If you're like many parents, you may be nervous that your baby has or will develop a peanut allergy. While in the past wee used to tell parents to avoid introducing peanut until a baby's first birthday, we now know that we had it exactly wrong. Newer studies have consistently shown that the best way to prevent peanut allergy is to offer peanut early (around 6 months) and often (at least 3 days per week) and freely consume peanut and peanut products during pregnancy and while breastfeeding (provided you do not have a peanut allergy).
The Learning Early About Peanut (LEAP) clinical trial showed that offering at least 6 grams of peanut protein given over 3 or more meals per week, decreased the risk of peanut allergy substantially. Only 3 percent of babies at high risk of peanut allergy who regularly consumed peanut developed allergy by age 5 (compared to 17% of babies who avoided peanut).
What does this mean for you?
1. First, before offering your baby his or her first taste of peanut, determine whether your baby is at low (no eczema or other food allergy), moderate (mild to moderate eczema), or high risk (severe eczema or egg allergy) for peanut allergy. If needed, consult your child’s pediatrician for help.
2. Then, follow the below guidance:
· Low risk baby (no eczema or other food allergy): Incorporate peanut into your baby’s diet freely. Start around 6 months and make sure your baby has tried peanut well before their first birthday.
· Moderate risk babies (mild to moderate eczema): Try egg first. If your baby does fine with egg, then offer peanut around 6 months of age. You don’t need to talk with your pediatrician before offering peanut. If your baby has a reaction to egg, you should see your child’s pediatrician to discuss further testing prior to introducing peanut (see below).
· Highest risk babies (severe eczema, egg allergy): Ask your pediatrician for a blood test for peanut-specific IgE. If your baby’s level is normal (<0.35), then proceed with offering your baby peanut at home or in your pediatrician’s office (based on your preference) at 4-6 months of age, after other first foods have been well tolerated. If the level is high (>0.35), your pediatrician will likely refer to you an allergy specialist. You should wait to introduce peanut until after this consultation and proceed according to the specialist or pediatrician recommendations.
3. When it’s time to introduce peanuts based on your baby’s level of risk noted above, offer at least 6-7 grams of peanut protein per week over the course of at least 3 meals or snacks. Don’t offer your baby a whole peanut as it is a choking hazard. Instead try out these few easy and safe ways to regularly include peanut in your baby’s diet:
· 1/2 tablespoon of peanut butter (all natural, no added ingredients), creamy, thinned with breast milk, formula, or water, smeared on a cracker or piece of bread – 2g peanut protein
· 1/2 tablespoon of peanut butter mixed with baby cereal - 2g peanut protein
· 1/2 tablespoon of peanut butter thinned with water/breastmilk/formula mixed in with mashed bananas – 2g peanut protein.
· 1 tablespoon peanuts, finely crushed – 4g peanut protein
For more on feeding your baby solids, check out my new resource How to Raise Healthy Eaters: Starting Solids, from which the above is adapted.