When Should I Feed My Baby Peanut Products?

When should I feed my baby peanut products? If your family has a history of food allergies or sensitivities, this can be a nerve racking question. Experts say the prevalence of peanut allergy among children in Western countries has doubled since 2005. While fear may persuade you to delay offering peanuts to your child, research indicates this is a riskier approach.

None of us want to experience anaphylaxis. None of us want to put our children at risk. And peanuts are hard to avoid. Your grocery store, favorite restaurant, mother’s day out, daycare or school can be filled with peanut products. Peanut ingredients may be hiding in Asian dipping sauces, curry, egg rolls, spring rolls, barbecue sauce, ice cream, candy, and cookies. Discovering the presence of peanuts is not as easy as looking for the word. Peanut ingredients may go by these names: arachidic acid, arachis oil, beer nuts, peanut oil, peanut butter, peanut flour, peanut meal, peanut protein, hydrolyzed peanut protein, hydrolyzed plant protein, hydrolyzed protein, hydrolyzed vegetable protein, mandelona nuts, cacahuètes, Earth nuts, ground nuts, goober nuts, goober peanuts, mani, Nu-Nuts, oncom or onchom (Indonesia), Valencias (Valencia is a variety of the peanut plant.), and kernel paste.

With a world full of peanuts, knowing how to reduce the risk for allergy can make you rest easier for years! Children who have severe eczema and/or an egg allergy are considered at risk for peanut allergy. That doesn’t necessarily mean you shouldn’t introduce peanuts at an early age.

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Introducing peanuts early significantly decreases the frequency of developing a peanut allergy and modulates immune responses to peanuts in those at high risk for this allergy.

Researchers in the Learning Early About Peanut (LEAP) trial (Du Toit G, et al. N Engl J Med. 2015;372:803-813) studied 640 infants at risk for peanut allergy who were between four and 11 months at the beginning of the study. They were randomized and assigned to separate groups based on sensitivity to peanut extract determined by a skin-prick test. One group had no measurable skin response. The other group had a wheal measuring one to four millimeters in diameter. The primary outcome of the study was assessed within each group as the proportion of participants with peanut allergy at five years of age.

The results among 530 infants with a negative skin test was a prevalence of 13.7% peanut allergy at five years for those who did not consume peanuts and 1.9% prevalence for those who consumed peanuts. Among 98 infants who initially had a positive skin test, the prevalence of peanut allergy at five years was 35.3% for those who did not consume peanuts and 10.6 percent in those who consumed peanuts. From this and other immune response data collected, researchers concluded that introducing peanuts early significantly decreases the frequency of developing a peanut allergy and modulates immune responses to peanuts in those at high risk for this allergy. Another study published earlier this year confirmed these findings.

Like much medical research, this result runs contrary to common sense. It seems as if it would be best to avoid something deemed likely to harm you, but in this case the opposite is true. Exposure to peanuts seems to reduce the frequency of allergy even in those at risk.

The American Academy of Pediatrics guidelines now recommend that you put your fears aside and introduce peanuts to at risk infants as early as four to 6 months. A child with severe eczema and/or egg allergy is advised to be tested for peanut allergy prior to introduction. A positive test means your doctor should help determine whether to introduce peanuts, how much, and over what period of time. Medically supervised feeding tests may be required.

The guidelines further recommend that infants with mild to moderate eczema be introduced to peanuts around six months of age to reduce the risk of peanut allergy. If these infants have successfully tolerated other solid food(s), they may have peanuts introduced at home without a doctor’s office evaluation, although such an evaluation can be considered.

Per the current guidelines, infants without eczema or food allergy who are not at increased risk can have peanuts introduced freely into the diet together with other solid foods in accordance with family preferences and cultural practices. This was the recommendation of my grandchildren’s pediatricians.

My family has a history of food allergies, sensitivities, and celiac disease. My second grandson had mild eczema at four months and my granddaughter is primarily tube fed due to a paralyzed vocal cord and a related swallowing problem. In spite of all of this, my sons were able to introduce peanuts at home without medical supervision.

They both kept the delivery method simple-a small bit of full-strength smooth peanut butter on a spoon. Because peanut butter is thick, this even worked for my granddaughter who is at risk for aspirating thin liquid. Many healthcare providers suggest a different delivery method.

In fact, Massachusetts General Hospital instructs parents to not give plain peanut butter to any child under four. While my grandchildren have suffered no ill effects from plain peanut butter, I like the detailed instructions, safety tips, and recipes MassGeneral Hospital for Children provides. If your pediatrician does not offer detailed instructions, these are great guidelines.

Most likely, your child’s pediatrician will bring up this subject at a well-care visit. If your child reaches six months of age before that happens, it may be necessary for you to initiate the conversation. Just add introduction of peanuts to your list of questions to ask the doctor. It is important to check with a physician before formulating a plan.

Research is one thing, but parental protectiveness is something much stronger. While you may intellectually understand it’s important to feed your baby peanuts, you may have a real aversion to doing so, especially if you grew up in the era during which guidelines recommended waiting.

If you are afraid to feed your baby peanuts, get some backup. Ask your doctor if a clinic or local hospital offers medical supervision that you can take advantage of. Ask a trusted friend with medical training (MD, APRN, RN, EMT) if they might be willing to come to your home to supervise you. Make sure a partner or friend is home with you to watch for signs of an adverse reaction. If your partner is responsible and less averse, it may be advisable for you to turn this task over to them and remove yourself from the situation to lessen everyone’s anxiety. Sometimes the best thing we can do is rely on someone else who we trust.

When you begin to wonder “When should I give my baby peanut products?”, the answer seems to be clear–sooner is better for reducing the risk of peanut allergy.

https://www.nejm.org/doi/full/10.1056/NEJMoa1414850

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5589409/

https://kidshealth.org/en/teens/nut-allergy.html

https://www.aappublications.org/news/2017/01/05/PeanutAllergy010517

https://pediatrics.aappublications.org/content/143/4/e20190281

https://www.massgeneral.org/children/food-allergies/introducing-peanut-products-to-your-baby.aspx

Should My Whole Household be Gluten-Free, Wheat-Free, Egg-Free, Dairy-Free, Nut-Free, Shellfish-Free, Soy-Free? Ten Important Considerations

pantry mixI’ve been visiting my son in LA and the question keeps coming up, “Should my whole household be gluten-free?” I think it first arose with the smell of chocolate chip cookies coming from the kitchen. They were for a client and contained the traditional wheat prevalent ingredients.

Of course the aroma piqued our desire for gluten-free chocolate chip cookies as well. It seemed like a good idea to bake both while the oven was hot, but the kitchen hadn’t been fully cleaned from prepping the traditional dough. Was it a good idea to mix up the gluten-free cookies yet?

This question led to a discussion of the labels on the pimento cheese containers and the two containers of yogurt (one used for traditional baking) in the fridge and the stash of teeny tiny jellies in the cupboard which then led to a debate on the possible merits of eliminating all gluten from the household.
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My family has members who are celiac, gluten-intolerant, allergic to shrimp, and able to eat absolutely anything. If your family is like mine, you’re familiar with the balancing act required to keep the affected parties away from harm while keeping the rest of the family satisfied.

Of course there’s no one size fits all solution for determining what works best, but here are a few things to keep in mind when discussing the options:

1)How severe is the allergy or intolerance?

The last time I ate shrimp, my throat swelled shut and I sounded like I had whooping cough when I tried to breathe. Households with peanut allergies may have experienced the horrible helpless feeling that comes along with severe anaphylaxis. Reactions of this level or that are obviously progressively worse with each exposure mean a food allergen will be eliminated from my house.

With gluten, the response to a tiny amount can vary widely. While I would not cook a gluten-free grilled cheese in the same skillet you just used for your regular sandwich without washing it in between, I have no hesitation about using the same skillet once it’s washed. I’ve never had a problem from a burger cooked on a grill where they heat regular buns. There have been times I’ve inadvertently eaten fries that were fried in the same oil as onion rings without suffering any ill effects. But that’s me and those were unique events. Your experience may be very different.

The severity of response to a particular allergen may require some patient observation. Once my gut had healed on the Specific Carbohydrate Diet, I returned to a gluten-free regimen only to discover that I can’t tolerate very much corn. It seems that some of my previously assumed gluten reactions were actually corn related.

2)How is an allergen or irritant stored and who has access to it?

My household has a different rule for medications. Since I have no allergic children or mentally impaired relatives living with me, I don’t mind placing a bottle of aspirin or cough syrup with codeine in the medicine cabinet even though ingesting a single aspirin will have me covered in hives in less than 30 minutes. I simply avoid opening the bottles and consuming the meds.

3)How many people in the household are detrimentally affected by the substance in question?

In the beginning of my gluten-free days, I was one-third of the household and the only one who had to follow the regimen. In other words, I was outnumbered. While I was careful to clean pots, pans, utensils, and surfaces in between, I continued to cook regular pasta, pizza, and dinner rolls for the rest of the family. (A gluten molecule is too large to pass through the skin, so any risk from cleaning up surfaces was easily avoided.) Another option would have been to designate certain pots and pans gluten-free. And, of course there were many more prohibitive options, but it seemed extreme to me to restrict 2/3 of the household as long as I was not suffering any detrimental effects.
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4)What are the ages and temperaments of the parties at risk?

Young children cannot be expected to read labels on packages or to consistently make good choices. Having a system in place that minimizes their risk and helps them learn at the same time is ideal. Children who tend to follow the rules may respond well to having only gluten-free options in the refrigerator door and a “special” shelf in the pantry from which they are allowed to make their own choices.

Children who are more prone to challenge or mischief may mean a need to eliminate all gluten from the household to minimize your risk as well as theirs. There was some rethinking of my system when my kids decided celiac was a “mental disorder”, meaning it was all in my head, and set out to develop secret tests to see if I would get sick. Funny how all that changed when one of them had to go gluten-free. Ahhhhh, irony…and paybacks! If you have enough patience, these things often work themselves out.

5)What is the cooking environment like?
Is a ceiling fan always running in the kitchen? Is there often a breeze blowing through the open windows or door when you bake? Strong air currents in the kitchen will carry flour particles a long way potentially causing a gluten cross contact problem. You may be careful to clean up the countertop where you’re working, but flour can ride the airwaves across the room to land on gluten-free muffins cooling on another counter.

I always have a cutting board sitting on the peninsula – usually the same one. Are you in the habit of using a single cutting board for everything? Is that cutting board made of a permeable material? How often does it get a thorough cleaning and will you remember to clean it each time it comes in contact with an allergen? All of these things must be considered when determining whether your kitchen environment is conducive to safely using allergens.

6)How many different people in the household cook?

If cooking is a shared duty, it will be necessary to assess the knowledge level and commitment to cooperation of each cook before making a plan.

7)What is your style of cooking or serving food?

Ben and I cook using primarily fresh fruit, vegetables, meat, poultry, and individual baking ingredients. James and my sister use more premixed seasoning packets, boxed meal extenders, and batter mixes. You may purchase mostly precooked, frozen or packaged foods. Some folks put the food in serving bowls, others fill plates in the kitchen, and still others put pots on the table and use a single spoon to dish out the food. You may remove jelly from the jar to your plate with a spoon that never touches your biscuit. We’re in the habit of sticking a knife in the jelly jar to drive my mom crazy. If you do that and smear a piece of regular toast with jelly then stick the knife back in the jelly jar, you’re trailing pieces of toast into the container and contaminating it with gluten.

Your family’s style of cooking and eating will present a unique set of considerations: Are you able to vary the pancake recipe if your child is allergic to eggs and milk? Do you stick your measuring cup in the wheat flour container and then in the sugar when you’re baking? If so, are you willing to break that habit or do you prefer to keep two different containers of sugar so that your gluten-free cupcakes don’t contain contaminated sugar? Are you in the habit of reading labels when pulling something out of the pantry or refrigerator to make sure it doesn’t contain any problem ingredient or do you prefer to be able to use anything in the house without having to think about it?

8)How much space do you have and how organized is your family?

Some families have elaborate storage systems and ample pantry space in which to easily categorize. In my kitchen with its narrow, deep pantry, reused plastic containers are stacked on plastic pull-out organizer drawers from The Container Store. It’s not unusual to see trail of white rice flour on the top of the sorghum flour container. Adding a container of wheat flour to this collection would be ill advised even if it were clearly labeled. In a different environment, a labeling system would be sufficient for preventing cross contact.
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9)How much waste will be created by having a dual system?

The discussions that prompted this post have often centered on how much food is getting thrown away. If everything were gluten-free in my son’s house, there would be less waste. Of course this means that to get a consensus for such an arrangement, there must be a high standard for the taste and texture of the gluten-free food so that it is pleasing to everyone. Households like this are one of the reasons Cooking2Thrive is committed to developing gluten-free recipes that go beyond providing an acceptable substitute in order to please the discerning gluten-eating palate.

10)Is it more costly to remove all allergens and irritants from the household or to purchase some of both?

Even with the finances, there’s no specific formula for deciding which will cost more. The answer will vary depending on how many packaged foods you buy, how many different allergies or sensitivities you must accommodate, and whether or not you end up regularly throwing away food. The more data you collect and the more accurate your observations, the greater your ability to determine this outcome.

There’s rarely an easy answer to the question, “Should my whole household be gluten-free, wheat-free, egg-free, dairy-free, nut-free, shellfish-free, soy-free?”, but exploring the options will make you more aware of your habits and the concerns of other family members. That is valuable information upon which to build. My family has found that developing an acceptable plan can reduce stress in the household and make it easier to support each other’s health.

And that would be a good thing for most families…problem is, we LIKE to argue the relative merits of pretty much anything. Of course, you can help us out. Start a whole new discussion by telling us how things work in your household.

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”