Q: How should new moms introduce peanut into their infant’s diet?

Michael Pistiner, MD: The National Institute of Allergy and Infectious Diseases (NIAID) issued new guidelines that flipped what we know about feeding highly allergenic babies back in 2017. These guidelines are specific to peanut.

What the guidelines say is that kids who are at high risk of developing peanut allergy – and they define high risk as having severe eczema, egg allergy or both – should be screened prior to having peanut introduced into the diet. The NIAID guidelines recommend this evaluation – and possible peanut introduction – happen at 4-6 months.

The screening will involve either a pediatrician sending the parents to an allergist to get their child skin tested, or the pediatrician sending the family to get a blood test to see if the child already is allergic to peanut.

Children who are at moderate risk – meaning they either have a family member with a peanut allergy or mild or moderate eczema – don’t necessarily need to be screened, but their parents should talk to a pediatrician about how and when to introduce peanut. The guidelines recommend around 6 months of age.

For children who are not at risk, the guidelines say that peanut be introduced in a developmentally appropriate way, when culturally appropriate and when appropriate to the family.

When you’re feeding a baby peanut, you want to be careful of choke risk. That means no loose nuts until age 5. Peanut butter itself can be a choke risk, too, if a baby takes a large spoonful.

The guidelines recommend two teaspoons of peanut butter three times a week – but it should be smoothed out. The study the guidelines were based on did this until the kids were age 5.

When you smooth out peanut butter, you can use pureed fruit or vegetables, breast milk or formula. You can also mix into oatmeal. As children get older and show no signs of peanut allergy, they should be able to handle different consistencies and multiple different forms of peanut foods.

Additionally, NIAID released patient resources to help with the introduction of peanut products. They include recipes and tips.

Michael Pistiner, MD, FACAAI, is a board-certified pediatric allergist and immunologist, Director of Food Allergy Advocacy, Education and Prevention of the Food Allergy Center at MassGeneral Hospital for Children in Boston, and co-creator of the educational website AllergyHome.org.

Have a medical question? Email editor@allergyasthmanetwork.org or write to Ask the Allergist, Allergy & Asthma Network, 8229 Boone Blvd., Suite 260, Vienna, VA 22182. 

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