FULL DISCLOSURE: I work for the National Peanut Board as a consultant, especially in the area of peanut allergy education and outreach and as @PeanutRD, but they did not pay me to write this post. I feel passionately about the potential to prevent many future peanut allergies through early introduction and want to share this information to caregivers everywhere.
DYK that recent research proved that peanut allergies can be prevented?! It’s TRUE! Since it’s #FoodAllergyAwarenessWeek, I wanted to take a moment to share this exciting update.
In 2015, researchers from King’s College London released the results of their Learning Early About Peanut (or LEAP) study. In this study, they randomized more than 500 infants who were at high risk for developing peanut allergy (each infant had either severe eczema or was already diagnosed 
with egg allergy). After being screened for peanut allergies, the babies either began to eat peanut foods when they were enrolled (at between 4-11 months old) or did not eat peanut foods. They were followed for 5 years. What they discovered was striking – there was a reduction of up to 86% in the risk for developing peanut allergies. Early introduction provided huge protectionagainst the development of peanut allergies in these high risk infants and this finding changed how experts think about introducing peanut foods to infants. In fact, more than a dozen health organizations, including American Academy of Pediatrics, American Academy of Allergy Asthma and Immunology, and the American College of Asthma Allergy and Immunology, came together to agree that infants, particularly high-risk infants, should be fed peanut foods early.
A percentage of the children who eat peanut foods early did still develop peanut allergies. Researchers don’t know if these children’s allergies were inevitable or if even earlier intervention was needed. While peanut allergies CAN be prevented, they may not be prevented in every case. This is a good place to say that if your child has a peanut allergy, IT IS NOT YOUR FAULT. If you withheld peanuts because your doctor/momma/bff/neighbor told you to, you did what you thought was the right thing to do that the time. We are all always doing the best we can with the information we have at the time – that goes for parents, researchers, and healthcare providers. When we know better, we do better. Shake off the guilt and go from where you are, friend. You are an awesome parent!
NIAID Gives the Details
Fast forward to January of this year when the National Institute of Allergy and Infectious Disease (NIAID) released their expert report providing the 2017 Addendum Guidelines for the Prevention of Peanut Allergy in the United States. In this report, the expert panel provided guidance for clinicians and caregivers on how to apply what we learned from the LEAP study. Essentially, they break infants into three categories of risk.
- In Guideline 1 the panel addressed those infants at highest risk – this includes infants with severe eczema and/or egg allergy. These infants should see their healthcare provider before introducing peanuts. They may need a skin prick test or blood test before eating peanuts; or their physician may want to supervise their first introduction to peanut in the doctor’s office. The greatest benefit for early introduction could be among this group, so they should begin eating peanut foods at 4-6 months and continue about three times per week.
- Guideline 2 addressed those infants with mild to moderate eczema. These infants do not need pre-screening by their healthcare provider, but may do so if the parents prefer. They should begin eating peanut foods at around 6 months of age.
- The final guideline, Guideline 3, is for those infants without eczema or known food allergies. They should eat peanut foods starting at 6 months or whenever their family prefers.
How To {Safely} Feed Babies Peanut Foods
Obviously you cannot feed babies whole peanuts – whole peanuts are a choking hazard! Even globs of peanut butter can be dangerous for infants and toddlers. But, you can easily feed a baby peanut butter when it has been thinned with a little warm water. You can also stir it into infant cereal or into pureed foods. Powdered peanut butter is another great option, because it dissolves easily. Or you can use peanut puffs (such as Bamba brand), which are meant to be a weaning food. About 2 teaspoons of peanut butter or peanut butter powder are the perfect amount. You can learn more from this handy-dandy introduction handout from NIAID. Y’all – babies should ALWAYS be supervised when they are eating. The NIAID introduction handout provides signs and symptoms to watch for in case your child may have a reaction.
My friends at the National Peanut Board (NPB) have also developed some fun resources to help answer questions about how to introduce peanut foods.
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- Check out this infographic on 5 easy ways to introduce peanut foods.
- And this adorable video featuring one of the cutest little sweetie-pie babies ever.
- And here is a little video I did providing three baby & toddler-friendly peanut recipes (remember, for babies, you want the peanut butter to be smooth and thinned).
Words of Encouragement for the Fearful Feeder
Remember: Most children do not develop food allergies. In fact, more than 98% of children will not be allergic to peanuts. Peanuts and peanut butter, milk, eggs, fish, and other potentially allergenic foods are nutritious and healthy foods for us and for our babies. Offering your baby a diverse diet that includes all of these foods (in age-appropriate forms and textures) may help prevent allergies (and a host of other diseases down the road by supporting a healthy microbiome). In addition, a varied diet may also help your baby become a better eater later. Become familiar with the guidelines and, if your child has no risk factors, move forward with confidence. If they do or if you’re not sure, discuss your baby’s risk with his or her doctor, then move forward as she recommends. Do not fear; just do the next right thing.
