Have you been wondering how and when to introduce peanuts and tree nuts to your baby?
In this video I’m going to talk about the safe ways to offer these potentially allergenic
foods, and the best age to introduce peanut and tree nut products to your baby.
If this is our first time meeting, I’m Dr. Belousov.
I’m a board certified pediatrician and I equip parents with knowledge, so they can
care for their children with confidence.
Many parents are nervous about introducing the common allergenic foods to their baby,
especially peanuts, because of fear of an allergic reaction.
I put together this video series to show you how simple it is to introduce these foods,
and to make you aware of the health benefits of introducing the allergenic foods early
and often.
This is the second video in the food allergy series.
I'll have the other ones linked at the end of this video once they’re released.
Starting off, let’s talk about what age you should begin introducing peanut and tree
nut products to your baby.
For many years parents were advised to avoid exposing their child to the common allergenic
foods in their first several years of life.
However more recent studies have shown that delaying the introduction of the common allergenic
foods can increase a baby’s risk of developing allergies to these foods.
The Learning Early About Peanut Allergy or LEAP study, showed that early introduction
of peanut to babies at risk for peanut allergy reduced their chances of developing a peanut
allergy by 80%.
According to the study, babies who were considered high risk for peanut allergy were those who
had severe, persistent eczema and/or a diagnosis of egg allergy.
It was found that these babies would benefit from the introduction of peanut-containing
foods as early as 4 to 6 months.
But before introducing a peanut product, it’s recommended that babies who are considered
high risk for peanut allergy have an allergy evaluation or allergy testing.
So if this is the case for your baby, speak with your child’s healthcare provider between
the ages of 2 to 4 months regarding a plan for how and when you should introduce peanut
products.
And if the test comes back positive for a peanut allergy, you will most likely be advised
to do the initial introduction in the supervised setting of a medical office.
Babies with mild to moderate eczema are also at a slightly increased risk of developing
peanut allergy.
To decrease their risk, they should be introduced to peanut containing products around 6 months
of age and continue to be exposed to peanut containing products regularly.
These infants don’t need to have allergy testing, and may have the peanut product introduced
at home.
Although tree nut allergy has been less studied than peanut allergy, the risk factors are
believed to be similar to those of peanut allergy.
Of tree nut allergies, walnut allergy is most common, followed by cashew, almond, pecan
and pistachio.
Allergies to hazelnut, pine nut, and macadamia are even less frequent.
Tree nut products can be introduced as early as 6 months of age.
After introducing your child to several low allergy foods, you can begin to offer the
common allergenic foods to your baby one at a time, even in the first week of starting
solids.
There’s no reason to delay exposing your baby to peanut and tree nut products early
on in the food introduction process.
It’s to the baby’s benefit to eat them early, and to continue to eat them often as
a strategy to lower your child’s risk of developing an allergy to these foods.
Now let's talk about how you can safely introduce peanuts and tree nuts to your baby.
Pick a good time in the morning or afternoon to introduce the new allergenic food.
This way you give yourself several hours of awake time to observe for a potential allergic
reaction.
Avoid introducing two new foods on the same day, that way in the event that your child
has an allergic reaction, it won’t be confusing which one was the cause.
When introducing peanut or tree nut for the first time, out of an abundance of caution
it’s recommended to spend several days giving the new allergenic food, and holding off on
offering any other new foods during those days.
However it’s fine to bring back foods that your baby had previously and did well with.
Whole nuts are choking hazards and should not be fed to babies or toddlers.
If whole or partially chewed nuts are accidentally breathed into the lungs, they can block the
airways.
It’s best to avoid giving whole peanuts or nuts to your child until they’re old
enough to be counted on to chew them well, which is usually after 4 years of age.
There are multiple ways that you can safely introduce peanut products.
In the LEAP study, they had baby’s take Bamba peanut puffs.
These are peanut covered corn sticks that are easily dissolvable.
Another great option are the peanut puffs from Puffworks.
They have no added sugar and minimal salt.
I have links for the Bamba and Puffworks items in the description below if you’d like to
check them out.
You may dissolve the peanut puffs with some breast milk, formula or water to soften them
if you’d like.
However most babies 6 months and older don’t have any trouble taking them as they easily
dissolve with their saliva.
Since nut butters are sticky and can be dangerous if given in their original form, I recommend
you offer the smooth version of peanut butter either thinned out with water or added to
a baby cereal or a fruit or vegetable puree that the baby has had previously.
If you’re going to be mixing it with water, the peanut butter will thin out quicker with
warm water.
For every teaspoon of peanut butter add one to two teaspoons of water, depending on the
consistency that you want.
When mixing peanut butter with a baby cereal or a pureed food add at least two to three
teaspoons of that food for every teaspoon of peanut butter.
You may also mix peanut butter in yogurt, but first be sure to introduce just yogurt
to your baby for several days to make sure there’s no allergic reaction, since milk
is one of the common allergenic foods.
As your baby gets older, you may also spread the thinned out peanut butter on a whole grain
bread.
Most babies do better with the bread toasted and cut into stips about the size of an adult
pinky finger or a little thicker.
Wheat is also one of the common allergenic foods, so first you’ll want to introduce
it plain.
To introduce tree nuts, it’s easiest to get the smooth version of almond, cashew or
walnut butter and just as I described with how you can offer peanut butter, you can also
thin out the nut butters with warm water or mix into a vegetable or fruit puree.
For an older baby you can also spread a thinned out nut butter onto strips of toasted whole
grain bread.
You may be wondering how much peanut and tree nut product you should be giving to your baby
and how often.
At this time there are no explicit recommended guidelines for the amount that a baby should
take.
In addition the exact amount of the allergen needed to decrease a child’s risk for developing
an allergy to that food is still unknown.
However the original LEAP study looked at giving 6 grams of peanut protein per week,
which translated to 7 Bamba puffs three times a week.
In the Enquiring About Tolerance or EAT Study, they asked parents to give their babies a
target of 4 grams of each allergenic food protein per week divided into two or three
meals, and found that early introduction was effective in preventing the development of
food allergy.
Children who are at higher risk for developing food allergies stand to benefit greatly from
early and frequent exposure to peanut and tree nut in their diet.
But even if your child doesn’t have any risk factors for food allergies, delayed introduction
can increase the risk of becoming allergic to these foods.
Therefore there’s no benefit to delaying their introduction.
In upcoming years I believe we will have clear guidelines on exactly how many grams of the
allergenic food to give and how many times a week.
But in the meantime, you can aim for a target of giving at least 2 grams of the allergenic
food protein two to three times a week.
And be sure to continue to expose your baby to them on a weekly basis, since regular exposure
is just as important as early introduction for allergy prevention.
And even if you aren’t able to give as much as I’m recommending, your child stands to
benefit from the consistency of being exposed to these allergenic foods in their diet.
If you’ll be adding peanut butter to your baby’s cereal, yogurt, or puree, each teaspoon
of peanut butter contains about 1 gram of peanut protein.
You can achieve offering 2 grams of peanut protein, by mixing 2 teaspoons of peanut butter
with one of these foods.
If you’ll be giving the Puffworks Peanut Puffs to your baby, each bag contains 2 grams
of peanut protein.
Or if you’ll be giving the Bamba peanut puffs, your baby will get about 2 grams of
peanut protein from eating 7 puffs.
Try to continue to offer peanut products to your child two to three meals a week.
When it comes to tree nut containing products, similar to what you would do with peanut butter,
you can do with any of the tree nut butters.
It’s easiest to mix 2 teaspoons into a warm baby cereal, yogurt, or puree at least two
times a week.
I know that parents worry about the potential that an allergic reaction might happen when
they offer peanut or tree nut products.
In the first video of this series I go into detail on how an allergic reaction would present
itself, and what to do in the event that your baby has an allergic reaction.
It’s linked up here if you’d like to check it out.
See you in the next video.