Please read this entire article before introducing peanut foods to your infant and feel free to contact us with any questions.
Introduction
The goal of this article is to review introduction of peanut foods into an infant’s diet to lower their risk of peanut allergy.
Guidelines from the American Academy of Pediatrics and the National Institute of Allergy and Infectious Diseases have been updated to recommend early introduction of peanut foods for infants at high risk of developing peanut allergy. These guidelines vary depending on a baby’s individual risk of developing peanut allergy. An infant’s risk of certain food allergies is increased if they have eczema or egg allergy. Eczema is an itchy, red, scaly skin rash that damages the skin barrier and can increase the risk of developing a food allergy.
Our providers can help you evaluate your infant’s risk factors for food allergies. We can also help determine when and how to introduce certain foods into baby’s diet, like age-appropriate peanut foods or eggs. Careful evaluation can especially benefit infants at high risk for these allergies.
Risk Assessment
Low Risk
Infants are at low risk of peanut allergy if they do not have eczema or an egg allergy.
- Age-appropriate peanut foods should be introduced at the same time as other solid foods according to your family preference and cultural practices.
Moderate Risk
Infants are at moderate risk of peanut allergy if they have mild or moderate eczema.
- Age-appropriate peanut foods should be introduced around 6 months of age at home or our office, depending on your preference and your provider’s preference.
- Infants with moderate eczema are also at increased risk for egg allergy. A recent study found that early introduction of egg can lower the risk of egg allergy in infants with moderate or severe eczema. Discuss early egg introduction with your provider.
High Risk
Infants are at high risk of peanut allergy if they have severe eczema and/or egg allergy.
- A blood test or skin prick test that should be done to help us evaluate your infant’s risk for peanut allergy.
- If test results show your infant is not likely to react to peanut, introduce age-appropriate peanut foods at 4 to 6 months of age at home or our office, depending on your preferences and your provider’s preferences.
- If test results show that you are moderately likely to react to peanut, work with your medical provider on how to best introduce age-appropriate peanut foods.
- If test results show your infant is highly likely to react to peanut, work with us and our allergist on next steps. Do not give peanut foods to an infant who has a peanut allergy.
- Infants with severe eczema are also at increased risk for egg allergy. A recent study found that early introduction of egg can lower the risk of egg allergy in infants with moderate or severe eczema. Discuss early egg introduction with your medical provider.
Introducing Age-Appropriate Peanut Foods at Home
Age-appropriate peanut foods should be introduced only at home or our office, not at locations outside the home. When introducing peanut foods at home, pick a time when your infant is healthy and you are able to devote your full attention for at least two hours so that you can watch for an allergic reaction. Symptoms of an allergic reaction are described below.
Steps
- Prepare a full portion of one of the peanut-containing foods from the recipes below. Each provides a 2-gram serving of peanut protein.
- Offer your infant a small taste of peanut-containing food on the tip of a spoon. Wait 10 minutes.
- If there is no allergic reaction after this small taste, give the remaining food slowly.
- Continue to watch your infant for at least two hours for an allergic reaction.
Age-Appropriate Recipes
Whole peanuts, peanut chunks and peanut butter are choking hazards for infants. Make sure that the peanut foods you provide are age-appropriate.
- Never give your infant whole peanuts or pieces of peanut.
- Never give your infant baby chunky or crunchy peanut butter.
- When giving your infant smooth peanut butter, thin it with water or pureed food
Peanut Puffs
You can use any brand of peanut puffs, but the serving should contain two grams of peanut protein.
- If your infant is less than seven months old, soften the puffs with four to six teaspoons of water.
- Feed your infant one puff at a time.
- Older infants who can manage dissolvable textures can eat puffs that haven’t been softened with water.
Smooth Peanut Butter
You will need smooth peanut butter and either hot water or pureed (smooth) fruit or vegetable.
- Measure two teaspoons of peanut butter.
- To thin with hot water, add two to three teaspoons and stir to blend well. Let cool. You can add more water or previously tolerated infant cereal to make your infant’s preferred texture.
- To thin with puree, add two to three tablespoons of pureed fruit or vegetable that your infant has tolerated in the past. You can add more or less puree to make our infant’s preferred texture.
Peanut Flour or Peanut Butter Powder
You will need powdered peanut flour or peanut butter powder and fruit or vegetable puree.
- Measure two teaspoons of peanut flour or peanut butter powder.
- To thin the flour or powder, add approximately two tablespoons of pureed fruit or vegetable that your infant has previously tolerated. You can add more or less puree to achieve a consistency that your infant likes.
Signs and Symptoms of an Allergic Reaction
Mild Symptoms
- Nose: Itchy or runny nose, sneezing
- Mouth: Itchy mouth
- Skin: A few hives, mild itch
- Gut: Mild nausea or discomfort
- If your infant experiences any of these mild symptoms, do not give any more of the peanut food and call our office.
Severe Symptoms
- Lung: shortness of breath, wheezing, repetitive cough
- Heart: pale, blue, faint, weak pulse, dizzy
- Throat: tight, hoarse, trouble breathing/swallowing
- Mouth: significant swelling of the tongue or lips
- Skin: many hives over body, widespread redness
- Gut: repetitive vomiting or severe diarrhea
- If your infant experiences any of these severe symptoms, do not give any more of the peanut food, administer auto-injectable epinephrine (if previously prescribed) and call 911 immediately.
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