It wasn’t that long ago that the advice was to wait to give peanut butter to your baby until they were toddlers. But all that has changed over the last few years! And understandably it has many parents worried and confused, not sure where to give peanut butter for the first time. So just what do you need to know?
Babies and Peanut Butter
In 2015 there was a landmark study (the LEAP study) that showed that babies who were at high risk for developing a peanut allergy actually had decreased occurrences of the allergy when they were exposed to peanut products early on and consistently.
As a result of the LEAP trial, and several others since, recommendations on introducing highly-allergenic foods, like peanuts, have changed.
When to Give Baby Peanut Butter
The current recommendations from the American Academy of Pediatrics and the National Institute of Allergy and Infectious Disease split babies into three groups.
Babies with Severe Eczema and/or an Egg Allergy
Babies with one or both of these conditions are considered to be at high risk for a peanut allergy. The recommendation is for these babies to have an allergy test first. Then, under the guidance of a doctor, introduce peanuts between 4 to 6 months. For those babies with positive skin prick tests, the recommendation is often to introduce peanuts in the doctor’s office.
Babies with Mild to Moderate Eczema
These babies are not considered to be at high risk for peanut allergies. But it is recommended that they be introduced to peanuts around the 6 months mark. There is no recommendation to have an allergy test before introduction like for those in the high-risk category. It is still a good idea to talk with your doctor about a plan for introduction, though.
Babies with No Eczema or Egg Allergy
For these babies, peanut products should be introduced along with other solid foods around or after 6 months. They can be served just as the family would normally serve them. It is not as vital for them to be given around that 6 months mark, but it is still a good idea.
Introducing Solids Early for Allergy Prevention
Since these recommendations have come out, many health professionals have started recommending parents start their babies on solid foods closer to the 4 month mark for allergy prevention. There is no evidence to support this for babies not at high-risk of allergies, and in fact goes against the recommendations.
Babies should still be introduced to solid foods around 6 months, when they are developmentally ready for it (link to when should babies start foods blog). Introducing babies to food too early can have negative effects on their tolerance of food as they grow, their microbiome, and can also be a choking hazard if they are not properly sitting up yet. If your baby is not in the high-risk category, there is no reason to offer them food before they are developmentally ready for it. This usually happens around 6 months.
Allergen Introduction Powders
The new recommendations have also created a whole new industry. There are now several companies out there who offer allergens in powder form as a way of introducing them to babies. By and large, these products are just an incredibly expensive form of food for the majority of the population. They are also capitalizing financially on a parents’ understandable desire to prevent food allergies in their child. If you wait until your baby is developmentally ready at around 6 months, then babies that are not in the high-risk category have no reason why they can’t just have peanut products just as they would any other food.
The powders potentially have a use for babies in the high-risk category who need to be exposed to peanuts before they are developmentally ready for foods. But this usefulness would only be between those 4 and 6 month ages. By placing these powders in liquids, babies can get allergen exposure without needing to fully ingest a full range of foods. This allows for exposure without all of the other issues that come along with starting foods early.
If your baby doesn’t fall in the high-risk category, though, I definitely recommend saving your money and just buying a jar of peanut butter!
Giving Baby Peanut Butter for the First Time
You may have heard that peanuts and peanut butter are a choking hazard for babies and kids. And they are! Which means you do need to do some alterations before serving to your baby. Kids under 4 should never be given whole nuts, including peanuts. And peanut butter on a spoon is a choking hazard due to how sticky it is. It has the ability to form a seal over a child’s airway.
Try stirring peanut butter (about a teaspoon) into oatmeal or yogurt for your baby. You can also spread a thin layer on a piece of toast for them. For straight exposure, you can add some warm water to peanut butter and make a puree from it, but there is no need to do that for most babies. Giving it to them as a form of food, just like anything else, is a great way to start.
What to Watch for When Introducing Peanuts to Babies
One of the most concerning things for many parents is what will happen if their baby does have an allergic reaction to peanuts (or any other food). Reactions can come in many forms, and can happen upon first exposure or after many.
Here are the signs of an allergic reaction to look for:
- Difficulty breathing
- Loss of consciousness
- Pale or blue skin
- Repetitive cough, wheezing
- Hives, redness or itching
- Diarrhea or vomiting
- Swelling of lips or tongue, itchy/runny nose, sneezing
If your child is showing signs of a mild reaction, such as an itchy or runny nose or a few hives, it is fine to wait to get an appointment with your medical provider and discuss the symptoms with them or an allergist.
If your child is showing signs of a severe reaction, such as difficulty breathing or loss of consciousness, call 911 and seek immediate treatment.
The Bottom Line
While it can be scary to introduce a highly-allergenic foods like peanuts, it is important to do so! Especially if your baby has eczema or an egg allergy. If you are especially concerned about peanut introduction, make sure you are talking with your child’s doctor about your concerns and how you should be introducing peanuts.