Empiric guidelines for selecting weaning foods in infants with FPIES

Ages and stages	Lower risk	Moderate risk	Higher risk
Four to 6 months (as per AAP, CoN): Vegetables 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	Broccoli, cauliflower, parsnip, turnip, pumpkin	Squash, carrot, white potato, green bean (legume)	Sweet potato, green pea (legume)
Six months (as per WHO): Fruit Complementary feeding should begin no later than 6 months of age In the breastfed 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	Blueberries, strawberries, plum, watermelon, peach, avocado	Apple, pear, orange	Banana
Eight months of age or when developmentally appropriate: High-iron foods Offer soft-cooked and bite-and-dissolve textures from approximately 8 months of age or as tolerated by infant	Lamb, fortified quinoa cereal, millet	Beef, fortified grits and corn cereal, wheat (whole wheat and fortified), fortified barley cereal	Fortified, infant rice and oat cereals
Twelve months of age or when developmentally appropriate: Other Offer modified tolerated foods from the family table: chopped meats, soft cooked vegetables, grains, and fruits	Tree nuts and seed butters* (sesame, sunflower, etc)	Peanut, other legumes (other than green pea and green bean)	Milk, soy, poultry, egg, fish

Risk assessment is based on the clinical experience and the published reports of FPIES triggers.
This table should be considered in the context of the following notes:

Exclusive breastfeeding until 4 to 6 months of age and continuing breastfeeding through the first year of life or longer as long as mutually desired by both mother and child.^[1]
If an infant tolerates a variety of early foods, subsequent introduction may be more liberal. Additionally, tolerance to 1 food in a food group (green pea) is considered as a favorable prognostic indicator for tolerance of other foods from the same group (legumes).^[2]

FPIES: food protein-induced enterocolitis syndrome; AAP: American Academy of Pediatrics; CoN: Committee on Nutrition; WHO: World Health Organization.
* Thinned with water or infant puree for appropriate infant texture and to prevent choking.

References:

Baker RD, Greer FR, Committee on Nutrition American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics 2010; 126:1040.
Sicherer SH. Food protein-induced enterocolitis syndrome: Case presentations and management lessons. J Allergy Clin Immunol 2005; 115:149.

Reproduced from: Nowak-Wegrzyn A, Chehade M, Groetch ME, et al. International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: Executive summary—Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol 2017; 139:1111. Table used with the permission of Elsevier Inc. All rights reserved.

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Empiric guidelines for selecting weaning foods in infants with FPIES