Cove Pure (0s):
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Phil Boucher (2m 11s):
Now Benadryl is a really old medicine and it causes a lot of sedation. You give a baby Benadryl and they are so sleepy that they won't even eat then or you're worried that something else is going wrong with them because you just can't get them awake And the risk of overdose is real. Hey

Katie Ferraro (2m 26s):
Hey There, I've Katie Ferraro, registered dietitian, college nutrition professor and mom of seven specializing in baby led weaning. Here on the Baby led weaning with Katie Ferraro podcast. I help you strip out all of the noise and nonsense about feeding, giving you the confidence and knowledge you need to give you baby a safe start to solid foods using baby led weaning. So just this week I was working with a family in a family coaching session for baby led weaning and the baby had an allergic reaction to egg. And it was so interesting 'cause the mom's first question was, do you have any Benadryl? And I know that is such a knee jerk question reaction that all parents have.

Katie Ferraro (3m 8s):
Like you, you think allergic reactions. So then your response is get Benadryl. But should we really be keeping Benadryl on hand when we're introducing allergenic foods to our babies? This is one of those things that kind of gets passed around in parent circles all the time. Like, oh, just have some baby Benadryl is what you hear. Like have that ready in case there's a reaction. But here's the thing, there's actually no such thing as baby Benadryl. And for babies who are starting solid foods, Benadryl may not be the best choice anyway. In this episode I'm interviewing a colleague of mine, Dr. Phil Boucher. He is a board certified pediatrician. He is a dad of six. He's a creator behind the Instagram account, Phil Boucher MD. This is an interview that we did a while back, a couple years ago now, but the message is still incredibly relevant.

Katie Ferraro (3m 51s):
And I was just thinking about it because I had this situation another day. I'm like, I gotta bring that one back to the top of your feed. Especially if you are feeling nervous about introducing allergenic foods. Dr. Boucher is gonna walk us through what mild versus more severe allergic reactions look like. Why most babies do not need an elaborate emergency plan just to be eating peanut or egg or yogurt. And then why he's not a big fan of Benadryl for babies. He's gonna share what he prefers instead and how parents can feel prepared without being panicked. So I always love talking to Dr. Boucher because he takes things that feel really scary and makes them feel a lot more practical and am a big family Mom.

Katie Ferraro (4m 31s):
I'm one of six, I have seven kids. I personally chose my pediatrician because he had five children himself. I love that Dr. Boucher has six kids. I feel like they have just kind of a little bit of a laissez-faire attitude that I sometimes need. 'cause I sometimes get like super spun up on stuff. I just love his approach on like yeah there might be an reaction but it's not really the end of the world. And we're certainly not downplaying the seriousness of food allergies because food allergies are very serious situations. But it is important to know that death from anaphylaxis from a food based allergy reaction in infancy, that's almost all but unheard of in infancy. And he's gonna explain how food allergy reactions actually get more severe the older your child gets.

Katie Ferraro (5m 13s):
So it's like, yeah, it might be a little bit scary but is your baby going to die from it? No. And offering these allergenic foods early and often is one of the few things. It's actually the only thing that you can do to lower your baby's risk of food allergy. So having this little bit of info about why we're not gonna do Benadryl and what you might do instead if in case your baby does have an allergic reaction I hope can help you feel a little bit more confident and prepared as you start solid foods. And so with no further ado, here is Dr. Phil Boucher talking about why Benadryl is maybe not the best idea when we're offering allergenic foods to babies. Well hey Dr. Boucher, thanks again for joining us on the podcast today. I'm so excited to interview you.

Phil Boucher (5m 54s):
Oh, me too. I am, I love talking about food and food allergies and everything with starting foods because I think there's so much wrapped up in it as You know, And so many information, misinformation, disinformation about foods that if I can help parents feel confident and enjoy starting solid foods and feeding their child more than I'm all about it.

Katie Ferraro (6m 13s):
And I love chatting with you because you are a pediatrician who actually is interested in food. A lot of times we hear from parents like, You know, my doctor, there's just not time to talk about food. And I know there's so many things pediatricians do have to do as a, I'm a college nutrition professor and I always like to remind my students that You know, 90% of physicians in the United States have never even taken a dedicated nutrition class. So sure you can't always rely on your pediatrician to be the best source for nutrition, but you are a pediatrician who's actually really interested in nutrition. So tell us a little bit about yourself and your job as a pediatrician.

Phil Boucher (6m 43s):
So I'm a pediatrician in Lincoln, Nebraska in the very middle of the country in private practice and see patients in the office. And I've developed kind of like an online presence, nothing as fancy or as large as yours, but I try and educate parents on and kind of demystify all of the things that parents hear, whether it be about sleep training or starting solid foods or timeouts or those sort of things just to try and take away the old wives tales, the shame and the guilt that goes along often with modern parenting. I think that having social media available is both a blessing and a curse in so many different ways. You can connect and hear from other parents and feel comradery with the gifts and the memes of what it's like to be a parent.

Phil Boucher (7m 25s):
But at the same time there's a lot of shaming, even accidental shaming or guilt or my kid's not doing that or we don't do that or I must be doing something wrong. Or they said you have to do it this way or that way. And so my hope is to just like cut to the chase of here's what you actually need to do, here's what the science and research shows. I'm a father of five, we're having baby number six in just a couple months now. And So that has influenced my pediatrics practice to a large extent as a parent, here's what actually works and here's what you should and shouldn't do or don't have to do to You know, enjoy parenthood more.

Katie Ferraro (8m 1s):
You know what, I actually picked my pediatrician 'cause I'm one of six and when I was having my first child I met the pediatrician like I didn't even research it, he just said he had five kids and I was like okay cool, I think we're gonna love you. And ended up like having a great relationship with him. But I like, I feel like I do better with pediatricians who have a lot of kids and have lived to talk about it. So I really appreciate you being here to talk today a little bit about food allergies and we're doing a lot of awareness around food allergies right now And so my audience is like familiar with some of the basics as far as the importance of early introduction of allergenic foods to help prevent food allergies. So I don't wanna focus on that. I wanna talk about like when you're actually doing the food introduction, parents are worried about the potential for an allergic reaction.

Katie Ferraro (8m 42s):
So can you talk a little bit about what to expect? What does it look like if your child is having an allergic reaction? What's the difference between mild, moderate, severe, what should we be on the lookout for when we're actually doing these foods?

Phil Boucher (8m 53s):
Right. So I think that is a super common question and parents at the four month visit, the six month visit, the nine month visit, they're all wondering about food allergy because you hear about it a lot and you think that like You know, half of America must have a peanut allergy because of EpiPens and peanut free tables and peanut free schools and you just feel like there's no way that I'm going to avoid having that happen to me and my family because it's just so common when we actually look at the numbers of children in the United States with food allergy, if we're looking at kids under age of five, it's probably about two to 4% of children have a food allergy. So it's not very common. And then the specific food allergy, the most common is actually cow's milk allergy, which is about one to 2% of kids hen's egg would be another 1%.

Phil Boucher (9m 39s):
And then peanut or tree allergy again would be about 1% of children in the United States. So it's actually not as common as it would seem. I mean it's just like often, You know, I think parents a similar thing getting off topic is helmets. Like parents think that every baby must have a helmet because you see one kid in a helmet at church or at Target and you think wow all babies must end up in with helmets 'cause it really sticks out. No

Katie Ferraro (10m 1s):
I do because when you go to get your assessment for the helmet, a hundred percent of the time they tell you that the baby needs the helmet. That's why I feel like oh yes

Phil Boucher (10m 7s):
The best way to avoid getting a helmet is not to get assessed for getting

Katie Ferraro (10m 10s):
A helmet. I took my quadruplet babies, I remember thinking one of them had a flat head so I took all four of them to the helmet place just for the assessment and I went to three different places and they're like, two of them were like, yeah all four of them need it. And then one other place was like nope, just one of them needs it. And I was like interesting. Oh my

Phil Boucher (10m 24s):
Goodness. Yes We won't get into the the finances of helmets and all of those sort of things but honestly in seven years of practice I've had one patient, literally one patient that ever got a helmet. So in the same token, as common as it seems that every kid has a helmet, it seems like every kid has a food allergy but it's because You know it stands out more and you hear about it and you're like oh my gosh, I don't want that to happen to my baby And it must happen to all babies. And then your, your ears are perked to it and then you hear about it more and feel like it just must be so common. But what we know is that food allergy is actually quite rare And it is safe to introduce foods to baby without having a plan for exactly what you're going to do if they have a food allergy.

Phil Boucher (11m 4s):
You don't have to have an EpiPen on hand, you don't have to have specific things on hand or do it in the emergency department parking lot or anything along those lines because what we know is that food allergies by and large and in the vast majority of cases they will have mild symptoms if they're going to have them then you can say, oh it seemed like they had these symptoms, well perhaps we should get evaluated and then you can go from there. So I think just bringing everything down a notch is the first thing that I try and teach parents when we're talking about the introduction of SOL or of allergenic foods. And then at the same time, as you've talked about on other episodes, the importance of introducing allergenic foods on a regular basis is the best way to prevent food allergies.

Phil Boucher (11m 44s):
So it's kind of like if you're afraid of air heights then exposing yourself to heights on a regular basis helps to decrease that fear in the same way exposure to those allergenic foods on a regular basis decreases the likelihood that you're going to get aller have an allergic reaction.

Katie Ferraro (11m 60s):
Oh I love that analogy of heights. That's a good one. You gotta do this anyway. You might as well do it early when we know it helps prevent. And I've also heard that the risk for and the severity, even if there were to be an anaphylactic reaction, it's significantly less severe in infancy compared to as the child gets older. Have you heard that as well or is that true?

Phil Boucher (12m 17s):
Correct. For sure. As they get older, if they do have an allergy the symptoms become more pronounced but it's not something where you need to have the EpiPen ready or have 9 1 1 on You know, standby for the first time that you stick some peanut butter in baby's mouth or give them a little bit of scrambled egg or something along those lines. And so that's the first thing that I try and teach parents is like it's rare and it's not serious for those infants that you're exposing for the first time. And as you've talked about, You know on episodes with dermatologists and everything like that, if they have a severe eczema or something like that, that's one time when you wanna talk with your doctor about is there some testing that we should do at the same time. But by and large, I think maybe once per year I do that testing before I say go ahead and expose them to egg milk or peanuts.

Phil Boucher (13m 0s):
Otherwise we don't get into it much because it's just not as common as parents think.

Katie Ferraro (13m 4s):
And I like that you're talking us off the fence with like the whole doing it in in the ER parking lot. Like for children that are the vast majority of children who are not in the high risk category, it's completely unnecessary.

Phil Boucher (13m 15s):
Totally. Yep. I mean you can do it like it's not a big deal. Like if it just gives you peace of mind. I tell parents that all the time. If it gives you peace of mind to just You know, park in the ER parking lot and then You know have them in their little chair and give them some peanut and sit there for a few minutes and watch them then just do that. I mean it's not that big of a deal. You know, you don't get, they don't swipe your HSA card or your insurance card for sitting in the parking lot. If that gives you peace of mind to do it, just do it because it's more important that you do it than to worry so much that you're just hemming and hawing about it and decide not to do it because of the very low risk that something could happen. So at the end of the day it's not something to lose sleep over if you decide I just can't handle doing this in the highchair, I'm too worried I'm gonna go to the ER parking lot and do it there just so I have the peace of mind, then just do that.

Phil Boucher (13m 57s):
Then nothing bad will happen if something that you're not sure about does you just walk into the er, it's, these are not like life threatening 10 seconds or less sort of emergencies whatsoever. I wouldn't go sit in the er. Yeah, exactly. Waiting room

Katie Ferraro (14m 10s):
And do it there but to do it. But you did just mention feeding in the car and sorry to be the nerdy dietician but just to point out that for all the parents listening, we actually never would feed babies in a car seat. It's reclined at the exact position that could potentially choke your child. We always want the child sitting at a 90 degree angle with their feet resting flat on a footrest. So feeding the baby in the car as Dr. Boucher said is not a good idea to be good with 'cause you don't really need to. Yes. But on top of that we really wanna make sure we're not increasing the risk of choking by ever feeding in a reclined highchair or in a stroller. A lot of parents don't realize that that's actually quite dangerous as well.

Phil Boucher (14m 39s):
That is a great point. And I had envisioned like the babysitting on your lap upright when I described that but I didn't clarify So that, so I appreciate your, your clarification on that 'cause that is important and that's how I, if I was gonna do it in the the ER parking lot, I'd either just like have them sit in your lamp or You know get outta the car and have sit with them or hold them or do something like that. But

Katie Ferraro (14m 59s):
I invited you odd 'cause we wanted to talk about Benadryl basics. Yes. I was like okay what should parents have on hand when they're introducing allergenic foods But you are gonna rock our world with your opinion about Benadryl and baby Benadryl in general. So take it away.

Phil Boucher (15m 12s):
I hate Benadryl. I think Benadryl is one of the worst medicines that's over the counter and the reasons for that, I could go on for quite a while. Number one, Benadryl is a really old medicine and it causes a lot of sedation. So you give a kid Benadryl when you're gonna put 'em on an airplane and then they're either really sleepy or they go wild and are wired for the rest of the airplane ride. You give a baby Benadryl and they are so sleepy that they, they won't even eat then or you're worried that something else is going wrong with them because you just can't get them awake. And the risk of overdose for Benadryl is real and there's a lot of side effects that can come because Benadryl is a first generation antihistamine and honestly I can't even think of the last time that I told a parent in the last seven years in practice you gotta go get some Benadryl and give your baby Benadryl.

Phil Boucher (15m 60s):
I just don't find it to be a useful medicine whatsoever. And I've talked with a lot of pediatric allergists at some of the leading institutions and they are in agreement too that there's no specific reason that you need to use Benadryl or have Benadryl on hand. Lastly, I also find it hard to make sure that they get the right dosing and parents are worried because they're thinking I need to give my baby an antihistamine. What's the right dose? I don't know, I'm just gonna give them the Tylenol or ibuprofen dose, I'll just pull some up and give it to 'em and they way overdose them And Benadryl overdose is one of the main reasons for hospitalization in terms of medical overdoses in children and I've seen some kids that have been pretty significantly ill because of accidental Benadryl overdose.

Phil Boucher (16m 40s):
Not that the baby got the bottle off the shelf and got it open and drank it but the parents just gave them the wrong dose and they got really tired, they got sleepy, they got flushed, their heart rate was high or low. Benadryl just has a load of, has a terrible side effect profile And it doesn't last very long. It lasts like four to six hours and then parents are dosing it again And it can be really confusing. So that is my Benadryl rant.

Katie Ferraro (17m 1s):
Diatribe, yes, I love it. Alright then what do you recommend you can't, you're not allowed to bash something if you don't have an alternative. So what do you recommend instead?

Phil Boucher (17m 9s):
I have the great alternative, I recommend cetirizine which the brand name in the US is X Tech And it is safe and effective for babies that are six months and older. And so you can have that on hand if you would like to when you're introducing these foods. And the nice thing about cetirizine, it's a second generation antihistamine, it doesn't have as much of the somnolence or making them drowsy or sleepy. Most kids that take Zyrtec cetirizine on a regular basis don't have any drowsiness and it's pretty much impossible to overdose them on it. Even I was reading some studies before we started talking and even doses where it's like 60 times the recommended dose, no side effects whereas even a double dose of Benadryl can give you some pretty nasty side effects.

Phil Boucher (17m 50s):
So cetirizine is my go-to if you're going to use it for any sort of allergy honestly, like whether it's eczema that's really itchy or a potential food allergy or hives from a recent upper respiratory illness or seasonal allergies where you don't wanna use a nasal steroid or itchy eyes, zec cetirizine would my be my go-to medicine in all of those circumstances. And then you just have one medicine on hand that you don't have to try and remember the dosing for. It's a fixed dose which is also nice about it too so you don't have to try and remember the dose or change the dose or figure out how much your baby weighed at the last checkup and then dose based on that or over under dose. It's just a fixed dose which is super nice for families that are in a pinch when they're like trying to figure out what to do for their baby 'cause they're worried their baby's having a food allergy.

Katie Ferraro (18m 36s):
When you say fixed dose, do you mean that for all ages like from zero months to 18 years it's the same amount. It's not based on weight, it's

Phil Boucher (18m 44s):
Not based on weight until you get to an older age. So it's 2.5 milligrams for all babies up until around four or five years old. So all those little kids are all gonna be the same 2.5 milligrams.

Katie Ferraro (18m 55s):
Okay, so this is mind blowing to me now. Is there like a baby Zyrtec at all or is it Yep,

Phil Boucher (19m 1s):
There's children's Zyrtec, there's generic, I am always a fan of generic medicines because they're cheaper and just as effective And so you can get the generic cetirizine same as Zyrtec at wherever you get medicines and just have that on hand and if they get hives or you're worried about an allergic reaction or they have a really swollen bug bite, then it's your go-to.

Katie Ferraro (19m 24s):
I know you don't love Benadryl but can you talk about why people sometimes refer to baby Benadryl when there's no such thing as baby Benadryl?

Phil Boucher (19m 30s):
I think they just refer to that because they think of like the adult tablets that somebody would take if as an adult they had it versus the children's suspension and formulation of it. There's no specific like baby Benadryl versus You know 2-year-old Benadryl. It's all the same dosing and or it's the same concentration and everything like that. There's also a marketing component too where You know they'll have it for younger babies and then older babies just like infant Tylenol versus children's Tylenol, infant ibuprofen versus children's ibuprofen.

Katie Ferraro (19m 56s):
Hey we're gonna take a quick break but I'll be right back. One thing I've always been surprised by is like there's not actually infant Benadryl like it says on the thing don't give to anyone under two and then parents are like wait a minute. Right. So then obviously I just wanna point out that whenever your child is having any sort of reaction, you always should of course call your pediatrician but correct, we have these conversations just so You know what to expect, like what's your pediatrician probably gonna say because they're not Dr. Boucher, they're gonna be like just give your baby some Benadryl, at which point you would need to know your baby's weight So that you can dose it appropriately. But then of course all those drawbacks that you mentioned, you're saying with the Zyrtec you would wanna have children's Zyrtec but it would be that fixed dose but you should still call your pediatrician.

Katie Ferraro (20m 41s):
Is that correct? If there is a reaction, yeah

Phil Boucher (20m 43s):
Definitely call your pediatrician if there's any reaction or any concern because we can often walk through, You know, the history and say well you've introduced this food before and they've been fine, this doesn't really sound like allergy sort of symptoms or it's, I mean the vast majority of the time it's a coincidental thing where they try some new food and then a few hours later they've got a rash but they had a respiratory illness last week or some other reason that comes up that causes a rash and parents connect the dots when there's really no connection to be made. And so we kind of are good at working through that and saying, well yes you did try peanut yesterday but the rash didn't come on till You know 20 minutes ago. So there isn't really that time correlation where where they're related.

Phil Boucher (21m 25s):
So we can work through all those things if you call and find out what to do if you're concerned about a baby's reaction and frankly most pediatricians are available all the time or they have the nursing staff or people available. So there's always somebody that you can call and get that information whether it be at noon or at midnight. I mean we, there's always somebody that can answer the phone and tell you what to do and I think most pediatricians have some sort of service or availability like that 'cause parents wanna know and it's something where you don't wanna wait and you don't wanna have to google it and then try and figure it out from there.

Katie Ferraro (21m 55s):
And I appreciate you pointing out the relationship between the dose and then the timing. Like parents will sometimes forget that if there's gonna be an allergic reaction to a food it's going to occur within the minutes or the hours following ingestion. It's not like you eat a strawberry and five days later there's a weird diaper and you're like oh my gosh it must have been the strawberry. We actually have a whole episode called Why you don't need to wait three to five days Between new Foods. It's with Corina Venter who is a pediatric dietician and also a researcher in food allergies and she really goes through the data that shows, You know, you don't need to be unnecessarily delaying the introduction of new foods, you're not gonna see signs or symptoms of an allergy three days down the road, it's gonna be shortly thereafter you feed the food. So I appreciate you reiterating that because we do wanna give our babies new foods frequently in order to help them establish that diet diversity there's and not to be unnecessarily waiting between foods.

Phil Boucher (22m 42s):
I explain it to parents 'cause that always shocks them too when they talk about that and I always talk to them about like You know cave mom, cave dad, cave baby. It's not like you can hang out by the strawberry patch or the squash field for three days while you keep the baby on one specific food because then You know the lion and the saber tooth tiger that are on the prowl for you will find you. So you gotta keep, You know back in the evolutionary days people had to keep moving and keep migrating and you found what you found and you fed baby what you had. And so there's nothing that's changed except for we've put all these strict guidelines and myths into practice of you have to wait a certain number of days and you can only do certain foods or you have to go in this specific order and it's just totally not what the thousand, 10,000 million years of previous evolution would tell us is how you feed babies.

Phil Boucher (23m 27s):
Which is why I like the the baby led weaning approach and the fact that you get to expose them to a a lot more foods than if you're restricting it to only a certain number of foods that you can cram in because you have to do three days per food, blah blah blah.

Katie Ferraro (23m 39s):
I also love to mention cave mom and cave baby and cave dad in that prior to the invention of commercial baby food in the earlier part of the 20th century, there were no pouches, there were no jars, there were no prepared baby foods and guess what? Parents fed their babies modified versions of the same foods that they ate. It's like the term baby led weaning is relatively new but as a concept of course it's millennial old. Right. Alright, when we were doing research for this episode looking a little bit about FDA recommendations, they say avoid any antihistamine medication with babies under two years old. So how come then it's still like pretty common practice for pediatricians to be like, have some children's Benadryl on hand and be ready to dose it to your baby. Like is it safe to actually be giving those products?

Phil Boucher (24m 21s):
Well that's another good point and another reason that I don't like Benadryl too is because I as the pediatrician them and I'm accepting that risk of hey give your baby this medicine that the box says don't give to them and please You know, dose it appropriately when you can't read the dose on the box, just trust me and make sure that you write it down correctly and give them two teaspoons and not two milliliters or two milliliters and not two teaspoons. It can be really confusing for parents in a pinch, which is why I like the FDA's actually approved cetirizine down to six months of age. And So that is helpful to me as a pediatrician to have that to bank on too of this is safe, it's been approved and shown to be fine. Another good reason to avoid Benadryl is just the risk to me of telling parents you should use Benadryl when we don't have that it it just kind of puts a risk on my plate.

Phil Boucher (25m 7s):
If something goes wrong, well maybe I told them the wrong dose or something along those lines. Whereas a fixed dose of a product that's approved down to six months of age is certainly much more convenient for me to tell parents and easy for them to remember and like I said earlier, almost impossible to overdose your baby on if you get mixed up on the dose.

Katie Ferraro (25m 26s):
And that's nice because it dovetails into the timeline, which is exactly when babies should be starting solid foods and not earlier. It's not safe to feed a baby anything except breast milk or formula prior to six months of age. So for parents that wanna do maybe like really, You know, parents, oh three months of age I wanna start doing shrimp. Like no, not safe, not necessary. And then the cetirizine it's not even appropriate for so wait till six months You guys, there's no reason to do it prior to that for the vast majority of babies. So back to Benadryl, sorry to like keep tying it back here, but I know that there are parents who do use Benadryl. You mentioned the drowsiness as a side effect. I mean I know people joke about it sometimes, oh you're gonna go on an airplane, give them some Benadryl to make 'em drowsy, but it's not really a joke, right? Like babies there can be negative side effects to the use of these over the counter medications.

Katie Ferraro (26m 8s):
Just like parents think with oh it's a supplement, I can go buy it without a prescription air go, it's harmless. That's not true. Could you talk a little bit about the side effects of Benadryl beyond the drowsiness maybe? Right,

Phil Boucher (26m 18s):
So the biggest side effect that we see for Benadryl is drowsiness, which is sometimes people think of it as a benefit because then you can give it to 'em on the airplane. The drawback is that it's not guaranteed drowsiness and sometimes they have a paradoxical reaction where instead of drowsy they are hyper wired and out of control and You know, I mean it's not anything that you want to intentionally do to your child, especially when you're getting onto an airplane when you just don't wanna have to deal with that on an airplane too with a kid that's running up and down the aisles and screaming and crying and losing their mind. And so that's why I don't actually recommend that too. I tell parents, You know, I would rather have them over screen timed than overmedicated on an airplane. So when we travel with our kids, everybody's got their tablet and we got backup chargers and everything like that So that we know we can keep them distracted and entertained in flight with entertainment rather than trying to medically induce quietness because you're definitely not guaranteed that other side effects that you can have with Benadryl when you get to a normal or an accidental overdose of it or too frequently administering it, you can have decreased breathing, you can have like flushing where they get really hot and are not, You know, sweating like normal, which can be uncomfortable for the child and disturbing to the parent and to the the child as well.

Phil Boucher (27m 36s):
You can have alteration in their mental status where they're acting unusual. Those are other things that you often see when you give too much Benadryl And it wears off quickly too. So if you're talking about an airplane, right, I still don't recommend it but it, I also tell parents like it might not last the whole time and they might wake up really angry towards the end of the flight And it would be better to just avoid the use in general of Benadryl. Parents

Katie Ferraro (27m 57s):
Often ask about the timing of the introduction of allergenic foods and I say for most foods it really doesn't matter what time of day you introduce them, but for the allergenic foods, because there is the very small possibility that there might be an allergic reaction, we oftentimes don't recommend introducing those later in the day knowing that mom's gonna, dad's gonna go to bed and baby's gonna go to bed. And if there were a reaction you'd both be sleeping. The Benadryl issue kind of compounds this problem that in that if the baby were to be exceptionally drowsy and there was a recurrent reaction, the baby might not be alert, you might not hear it. Is that a potential further concern for Benadryl?

Phil Boucher (28m 27s):
I guess that could be. I had never considered that really. And I think that when you were saying, You know, avoid it in the late evening, I thought of it more from a cost of going to the ER perspective than a concern for that. Just like how can I avoid the copay of going to the emergency department? But I think in general, yes, so you could have that be something that you might worry about too is if you give the baby the Benadryl And it's bedtime and then there are tired or extra tired or drowsy because of that and then they might be zonked out when they're having more of a significant reaction to it too. So sure that's something that I would, again, another reason to avoid baby Benadryl.

Katie Ferraro (29m 3s):
Okay, So Dr. Boucher, let's say I'm a brand new mom, I'm coming to you six month appointment with my first baby. You're super laid back. I love you as my pediatrician. You also have five kids, but I'm a little bit nervous about starting solid foods. My baby is not at high risk for food allergies, especially peanut, so there's no egg allergy, there's no severe eczema, but I'm still nervous and I wanna know, okay, what can I do to be prepared as far as like what should I have on hand when I'm gonna start introducing these allergenic foods at home? How do you respond? Right? I

Phil Boucher (29m 28s):
Just try and reiterate to parents that the likelihood of food allergy is really low. It is not common, it's not serious when they're first exposed to it. And so we don't have to have anything in particular on hand. There's a subset that really wanna have some medicine available as antihistamine just to be sure just So that it doesn't come up and You know, cause an issue where we're running to the grocery store or pharmacy in the late evening and all of that. And so if you wanna have anything on hand, I would have children's cetirizine on hand So that if they're need arises that you're prepared to give them any antihistamine. The likelihood is low but it certainly doesn't hurt just to have it in the medicine cabinet. But I think the vast majority of babies, even if they start to have some sort of reaction to it, the best thing to do is just watch them and then snap some pictures because it'll be gone before you see your pediatrician So that they can see okay, that rash definitely is just around the mouth and you were giving them strawberry or tomato or something like that.

Phil Boucher (30m 24s):
It's probably just because of acidic food, it's not because they have an actual allergy to it. We're AO okay to just keep introducing that versus that is a distant rash right after the introduction and it's hive. Like that's something where we should do a little bit further evaluation before subsequent exposure. So I think really just having vigilance and your camera available, I mean your camera, your phone is gonna be available 'cause you're gonna snap pictures of them of course while they're in their highchair eating and everything like that. But, but getting those pictures if there is a concern that arises. And then just making sure that You know how to contact your pediatrician So that if the need arises that you can call them and say, Hey, what should I do?

Katie Ferraro (31m 1s):
And I wanna mention, 'cause you're mentioning pictures on my Instagram page at baby led wean team, every other Wednesday I do a series that shows what allergic reactions look like. So parents of children who've had allergic reactions to different foods, send them to me. There's a cover on it. 'cause it's certainly something kind of strange to happen upon in your Instagram feed. But if You guys look at the, every other Wednesday I do three posts, it's the third post of that day. It says beware allergic reaction. If you scroll through those carousels, you can see what food allergies look like or allergic reactions rather in babies, especially with babies of different color skin. Because we oftentimes say, You know, you're looking for hives, which are red, raised, itchy patches that appear empty, but they look a little bit different depending upon the color of skin.

Katie Ferraro (31m 42s):
So I would encourage you to be aware of what they look like because as you explained Dr. Boucher, oftentimes what parents are gonna experience is just contact or dermatitis, a slight rash around their mouth. You're introducing these new foods at the same time your baby is teething, there's excessive drool. The drool comes into contact with the new protein from the food. Yeah, there's a little rash around their mouth goes away on its own or maybe with a little bit of cetirizine. But you do wanna be taking pictures just so you can show to your pediatrician, but you're scared of the moment, but it might not be the sign of a severe allergy. So could you maybe just close it out by telling us the difference again, what we're looking for severe allergic reaction from foods compared to mild or moderate reactions?

Phil Boucher (32m 18s):
Right. So in most reactions that I hear about from foods, it's more of a contact dermatitis, like you were saying, where they have some new food that they're trying or food that they've had before. They've got drool, their skin is a little bit dry or irritated in general, baby skin is often more sensitive in general and they get a little redness around the mouth, around the neck, around the, You know, anywhere that the drool and food would come in contact with, they can have a little bit of redness or irritation. That is not what I see with food allergy where we even do an evaluation. I would just reassure the parents in those cases just to keep going and keep introducing the foods. When we're talking about more significant reactions where we're concerned this could be a food reaction, we should do an evaluation before we expose to the food.

Phil Boucher (33m 1s):
Again, the most common is skin related. And so what we see typically is hives. So hives are raised patches and they're usually at distant sites, meaning on the trunk, the back, the abdomen or the legs. Other places other than just around the mouth and areas where drool drips and they are red, they seem itchy or baby's trying to itch them or seems uncomfortable and they're typically raised like a plateau. That's basically what a hive looks like. You can also see swelling. So swelling can occur, especially around the mouth, lips, tongue and airway. And that would certainly be one of the more concerning signs that we would see and warrant a call to your pediatrician and a dose of antihistamine. In those cases, sometimes you'll see airway issues, although that is very uncommon, especially in babies when we're talking about the the first episodes or an early introduction of a food where it turns out that they do have an allergy to it where they have difficulty breathing and that usually coincides with the airway swelling and is more of a function of the airway swelling than any issue with the lungs.

Phil Boucher (34m 2s):
You can also, babies will often have nausea, vomiting, diarrhea, or seem like they're having a lot of abdominal discomfort. And the the hallmark is that it's within a few minutes to an hour of food introduction. If you give them a new food and then tomorrow they're having diarrhea or they vomit three days later, that is not a food allergy. It's unrelated to the foods. If you give them a new food and then the next day or two days they develop a rash that is also not a food allergy or something. It's very temporally related to the food introduction. And So that gives me reassurance. When parents come in, they say, we gave them peanut and then You know, the next day they had this and this and this.

Phil Boucher (34m 42s):
Well, it's just coincidental that you gave them peanut, that it caused those things that much later.

Katie Ferraro (34m 47s):
Well, Dr. Boucher, thank you so much for taking the time to share your insight. I really appreciate you kind of bucking the trend with regards to Benadryl. I we're gonna link to some of the research that Dr. Boucher was talking about in the show notes for this episode. If You guys go to blwpodcast.com, you can find that there. Tell us where our audience can go to find out more about you and your channels and your platforms. Dr. Boucher,

Phil Boucher (35m 10s):
Thank you so much. Yeah, this has been really fun to talk about and I know that I, I'm gonna like, it's gonna be one of those record stop sort of things like, wait, not Benadryl, and I'm gonna have to do before this episode comes out, do some, You know, pre-wiring of my audience to change in the paradigm on Benadryl too. I have an Instagram channel, it's at raising good parents. I have a podcast that's also called Raising Good Parents and a YouTube channel all called Raising Good Parents. So those are the main places to find me. I also have a Facebook group raising Good parents, so basically across all platforms, raising good parents where I talk to parents about how to feel comfortable and confident with in the plan for parenting their new child.

Katie Ferraro (35m 46s):
Well, thank you so much and I'll link to all of your platforms as well on the show notes@blwpodcast.com. Thanks again for joining us.

Phil Boucher (35m 52s):
You bet. Thank you so much.

Katie Ferraro (35m 54s):
Well, I hope You guys enjoyed that interview with Dr. Phil Boucher talking about why Benadryl is not the best idea when we're offering allergenic foods to babies. Give me the down to earth pediatrician all day long. I just love his outlook. I'm gonna put a link to Dr. Phil Bower's resources and some of the other places where you can find him online. Those will be on the show notes for this episode, which you can find@blwpodcast.com/130,

Airwave Media (36m 19s):
and a very special thank you to our partners at AirWave Media. If You guys like podcasts that feature food and science and using your brain, check out some of the podcasts from AirWave Media or online@blwpodcast.com. Thank you so much for listening. I'll see you next time.