Why Benadryl is Not the Best Idea when Introducing Allergenic Foods with @raisinggoodparents Phil Boucher, MD

Dr. Phil Boucher (0s):

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.

Katie Ferraro (15s):

Hey there, I'm Katie Ferraro, Registered Dietitian, college nutrition professor, and mama of seven specializing in baby led weaning. Here on the Baby-Led Weaning Made Easy podcast I help you strip out all of the noise and nonsense about feeding, leaving you with the competence and knowledge you need to give your baby a safe start to solid foods using baby led weaning. You guys. Welcome back. Today's episode was supposed to be about what I thought was going to be a fairly innocuous topic. Benadryl, like most parents have Benadryl probably somewhere in their house, or you'll hear about parents who have Benadryl on hand when they're introducing potentially allergenic foods.

Katie Ferraro (58s):

You sometimes hear people refer to baby Benadryl, even though there's no such thing. So I invited my friend, Dr. Phil Boucher. He's a pediatrician from the raising good parents community. He's also the host of the raising good parents podcast. And I wanted to pick his brain all about Benadryl as it pertains to the introduction of new foods. So we are going to call this episode Benadryl basics, what to have on hand when introducing allergenic foods with Dr. Phil Boucher. So I get him on the interview and I realize Dr. Boucher is totally bucking the trend when it comes to pediatricians and Benadryl. In fact, he actually does not recommend Benadryl. He's going to explain why in the episode, he makes some really great points about its limitations and why he currently is not recommending Benadryl in his pediatric practice.

Katie Ferraro (1m 40s):

Now he has a great alternative and some really practical tips about how to be prepared when you're introducing potentially allergenic foods to your baby. But the interview took a little turn compared to what I was expecting. So I tweaked the title and now we're going to be chatting about this is Dr. Boucher's idea why Benadryl is not the best idea when introducing allergenic foods. So I want to introduce you guys to the raising good humans podcast, host and pediatrician Dr. Phil Boucher. Well, Hey, Dr. Boucher, thanks again for joining us on the podcast today. I'm so excited to interview you.

Dr. Phil Boucher (2m 12s):

Oh, me too. I am. I love talking about food and food allergies and everything was 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 (2m 31s):

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 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.

Dr. Phil Boucher (3m 0s):

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 sorts 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 means of what it's like to be a parent.

Dr. Phil Boucher (3m 43s):

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 (4m 19s):

You know, 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 going to 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 allergy. So I don't want to focus on that. I want to talk about like, when you're actually doing the food introduction, parents are worried about the potential for an allergic reaction.

Katie Ferraro (5m 0s):

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?

Dr. Phil Boucher (5m 10s):

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 allergies is the most common is actually cow's milk allergy, which is about one to 2% of kids.

Dr. Phil Boucher (5m 54s):

Hen's egg would be another 1% and then peanut or tree nut 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 because it really sticks out.

Katie Ferraro (6m 18s):

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.

Dr. Phil Boucher (6m 25s):

The best way to avoid getting a helmet is not to get assessed.

Katie Ferraro (6m 28s):

Well, 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 went to three different places. There are like two of them, like, yeah, all four of them need it. And then the one other place was like, Nope, just one of them needs it. And I was like, interesting.

Dr. Phil Boucher (6m 44s):

We won't get into the, the finances of helmets and all of those sorts 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. You're like, oh my gosh, I don't want that to happen to my baby. And it must have it 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, you don't have to have an epi pen 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.

Dr. Phil Boucher (7m 30s):

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 and notches, the first thing that I try and teach parents when we're talking about the introduction of salt 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. So it's kind of like if you're afraid of 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 out or having an allergic reaction.

Katie Ferraro (8m 18s):

Oh, I love that analogy of Heights. That's a good one. You got to 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?

Dr. Phil Boucher (8m 35s):

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 epi pen ready or have nine 11 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 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 want to 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.

Dr. Phil Boucher (9m 18s):

Otherwise we don't get into it much because it's just not as common as parents think.

Katie Ferraro (9m 22s):

And I like that you're talking us off the fence with like the whole doing it 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.

Dr. Phil Boucher (9m 32s):

Totally. Yup. 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 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 you lose sleep over. If you decide, I just can't handle doing this in the high chair, I'm too worried. I'm going to go to the ER parking lot and do it there.

Dr. Phil Boucher (10m 13s):

Just so I have the peace of mind, then just do that. 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, waiting room,

Katie Ferraro (10m 27s):

Do it there, 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 foot rest. So feeding the baby in the car as Dr. Boucher said is not a good idea to begin with because you don't really need to. But on top of that, we really want to 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.

Dr. Phil Boucher (10m 57s):

That is a great point. And I had envisioned like the baby sitting 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 going to do it in the ER parking lot, I'd either just like, have them sit in your lap or, you know, get out of the car and sit with them or hold them or do something like that. But

Katie Ferraro (11m 17s):

I invited you cause we wanted to talk about Benadryl basics. I was like, okay, what should parents have on hand when they're introducing allergenic foods, but you are going to rock our world with your opinion about Benadryl and baby Benadryl in general. So take it away.

Dr. Phil Boucher (11m 30s):

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 them 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 anti histamine.

Dr. Phil Boucher (12m 10s):

And honestly, I can't even think of the last time that I told a parent in the last seven years in practice, you've got to go get some Benadryl and give your baby Benadryl. I just don't find it to be a useful medicine whatsoever. And I've talked with a lot of pediatric allergist at some of the leading institutions and they are in agreement to 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 anti-histamine what's the right dose. I don't know. I'm just going to give them the Tylenol or ibuprofen dose. I'll just pull them up and give it to them. And they way overdose them and Benadryl overdoses. One of the main reasons for hospitalization in terms of medical overdoses in children.

Dr. Phil Boucher (12m 52s):

And I've seen some kids that have been pretty significantly ill because of accidental Benadryl overdose. 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 higher. Low Benadryl just has a load of as 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 (13m 21s):

All right, 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?

Dr. Phil Boucher (13m 28s):

Great alternative. I recommend cetirizine, which the brand name in the US is Zyrtec 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 anti histamine. 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.

Dr. Phil Boucher (14m 8s):

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 want to use a nasal steroid or itchy eyes, Zyrtec cetirizine would be my go-to medicine in all of those circumstances. And, and then you just have one medicine on hand that you don't have to try and remember the dosing for it. 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.

Dr. Phil Boucher (14m 52s):

Cause they're worried their baby's having a food allergy.

Katie Ferraro (14m 54s):

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

Dr. Phil Boucher (15m 1s):

On weight. It's not based on wait 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 going to be the same 2.5 milligrams.

Katie Ferraro (15m 13s):

Okay. So this is mind blowing to me now, is there like a baby's Zyrtec at all?

Dr. Phil Boucher (15m 20s):

There's, children's Zyrtec. There's generic. I'm 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 (15m 42s):

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

Dr. Phil Boucher (15m 48s):

Benadryl? I think they just refer to that because they think of like the adult tablets that somebody would take 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, two 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 (16m 14s):

I've always been surprised by, I was like, there's not actually infant Benadryl. Like it says on the thing don't give to anyone under two. And then parents were like, wait a minute. So then obviously I just want to 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 going to say, because they're not Dr. Boucher. They're going to 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 want to have children's Zyrtec, but it would be that fixed dose, but you should still call your pediatrician. Is that correct? If there is a reaction

Dr. Phil Boucher (16m 49s):

Yeah, 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 until, you know, 20 minutes ago. So there isn't really that time correlation where, where they're related.

Dr. Phil Boucher (17m 31s):

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, 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 because parents want to know. And it's something where you don't want to wait and you don't want to have to Google it and then try and figure it out from there.

Katie Ferraro (18m 1s):

Yeah. And I appreciate you pointing out the relationship between the dose and in the timing like parents will sometimes forget that if there's going to 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've been the strawberry. I'm actually have a whole episode called why you don't need to wait three to five days between new foods. It's with 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 going to see signs or symptoms of an allergy three days down the road. It's going to be shortly thereafter, you feed the food. So I appreciate you reiterating that because we do want to give our babies new foods frequently in order to help them establish that diet diversity, theirs, and not to be unnecessarily weighting between foods.

Dr. Phil Boucher (18m 48s):

I explained it to parents cause that always shocks them too. When they talk about that. And I always talked 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've got to 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, which is why I like the baby led weaning approach.

Dr. Phil Boucher (19m 36s):

And the fact that you get to expose them to 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 (19m 46s):

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? All right. When we were doing research for this episode, looking a little bit about FDA recommendations, they say avoid any anti-histamine 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

Dr. Phil Boucher (20m 28s):

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 has 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 to 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 just kind of puts the risk on my plate.

Dr. Phil Boucher (21m 14s):

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 (21m 33s):

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 want to do maybe like really, you know, parents, all three months of age, I wanna start doing shrimp. Like no, not safe, not necessary. Then the citizens 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 that drowsiness as a side effect. I mean, I know people joke about it sometimes. So you're going to go on an airplane and give him some Benadryl to make him 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 medication.

Katie Ferraro (22m 14s):

Just like parents think, 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?

Dr. Phil Boucher (22m 24s):

Right. 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 them 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, especially in 2021 and beyond when you just don't wanna have to deal with that on an airplane too, with the 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 over medicated on an airplane so that when we travel with our kids, everybody's got their tablet and we got backup chargers and everything like that.

Dr. Phil Boucher (23m 11s):

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 sweating like normal, which can be uncomfortable for the child and disturbing to the parent and to the, the child as well. 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.

Dr. Phil Boucher (23m 53s):

So if you're talking about an airplane, right, I still don't recommend it, but 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, a Benadryl

Katie Ferraro (24m 5s):

Parents often ask about the timing of the introduction of allergenic foods and who 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 going to, dad's going to go to bed and baby's going to go to bed. And if there were a reaction, you 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 that baby might not be alert, you might not hear it. Is that a potential further concern for Benadryl?

Dr. Phil Boucher (24m 35s):

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 they're 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. Okay. So

Katie Ferraro (25m 12s):

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 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 want to know, okay, what can I do to be prepared as far as like, what should I have on hand when I'm going to start introducing these allergenic foods at home? How do you respond?

Dr. Phil Boucher (25m 36s):

I 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 want to have some medicine available as anti-histamine just to be sure, just so that it doesn't come up and, you know, cause an issue or running to the grocery store or a pharmacy in the late evening and all of that. And so if you want, have anything on hand, I would have children's cetirizine on hand so that if the need arises, that you're prepared to give them any into his me, 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.

Dr. Phil Boucher (26m 33s):

It's probably just because of acidic food. It's not because they have an actual allergy to it. We're A OK to just keep introducing that versus that is a distant rash, right after the introduction and 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 going to be available because you're going to snap pictures of them. Of course, while they're in their high chair, 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 (27m 10s):

I want to mention, cause you were mentioning pictures. I'm 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 up at the every other Wednesday, do three posts, 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 dematis, but they look a little bit different depending upon the color of skin.

Katie Ferraro (27m 50s):

So I would encourage you to be aware of what they look like, because as you explained, Dr. Boucher, oftentimes what parents are going to experience is just contact 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 drill 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 want to be taking pictures, just 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,

Dr. Phil Boucher (28m 27s):

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 drooled. 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.

Dr. Phil Boucher (29m 9s):

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 of 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 certainly be one of the more concerning signs that we would see and warrant to call to your pediatrician and a dose of anti-histamine in those cases.

Dr. Phil Boucher (29m 50s):

Sometimes you'll see airway issues, although that is very uncommon, especially in babies, when we're talking about 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. You can also, babies will often have nausea, vomiting, diarrhea, or seem like they're having a lot of abdominal discomfort. And th 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.

Dr. Phil Boucher (30m 32s):

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 temporarily 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, well, it's just coincidental that you gave them peanut that, that caused those things that might

Katie Ferraro (30m 56s):

Well, Dr. Boutcher 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 going to link to some of the research that Dr. Boucher was talking about in the show notes for this episode. If you guys go to blw podcast.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.

Dr. Phil Boucher (31m 19s):

Yeah, this has been really fun to talk about. And I know that I am going to, it's going, gonna be one of those records stopped sort of things like, wait, not Benadryl. And I'm going to have to do before this episode comes out, do some 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 in the plan for parenting they're neutral.

Katie Ferraro (31m 54s):

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.

Dr. Phil Boucher (32m 1s):

You bet. Thank you so much.

Katie Ferraro (32m 3s):

Well, I hope you guys enjoyed that interview with Dr. Phil Boucher with his take on why Benadryl is not the best bet for our babies. When we're introducing potentially allergenic foods. I really appreciated that he walked us through his interpretation of the potential drawbacks of Benadryl. He offered his preferred alternative, and then I think most importantly reminded us that for the most part, introducing allergenic foods should not be something that we need to be scared of or something that we need to over-prepare for. We've got to do the foods. We need to do them early and often. It's just one more thing to check off your list of things to do as the parents actually ate things on the big eight list, plus allergenic foods there as well. So if you guys want to check out Dr.

Katie Ferraro (32m 44s):

Boucher, he has a fabulous podcast called raising good parents. I was a guest on his podcast a while back talking about baby led weaning for his audience. And I just think he's a really down to earth pediatrician. I like how he's pretty laid back. I think that probably comes from him having five. Now, almost six kids. I know that's not everyone's style, but if you do enjoy just a different opinion or a different interpretation from some of the things you might be hearing from your pediatrician, doesn't hurt to listen to different people's ideas. I'll go ahead and link to Dr. Boucher's resources and his platforms where you can learn more about him. You can find all of that listed on the show notes for this episode. If you go to blwpodcast.com.

Katie Ferraro (33m 25s):

Thanks for listening. Bye now!