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.

baby

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

Baby Knows Best

I know it sounds counter intuitive, but sometimes baby knows best. If you’re having trouble getting your baby to eat, try following his lead. Obviously, babies don’t know anything about nutrition, or electric outlets, or the dangers of drinking antifreeze. That means they don’t need to run the show, but it doesn’t mean their preferences should be ignored entirely.
DJ4
Babies come equipped to express their needs. If you’re a parent, you’re well aware of your baby’s ability to communicate hunger, discomfort, frustration, anger, and a preference for mommy and daddy. Each baby, like each adult, is slightly different. A one-size-fits-all approach to introducing solid food can result in frustrated babies and irritated parents. Eventually, all babies will learn to eat solid food, but why not make the process as painless as possible?

This is a frequent topic of discussion with my son who believes that hands and the floor should stay clean and whatever’s offered should be eaten…no matter what. Sometimes I wonder if he’s forgotten how he was raised. He was allowed to make a mess, get his hands dirty, and choose not to eat something as long as he was eating something else that was offered.

Mind you, I understand it’s not fun to clean up the mess my grandson DJ makes. The first day I decided to see if he was ready to scoop food out of a bowl by himself, I ended up with food all the way to the top of my refrigerator door. From this I determined he’s not ready to handle a bowl, but he knows how to have fun!

I prefer to keep meal time a lighthearted learning experience rather than a battle of wills. All this requires is a sense of humor, attentive observation, and a little preventative maintenance. I now cover the floor under the high chair with a sheet so that cleanup is quick and easy. If DJ wants to mash the banana on his tray rather than eat it, we make a game of it. After all, he’s learning what foods are called, how taste & textures vary, how to pick up small pieces of food, and depth perception. At 8 months, he’s not ready to learn table manners yet. That will come. Of course I set some limits. When DJ decides to spit peas, he gets one free pass. After that, the peas go away until another meal.
snarl
It can be easy to assume a baby wants to spit peas because she’s misbehaving or hates green vegetables, but it’s obvious that DJ is just having fun making noise, making a mess, and watching my response. He loves it when I think he’s funny. After we have a laugh, he usually goes right back to eating. He actually likes peas.

Food preferences can develop before a baby is born. A child who spits out spinach may gobble up asparagus or broccoli. When you offer a large variety of fresh vegetables and fruits, you’ll soon learn where your child’s preferences lie so that you can incorporate some of those foods into the family menu on a regular basis.

DJ’s parents feed him regular food that they prepare at home. That way he can eat the same foods they’re eating and they can know exactly what he’s consuming. While they have chosen not to use prepared baby food, they are creating traditional purées for him to eat from a spoon.

After a month or so of success introducing foods, DJ began to gag or shudder whenever the spoon approached his mouth. He no longer seemed to like foods that he loved the day before. He also seemed reluctant to touch his tray, and he clearly wasn’t enjoying himself at meal time.

I might not know how to solve that specific problem immediately, but I know how to make the experience more engaging. Once a baby is engaged, a little observation can lead to some possible solutions. Babies love to put things in their mouth. They enjoy touching new textures. DJ needed to get his hands dirty.
spoon
I bought him a silicone spoon that works as both a teether and a spoon. It’s easy to hold with no pointed end to endanger a baby’s eyes. Of course DJ wanted to grab it and chew on it. Then I added food — the same food that he gagged at when I tried to feed him. He grabbed the spoon, ate a big bite, looked at me and said, “Mmmmm!” He had fun for the rest of the meal. Weeks later, DJ is still having fun at meal time and he’s eating well. Sometimes he’s happy for me to feed him. Sometimes, he wants control of the spoon. I simply follow his lead.

The result of a little observation and willingness to experiment is a baby who has shown us that he prefers vegetables to fruits and eats a wide variety — spinach, green peas, broccoli, cauliflower, sweet potato, butternut squash, black eyed peas, potatoes, and carrots. He also likes chicken, avocado, cantaloupe, dates, and mango. He doesn’t like to eat bananas, but he loves to smash them into his tray.
DJ Eating
As his world expands, DJ’s preferences will continue to evolve. We plan to take note and include his new preferences in our meal plans. We will offer simple choices between A and B rather than open ended questions regarding what he wants to eat. This will give DJ control over his diet within the boundaries of the adults who know he will thrive with fresh vegetables, fruit, meat, and eventually eggs, dairy, and whole grains. Our goal is to provide healthy food while keeping meal time peaceful and fun. My son and I can agree on this.

If you run into a problem getting your child to eat, keep offering a variety of fresh food, follow his lead whenever it makes sense, and remember to have fun! That may be all it takes to solve the problem.

World Breastfeeding Week

SidebabyWorld Breastfeeding Week just drew to a close. What? There’s a World Breastfeeding Week? Well, yes there is. It’s coordinated by the World Alliance for Breastfeeding Action (WABA) and began about 15 years ago.

WABA’s core partners are the Academy of Breastfeeding Medicine (ABM), International Baby Food Action Network (IBFAN), International Lactation Consultant Association (ILCA), La Leche League International (LLLI), and Wellstart International.

This year, in addition to encouraging women to breastfeed, WABA focussed on raising awareness of the links between breastfeeding and Sustainable Development Goals along the following themes:
1)Nutrition/food security
2)Health, well0being and survival
3)Environment and climate change
4)Work productivity, empowerment, social protection, and
5)Sustainable partnerships and rule of law

That sounds lofty and idealistic, but in the US, there’s a huge gap between our lofty breastfeeding goals and our actual practice. The American Academy of Pediatrics recommends feeding babies nothing but breast milk for the first 6 months of life. When moms arrive at the hospital to give birth, the majority say they are planning to follow this guideline. Three months later, 43.3% are exclusively breastfeeding and 29.3% are supplementing with formula. By 6 months according to the CDC, the percentage of exclusively breastfed babies has dropped to 21.9% and 35.4% of nursing mothers have supplemented with formula.*

Rates of Rates of breastfeeding declined in the US between 1911 and 1972 when only 22% of women initiated breastfeeding. While the rates have increased since 1972, they remain low in spite of the known health benefits to both infant and mother. So it seems that our tortured relationship with healthy food in this country literally begins at birth and for many of the same reasons adults cite as impediments to healthy habits – convenience, lack of social support, confusing messages from the medical community, and advertising that reassures us a product is healthy (the closest to breast milk).
scream

When it comes to convenience, I feel like we often think of things in a topsy turvy manner. What could be more convenient than always having milk ready and at the right temperature when a baby gets hungry? It becomes inconvenient when women feel they must go back to work quickly to support their families or believe that they’ll get behind in their careers if they take off a few years to raise children. While this is sometimes the reality, other times it isn’t, but the belief has become so ingrained that we rarely challenge it.

We don’t always run the numbers to see if our jobs really cost more than they bring in, especially if we have more than one child in day care. We appear to forget that added trips to the doctor for either baby or mother who has missed out on the health benefits of breastfeeding take time out of our schedule.

Nor is there much social support for breastfeeding in public places in many communities in the US. You may have seen the recent video of a man telling a breastfeeding mother in Target how disgusting she is. This type of experience has been reported by 25% of breastfeeding moms.

This seems kinda crazy to me considering the number of reality TV stars who run around with half of their boobs showing all the time. Is it the addition of a baby that makes seeing a breast disgusting? I guess that could make sense. Babies are kinda gross sometimes.

Almost 20% of US babies receive supplementary formula within the first two days following birth. That means it’s often being fed while mom and baby are still in the hospital. When you combine this with the formula samples and ads that are often sent home with the mothers, it can appear like a medical endorsement of formula. Studies show that leaving the hospital with formula samples reduces the duration of breastfeeding.

While it’s easy to brush all of this off as insignificant as long as our life expectancy remains the same, the rise in chronic diseases is making our lengthy lives of lower quality. Perhaps someday soon, we’ll recognize that quality can be as valuable as quantity. We’ll see that we don’t have to rush to accumulate, achieve, or hit some arbitrary target to bring value to our lives, our communities, and the world.

In the meantime, I wish you the courage and perseverance to give yourself and your children the best nutritional support available even when it’s not as easy, convenient or well-supported as you believe it should be.

monkey hand

*Based on most recent CDC statistics available (2012) https://nccd.cdc.gov/NPAO_DTM/

http://www.bfmed.org/
http://www.ibfan.org/
http://www.ilca.org/home
http://www.llli.org/
http://www.wellstart.org/

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)00210-5.pdf
http://abcnews.go.com/Health/story?id=117395&page=1

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.”