By Dr. Maria Rivera
Why You Should Feed Your Baby Peanuts (According to Science)
Are you confused about what you should be doing when it comes to introducing food allergens like peanuts to your baby? I don’t blame you. The evidence and guidelines have changed a lot in the last couple of years and it is hard to keep up. It shouldn’t be that complicated, but it is. So let’s demystify it!
Update: The recommendations keep changing! We are updating this article after the AAP officially updated their guidelines this week.
You might be thinking to yourself, with my last child I wasn’t supposed to give them peanuts until they were older, right?
Yes, that’s right. The previous thinking was that we shouldn’t give any form of cow’s milk protein until 1 year of age, eggs until 2 years, and peanuts or seafood until 3. This was particularly important for kids we thought were at high risk of food allergies. These are kids with eczema, asthma, or that had other family members with food allergies. We thought exposing kids to these allergens too early would cause them to get food allergies or asthma.
Believe it or not the American Academy of Pediatrics actually changed its guidelines back in 2008 and said that parents did not have to delay introduction because there was little evidence that delaying actually prevented allergies. However, many doctors did not realize this had changed and were still recommending a delay. The AAP just updated their guidelines this week for 2019 and gave more recommendations. We will focus just on their recs for allergen introduction (though they covered other interesting stuff like breastfeeding & eczema!)
The biggest change came after results were published on a study called the LEAP study. They compared a group of babies where peanuts were introduced between 4 and 11 months to a second group where introduction was delayed until they were 5 years old. They then looked at both groups when they turned 5 and found that those that got peanuts early and frequently had way fewer allergies than those that waited (86% reduction!). They did a few more comparisons and kept finding that giving peanuts early seemed to prevent the allergy.
What do the experts say now?
Early and often is the new approach. But note that the recommendations are mainly based on peanuts! That’s where the strongest data is. So for peanuts, there are now specific guidelines for introduction depending on where your child fits in.
What is early?
- If your child has severe eczema, an egg allergy, or both:
- FIRST strongly consider getting evaluated for peanut allergy by an allergist (peanut allergy testing is recommended before introduction). If negative,
- THEN introduce peanuts at 4-6 months of age when they are developmentally ready for solids
- If your child has mild or moderate eczema:
- THEN introduce peanuts at 6 months (no testing needed)
- If your child does not have any food allergies or eczema:
- THEN no strict guidelines on when to introduce. Though some experts also argue you should introduce early and often
If you already have a child with a food allergy or peanut allergy, you should definitely talk to your doctor about early introduction as well.
For all, a good time to bring this up with your pediatrician is at the 2 month well-child visit, way before you are starting to think about food introduction.
What is often?
Well the studies done usually have families give the allergen every day. To be exact the LEAP study gave babies 6g of peanut protein a week in the form of Bamba peanut puff or other cooked peanut (We calculated that out to be about 8 Bamba per week). Obviously, this can be difficult and impractical. The goal is that by the time your child is 12 months of age you expose them to the top 8 allergens as often as you can and diversify their diet with other foods as much as you can.
So what about for other foods?
There haven’t been any studies as clear cut as the LEAP study for other allergens. However, most experts agree that the same strategy makes sense because of other smaller studies, particularly with eggs. Though the AAP did not make any specific recommendations on early introduction any other allergen, they did state that there is no evidence showing that delaying introduction prevents allergies. Many do believe that introducing allergens early and often can help prevent food allergies. The important allergens to think about in the United States are: milk, wheat, soy, egg, fish, shellfish, tree nuts, and sesame.
So if I am just starting out solids, what do I do?
First you wait to make sure your child is ready to start eating solids. They should show interest to food, be able to sit when supported, hold up their heads, and not push food out with their tongues when you try and feed them.
Then introduce anything! You can introduce any food you like! Yes really. A lot of experts still recommend introducing foods less likely to cause allergies as the first ever food (like oat baby cereal) since the baby is still learning to eat. But after that, anything is fair game- and we believe the earlier you introduce allergens the better. Also, did you know that the common belief that you need to wait 3-5 days in between foods is not actually based in any evidence? It is ok to still follow that tip if it makes you feel more comfortable, but if you want to go faster- go for it.
Finally, keep giving foods and introducing them. It is really common for kids to reject foods at first taste. However, the more diverse their diet by the time they are 1, the better!
So how do I introduce these allergens?
You could puree in allergens like fish into your child’s food. If that sounds hard or gross, there are several products out there that can help you introduce allergens. SpoonfulOne is a powder developed by an allergist at Stanford that can be mixed into your kids’ food. Inspired Start is a company making baby pouches that each contain a common allergen. My son tried these and loved them, even the weird pear and egg combo. Bamba is a peanut puff snack from Israel that you can now buy on Amazon or Trader Joe’s. That one is also a favorite in our home and was the one used in the studies. (Foublie is not affiliated or sponsored by any of these companies, we just want parents to have good options!)
Is there anything else I can do to prevent food allergies?
Yes! Exposing your kids to dirt, treating their eczema, using fewer antibiotic soaps and detergents, getting adequate Vitamin D, and even getting a dog have been shown to reduce allergies. This awesome TedX talk by expert Dr. Kari Nadeau summarizes it nicely.
What if I am exclusively breastfeeding?
The AAP recommends exclusively breastfeeding until around 6 months. The EAT study, another big study on introducing food allergens, did suggest that introducing allergens before 6 months was feasible and did not seem to affect breastfeeding. Breastfeeding should remain your child’s major source of calories either way. Bottom line, when exactly to start solids should be a decision you make with your doctor.
Lastly, if your child already has a food allergy just remember it is not your fault! I know parent guilt is terrible but just remember you are doing your best and will continue to do so!
We’ve put together some resources for parents managing a new food allergy. Check those out here.