Strong evidence continues for babies getting peanuts before a year of age. Now, more than ever, I believe parents to babies at risk for allergies need to pay close attention during the first 6 months. Although the pendulum has swung about how, when and why to introduce peanuts to babies over the past years, more and more experts agree. There are 3 categories and 3 specific recommendations for babies. Babies at risk for allergies should get peanuts by 4 to 6 months of age, although there are conditions and specific recommendations, based on a baby’s family history and health, so read the 3 tips below carefully.
I’ve noticed with the advice swirling and moving the last decade, parents remain a bit shy about starting peanuts before a year of age. I have a comprehensive blog post, Peanuts During Infancy To Prevent Peanut Allergy, detailing the ground-breaking study (I truly don’t think I’m overstating the ground-breaking part) that came out last year. Basically, researchers found that babies at higher risk for allergies (eczema, family history of allergies, egg allergy) had less peanut allergy in life when given peanuts as babies compared to babies who waited to have peanuts. Since that time more data has unfolded that points the same direction.
Even as the data mounts, I think the shyness to introduce peanuts continues for some families. Simply because we’ve heard the opposite advice for previous years. Read on and please share this. Over the next decade we may turn some of the tide on peanut allergy.
Science shifts its weight a lot so it’s hard to register immediate trust in shifting advice. The shyness makes sense but I hope this post helps combat it. This New York Times article about why advice changes, by pediatrician Dr. Aaron Carroll, is worth your time if you’re curious about the rationale and reason for shifting medical advice. When it comes to peanuts I feel good about early introduction for nearly all children. Here’s why:
An expert panel published new guidelines in the Journal of Allergy and Clinical Immunology this month about when to introduce children to peanut-containing foods to help prevent food allergies. Here’s a summary of the panel’s report written for parents. The science, as detailed in the post I wrote last year was strongly influenced by previous research. The panel says, “recent scientific research has shown that peanut allergy can be prevented by introducing peanut containing foods into the diet early in life. Researchers conducted a clinical trial called Learning Early About Peanut Allergy (LEAP) with more than 600 infants considered to be at high risk of developing peanut allergy because they had severe eczema, egg allergy, or both. The scientists randomly divided the babies into two groups. One group was given peanut-containing foods to eat regularly, and the other group was told to avoid peanut-containing foods. They did this until they reached 5 years of age. By comparing the two groups, researchers found that regular consumption of peanut-containing foods beginning early in life reduced the risk of developing peanut allergy by 81 percent.”
How To Reduce Peanut Allergy Risk For Your Baby:
In general, the easiest way to think on this is that waiting on peanuts likely isn’t safer when it comes to preventing allergies. When and how to introduce depends specifically on who you child is, what’s possibly in their genes, if they have shown a tendency to be allergic, and how old they are. Here’s 3 categories:
- Children who have significant or severe eczema, egg allergy or both: parents should first talk with their pediatrician and likely consult with an allergist. Many of these children should get peanuts at 4 to 6 months of age but will need testing first (skin prick test or a blood test) to see whether the infant is allergic to peanuts. If the child is not allergic, parents should follow the recommendation of introducing peanut-containing foods at 4 to 6 months. However, if the infant is allergic, parents should refrain and see an allergist. Introduction may still be possible but if allergic, would need to be in the care of an allergist or pediatrician’s office. See video below.
- Children with mild to moderate eczema: these children should be introduced to peanut-containing foods about 6 months of age. Avoid whole peanuts (choking risk) or thick peanut-butter, but diluting peanut-butter into a puree can be a good way to start. Parents should make sure the child is ready to start foods with other purees for a couple of weeks first. Don’t choose peanuts as the first food (how about some fruits and veggies first, at least!) and make sure you go slow on the day you start. You can do this at home without an in-office examination prior but if you’re a worrier, it’s okay to coordinate with your pediatrician, too. The panel states, “infants in this category may have dietary peanut introduced at home without an in-office evaluation. However, the expert panel recognizes that some caregivers and healthcare providers may desire an in-office supervised feeding, evaluation, or both.
- Children with no eczema or food allergies and no family history: these children can either be fed peanut-containing foods or not at any age, based on family/parent preference. There isn’t strong data that in low-allergy-risk children they NEED early introduction but that it may make sense. It’s my belief that families should try to introduce during infancy, and slowly, as advised in the video below.