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.
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.