When Should I Give My Baby Peanut Containing Foods?

by Dana Crosby, MD

Why Is It Important?

• Peanuts are the number one cause of death from food induced anaphylaxis, or severe allergic reaction of the body, in the United States.
• Peanut allergy is typically a lifelong problem.
• Risk of death related to peanut allergies leads to significant stress and anxiety for the patient and their family.
• The rate of peanut allergy has been increasing. In 1999 peanut allergy affected only 0.4% of children, but by 2010 this increased to 2% of children. 

Why Is There Confusion?

• In the late 1990s the recommendation from multiple medical societies was to avoid peanut containing foods in infants thought to be at risk of developing food allergies.
• As recent as 2010 medical societies guidelines still recommended avoidance of peanut containing foods until the toddler years.
• Recommendations have now changed dramatically!

Why Have The Recommendations Changed?

• A very important research study was published in 2015, called the Learning Early about Peanut Allergy (LEAP) trial.
• This study showed over an 80% decrease in risk of developing peanut allergy when peanut containing foods were given early in infants who were at high risk of food allergy.
• The LEAP trial showed that introducing peanut containing foods early was safe and protective for most infants.

Current Recommendations

1. If an infant has no eczema (red, itchy skin) and no known food allergy, parents should introduce peanut containing foods early at a time that is right for the family, typically between ages 6 to 8 months.
2. If an infant has mild to moderate eczema (red, itchy skin), introduce peanut containing foods around 6 months of age.
3. If an infant has severe eczema (red, itchy skin) or egg allergy, discuss giving peanut containing foods to infant with pediatrician and/or allergist.

Pearls

• Give other solid foods first to ensure your child is able to eat solid foods.
• All peanut butter should be avoided in children under 4 years of age.
• Do not feed whole peanuts or chunky peanut butter to children under 5 years of age as it could cause choking.
• Peanut butter can be introduced in multiple ways. Peanut butter containing recipes and food products suitable for infants are available online.
• Introduce peanut containing foods only when your child is healthy. If they are experiencing a cold, vomiting, diarrhea, or other illness wait until they have recovered.
• Give first peanut containing food at home when your child can be supervised directly for at least 2 hours to watch for signs of a reaction.
• Common signs of food allergy are rash, swollen lips or tongue, itching, vomiting, coughing, wheezing, difficulty breathing.
• If you are concerned that your child is having a reaction, seek medical attention immediately. Call 911.