollander et al. BMC Pediatr. .

Abstract

Background: The timing of introduction to solid food has been associated with eczema and wheezing in childhood. Our aim was to determine whether differences persist within the recommended 4 to 6 month age range.

Methods: A longitudinal cohort study with repeated measures was conducted among children from birth to 10 years of age who were participating in the TARGet Kids! practice based research network in Toronto, Canada. The primary exposure was the timing of introduction to infant cereal as the first solid food. The primary outcome was eczema and the secondary outcome was wheezing collected by parent report using the validated International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Multinomial generalized estimating equations were used and effect modification by family history of asthma and breastfeeding duration were explored.

Results: Of the 7843 children included, the mean (standard deviation) age of introduction to infant cereal was 5.7 (1.9) months. There was evidence for family history of asthma and breastfeeding duration to be effect modifiers in the eczema (P = 0.04) and wheezing (P = 0.05) models. Introduction to infant cereal at 4 vs. 6 months of age was associated with higher odds of eczema (OR 1.62; 95% CI: 1.12, 2.35; P = 0.01) among children without a family history of asthma who were not breastfeeding when solid foods were introduced. Introduction to infant cereal at 4 vs. 6 months of age was associated with a higher odds of wheezing (OR 1.31; 95% CI: 1.13, 1.52; P < .001) among children without a family history of asthma who were breastfeeding when solid foods were introduced. There was little evidence of an association among the remaining strata for either outcome.

Conclusion: The findings of this study support recommendations to introduce solid food around 6 months of age.

Keywords: Allergy; Atopic dermatitis; Atopic disease; Breastfeeding; Eczema; Timing of introduction to solid food; Wheeze.

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Conflict of interest statement

JM has received research funding from the Canadian Institutes of Health Research, Physician Services Inc., Ontario SPOR Support Unit as well as an unrestricted research grant for a completed investigator-initiated study from the Dairy Farmers of Canada (2011–2012) and Ddrops provided non-financial support (vitamin D supplements) for an investigator initiated study on vitamin D and respiratory tract infections (2011–2015).

CB has received research funding from the Canadian Institute for Health Research, Heart and Stroke Foundation of Canada, Physician Services Inc, The Leong Center at the University of Toronto, Centre for Addictions and Mental Health, Ontario Child Health Support Unit (OCHSU) Impact Child Health Award, and a Walmart Community Grant through the SickKids Foundation for a study on food insecurity in the inpatient hospital setting.

CD, CK, and DO have no competing interests to disclose.

Figures

Fig. 1
Fig. 1
Participant flow chart. Legend: Bottom row shows number of children with eczema and/or wheeze. Child considered to be diagnosed with eczema or have wheezing if an affirmative response on the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was provided at any visit. n = 4829 (61.6%) without wheeze or eczema
Fig. 2
Fig. 2
Timing of introduction to infant cereal and probability of eczema and wheezing by family history of asthma and breastfeeding duration. Legend: A-D Non-linear models adjusted for variables described in text. Shaded area shows 95% CI. A Probability of eczema for children without family history of asthma by breastfeeding duration. B Probability of eczema for children with family history of asthma by breastfeeding duration. C Probability of wheeze for children without family history of asthma by breastfeeding duration. D Probability of wheeze for children with family history of asthma by breastfeeding duration
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