Are We Nuts to Give Peanuts to Babies?

Food allergies, and peanut allergies, in particular, have been at the forefront of concern in the US for the last decade. It’s estimated that about 2% of US children suffer from a peanut allergy – and because peanut allergy is less likely to be outgrown, peanut allergy is an important public health issue. Peanut allergies, along with other food allergies, can be life threatening. To date, strategies to reduce risk for children involve avoiding peanuts, establishing food safety guidelines for schools and food servers, and educating the public about allergies. Until now.

We now have compelling scientific evidence to help us PREVENT peanut allergy in children based on the results of the LEAP Study. Published less than 2 years ago, this large and well controlled study looked at babies at high risk for developing food allergy (with severe eczema, egg allergy or both) and asked the question, “Does early introduction of peanut protein help a baby develop tolerance (peanut as friend) or promote allergy (peanut as enemy)?” Suffice it to say that after 7 years, the study showed an 85% REDUCTION in peanut allergy in the study group that received 3x weekly peanut protein from the age of 4 months on.

Early this January, the Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel was released. These new guidelines now give parents and clinicians the tools by which we hopefully can reduce peanut allergies in our new generations. Instead of waiting until 3 years to introduce peanut (as was previously thought to be beneficial), we’ll be giving peanuts early. Here’s how it works:

  1. The new addendum provides guidance for the introduction of peanut foods according to three specific risk categories of infants, namely those with:
    1. Severe eczema or egg allergy or both
    2. Mild to moderate eczema
    3. No eczema and no food allergy
  2. Peanut foods should be introduced to infants as recommended by the expert panel in accordance with their specific risk as follows:
    1. Babies with severe eczema, egg allergy or both – introduce age-appropriate peanut foods as early as 4-6 months, after (1) introduction of other solid foods and (2) evaluation with blood Ige or skin prick testing by your child’s doctor or allergist.. Infants in this category should see their healthcare provider before introducing peanut foods. Depending on the results of the blood or skin tests, peanut foods should be introduced under supervision by a knowledgeable healthcare provider or at home.
    2. Babies with mild to moderate eczema – introduce peanut foods around 6 months of age, in accordance with family preferences and cultural practices. Age-appropriate peanut foods can be introduced at home without an in-office evaluation by a healthcare provider, unless the infant’s healthcare provider or caregiver prefer an evaluation or supervised feeding or both.
    3. Babies with no eczema or food allergies – freely introduce age-appropriate peanut containing foods together with other solid foods and in accordance with family preferences and cultural practices.
  3. Introducing peanut foods to infants is easy and can be done by:
    1. Feeding the infant 21 pieces of Bamba or similar peanut puff product (either as is or softened with 4-6 tsp of water)
    2. Mixing 2 tsp of peanut butter into 2-3 tsp of hot water (allow to cool before feeding)
    3. Mixing 2 tsp peanut butter into 2-3 tbs previously tolerated pureed fruit or vegetables
    4. Mixing 2 tsp of powdered peanut butter or peanut flour into 2 tbs of previously tolerated pureed fruit or vegetable
    5. **Whole nuts should not be given to children under 5 years of age. Peanut butter directly from a spoon or in lumps/dollops should not be given to children less than 4 years of age.
    6. The recommendations include giving peanut products 3 times/week to those babies at high risk, and ad lib (when wanted, but at least 3 times weekly) to babies at medium or no risk.

The hope is that, over the next decades, we will see a marked reduction in peanut allergy by incorporating these guidelines into the diets of our babies. And what better way to blend that peanut protein into a baby’s diet than using the Baby Bullet!

It’s important here, to speak with your healthcare provider first, before introducing solid foods to your baby. This way you are on the same page on the road to a healthy, well-nourished baby.

 

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About Dr. JJ Levenstein

Dr. JJ Levenstein is a board-certified pediatrician and fellow of the American Academy of Pediatrics and in 2012 retired from her thriving private pediatric practice in Encino, California. She served on the staff of CHLA and Encino Tarzana Hospitals for 20 years and was consistently voted one of the Best Doctors in America® from 2003 through 2012. Drawing from her experience as a pediatrician and mom, Dr. Levenstein serves as president and co-founder of MD Moms, makers of Baby Silk, the first personal care line for babies developed by pediatrician moms. She serves on the board of United Cerebral Palsy LA, is an active writer and sits on the advisory boards of several child-centered websites. She is an accomplished chef and completed culinary school in 2013! She has had a lifelong interest in child nutrition and all things related to preventive health.

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