If you are like me and have older children you probably have noticed quite a few changes in the allergy prevention advice over the past few years.
I certainly did!
When my first child was introduced to solids 10 years ago, the recommendation was to wait with nuts and all the rest of potentially allergenic foods until at a least 1 or even 3 years of age.
Then at the end of 2010 the “Guidelines for the diagnosis and management of food allergy in the United States” were published and we learnt that delaying introduction of allergenic foods does not help to prevent allergies and may, in fact, have an opposite effect.
I remember speaking at a group workshop for a about 50 uptown moms a few days the guidelines came out and one of them asked me about them. Oh boy was I glad I had current information on the topic. Love it when parents keep me on my toes :).
Unfortunately, the guidelines from 2010 did not offer any strategies for allergy prevention because we did not have enough strong evidence for it yet.
And then, in 2015, results of a very important study called LEAP (Learning Early About Peanut Allergy) came out. Its subjects were babies between 4 and 11 months who had severe eczema, egg allergy or both.
The babies were divided into two groups. One of the groups was getting peanut containing food until the children were about 5 years old and the other one did not.
When the children were tested for peanut allergy, those who were not exposed to peanut protein from early on were much more likely to develop an allergic reaction to peanuts. The peanut containing product used in the study was Bamba, an Israeli peanut snack commonly given to children from around 7 months.
Since the results of this study were released, all medical community and parents of peanut allergic kids were anxiously waiting for an update in the official recommendations. About 2% of children suffer from this potential life threatening allergy so if there was away to prevent it, everyone wanted to know.
Finally, a couple of weeks ago, in January 2017, National Institute of Allergy and Infectious Diseases (NIAID) released a new set of guidelines which may finally help prevent many children from getting peanut allergies in the future.
Below is a brief overview of the new recommendations.
When to introduce peanuts?
It depends. If your child is at a high risk for developing peanut allergy, you may need to start earlier. Depending on your child’s risk, he may belong to one of the three groups:
Group 1: Children with severe eczema and/or egg allergy. They should be introduced to peanut containing foods between 4 and 6 months of age, as soon as they tried other solid foods. It is very important to discuss evaluation with the child’s doctor prior to giving him peanut containing foods, to estimate the risk of an allergic reaction. In case the child’s risk is high, he may need to be at a health professional’s office at the time of introduction of peanuts. If the risk is low, you will be most likely instructed on how to safely introduce peanuts at home following a specific protocol outlined in the guidelines.
Group 2: Children who have mild to minimal-to-moderate eczema and no egg allergy. They should be introduced to peanut containing products at around 6 months of age, as soon as they tried other solid foods. No evaluation for peanut allergy is required in this case and family does not need to follow any protocol when introducing peanuts.
Group 3: Children who have neither eczema nor egg allergy. They can be introduced to peanut containing products when solids are started, can be later than 6 months. There is not need to worry about doing it at a certain time or following a specific procedure.
How much peanut products to give to your child
If your child has severe eczema and/or egg allergy but the allergy evaluation determined that he is at a low risk for peanut allergy, you will have to follow a certain protocol to introduce peanuts to your child at home.
If your child has no eczema, or mild to moderate eczema and no egg allergy, you do not have to follow any rules regarding the amounts or frequency and can introduce peanut containing foods in any amounts and offer them as often as you wish.
Giving peanuts to your baby: safety first
1. Never give your child whole peanuts or peanut butter from a spoon, they are choking hazards.
2. Make sure your child is healthy.
3. Choose a day when you are at home, not in a restaurant, daycare or traveling and watch your child for at least 2 hours after the feeding. It is also very important to familiarize yourself with the signs of an allergic reaction.
If your child is older than 6 months
If your child is older than 6 months, he can still benefit from introduction of peanut containing food. The children who participated in the LEAP study were between 4 and 11 months at the time of peanut introduction and their risk of developing peanut allergy was still reduced.
So if you are strictly following Baby Led Weaning and your baby is not ready for finger foods by 6 months of age, he will still benefit from introduction of peanut containing foods whenever solids are started.
The same goes for children with developmental delays who may not be ready for solid foods by 6 months of age.
5 ways to safely introduce peanuts to your baby
For children without eczema or egg allergy and those with mild to moderate eczema you do not need to specific recipes or protocols to introduce peanuts safely. Here are a few suggestions you can use to safely incorporate peanuts in your child’s food.
- Peanut snacks. The same peanut containing snack Bamba as the researchers did in the LEAP study or a similar product containing protein powder. It can be offered as a finger food or softened with milk or water and fed with a spoon.
2. Peanut butter, thinned with hot water, formula or breast milk. You can add it to purees, yogurt, mixed dishes or just feed your baby as is.
3. Ground peanuts. Grind some fresh peanuts into powder and add to purees, yogurt or mixed dishes.
4. Sprinkle peanut powder on finger foods. Roll your baby’s finger foods in peanut powder. This makes them less slippery, boosts nutrition and adds variety.
5. Peanut butter toast. Spread a very thin layer of peanut butter on a toast to serve as a finger food.
I hope this post will help to sooth some of your concerns when it comes to introducing peanuts to your baby as well as provide some actionable steps to do it safely.
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