First Peanut Exposure - Where And How To Do It
We've all heard the news stories about food allergies and the seemingly endless string of “poor Johnny found out he has a peanut allergy…” from friends, neighbors, coworkers, and more.
So it makes sense that the official guidance from the AAP to start feeding your child peanuts early on can be scary.
But it doesn't have to be. Feeding your baby their first peanuts can be managed safely, responsibly, and stress-free. Let's dive into how to give your baby their very first peanut, whether it's peanut powder, peanut puffs, or peanut butter.
The information below has been gathered and summarized from various official sources, including the American Academy of Pediatrics, the NIAID Guidelines, and related Addendums.
The pediatric guidelines purposely divide patients into three groups based on their risk of a peanut allergy.
Low Risk Children
This group includes children with no family history of food allergy, no known food allergies, and no eczema.
For these babies, there is no reason to wait, worry, or do anything out of the ordinary. Doctors suggest low risk children be given peanuts starting when the family feels appropriate, in line with their customs and preferences. You can follow the instructions for first feeding below, and after that, continue to make peanuts a regular part (2-3 times a week) of their diet.
Medium Risk Children
Children with mild-to-moderate eczema
For medium risk children, the risk of a peanut allergy is still really low. If your child is medium risk, doctors suggest starting peanuts around 5-6 months old at home. For the first feeding, follow the instructions below, and maintain regular exposure to peanuts in baby’s diet 3-4 times per week for the first year.
High Risk Children
Children with severe eczema, egg allergy, or both
For children with severe eczema or an egg allergy, doctors recommend starting solid foods beginning at 4 to 6 months of age. First, start with a food other than peanut (mashed fruit or vegetables), so that you can establish that the baby is ready for solids. Again, follow the instructions below.
Baby's First Peanut Exposure
Almost all infants have a 4 month and 6 month well visit, which is a great time to discuss solids and early introduction with your pediatrician, and get assessed for signs of eczema. If you miss the 4- to 6-month time window, still start. Older babies who have not had peanut do have a higher likelihood of a peanut allergy, but the LEAP study showed that starting anytime between 4 and 11 months is better than not exposing them to peanuts at all during this time.
Feed your infant only when he or she is healthy; do not do the feeding if he or she has a cold, vomiting, diarrhea, or other illness.
Give the first peanut feeding at home and not at a day-care facility or restaurant.
Make sure at least 1 adult will be able to focus all of his or her attention on the infant, without distractions from other children or household activities.
Make sure that you will be able to spend at least 2 hours with your infant after the feeding to watch for any signs of an allergic reaction.
Feeding your infant
Prepare a full portion of one of the peanut-containing foods
Offer your infant a small part of the peanut serving on the tip of a spoon.
Wait 10 min.
If there is no allergic reaction after this small taste, then slowly give the remainder of the peanut-containing food at the infant’s usual eating speed.
What are symptoms of an allergic reaction? What should I look for?
- Mild symptoms can include:
- a new rash
- a few hives around the mouth or face
- More severe symptoms can include any of the following alone or in combination:
- lip swelling
- widespread hives (welts) over the body
- face or tongue swelling
- any difficulty breathing
- repetitive coughing
- change in skin color (pale, blue)
- sudden tiredness/lethargy/seeming limp
If you have any concerns about your infant’s response to peanut, seek immediate medical attention/call 911.