Why & When You Should Feed Your Baby Peanuts (According to Science)
By Dr. Maria Rivera
Are you confused about how and when to introduce 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’s hard to keep up. It shouldn’t be that complicated, but it is. So let’s demystify it!
Update: The recommendations keep changing! We updated this article after the AAP officially updated their guidelines.
Are you thinking: “I wasn’t supposed to give my last baby peanuts until they were older, right?”
Yes, that’s right. The previous recommendation was that we should not feed children 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 who were thought to be at high risk for food allergies — kids with eczema, asthma, or those that had other family members with food allergies. We thought that 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. These new guidelines said that parents did not have to delay introduction, because there was little evidence that delaying actually prevented allergies. However, many doctors didn’t realize this had changed and were still recommending a delay. The AAP just updated their guidelines for 2019 and gave more recommendations. We will focus on their recommendations for allergen introduction (although they covered other interesting stuff like breastfeeding & eczema!)
The biggest change came after results were published on a study called the LEAP study. In the study, researchers compared a group of babies that had peanuts introduced between 4 and 11 months to a second group where introduction was delayed until they were 5 years old. Next, researchers looked at both groups when they turned 5 and found that those that had peanuts early and frequently had way fewer allergies than those that waited (86% reduction!). They did a few more comparisons and kept finding that early peanut introduction seemed to prevent the allergy.
So what do the experts say now about when and how to introduce peanuts?
The new approach is EARLY and OFTEN. But, note that these recommendations are mainly based on peanuts! That’s where the strongest data is. There are now specific guidelines for peanut 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
- mild or moderate eczema:
- THEN introduce peanuts at 6 months (no testing needed)
- no 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 parents, the 2-month well-child visit is a good time to bring up allergen introduction with your pediatrician, long before you are starting to think about food introduction.
What is OFTEN?
In these studies, the families usually give the allergen every day. To be exact, the LEAP study gave babies 6g of peanut protein per week in the form of Bamba peanut puff or other cooked peanuts (we calculated that to be about 8 Bamba per week). Obviously, this can be difficult and impractical. The goal is to 1) expose your child to the top 8 allergens as often as possible by the time he or she is 12 months of age and 2) diversify their diet with other foods as much as you can.
What about introducing your baby to allergens other than peanuts?
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 for other foods, because of findings from other smaller studies, particularly with eggs. Though the AAP did not make any specific recommendations on early introduction of any other allergen, they did state that there is no evidence showing that delaying introduction prevents allergies. Many experts believe that introducing allergens early and often can help prevent food allergies. In the United States, the important allergens to consider are: milk, wheat, soy, egg, fish, shellfish, tree nuts, and sesame.
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 in 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. Many experts still recommend introducing foods that are 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 food 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? If it makes you feel more comfortable, it is perfectly find to follow that tip, but if you want to go faster — go for it.
Finally, continue giving your child the newly introduced foods. It’s very common for kids to reject foods at first taste. However, the more diverse their diet by the time they are 1, the better!
How do I introduce these allergens?
You could puree in allergen 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 that makes 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 kid-friendly 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 with 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. Either way, breastfeeding should remain your child’s major source of calories. 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 that 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 or on the foublie app.
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