Infants as young as 4 months old should be introduced to peanut-containing foods to prevent the development of peanut allergies, according to new guidelines from the National Institute of Allergy and Infectious Diseases.
“It’s an important issue for lots of parents. They don’t want their kids developing a food allergy,” said Dr. Ruchi Gupta, who helped develop the guidelines and is an attending physician at Lurie Children’s Hospital specializing in asthma, food allergies and eczema.
“If it’s something they can prevent through something as simple as incorporating food in their [child’s] diet, I think they’d be interested in doing that.”
Peanut allergies are the most common food allergy in children—impacting 2 percent of kids—and have been increasing in America, according to Gupta.
In 2000, as the prevalence of peanut allergies rose, clinicians began recommending parents avoid introducing them to children until at least age 3. In 2008, clinicians began encouraging parents to make their own decisions about if and when to introduce peanut products to children due to a lack of evidence supporting the 2000 recommendations, Gupta said.
The latest recommendations are in response to research that shows children who were introduced to peanuts early in life were significantly less likely to develop peanut allergies than those who avoided peanuts.
Introducing peanuts to infants at high risk of developing peanut allergies (meaning children with moderate to severe eczema or egg allergy) led to an 81-percent decrease in the subsequent development of a peanut allergy, according to a study of more than 600 at-risk children.
Based on that study’s results, a 26-member panel of specialists developed a set of guidelines for introducing peanut products to children contingent on their level of risk of developing peanut allergies.
Parents of a child who is at high risk of developing peanut allergies should consult with their child’s pediatrician before introducing peanuts into a child’s diet. Pediatricians will most likely perform a blood allergy test or send a child to see an allergist for a skin-prick test to see how a child reacts.
If there is no reaction, clinicians will recommend parents introduce peanuts to the child on their own. However if there is a positive reaction, the course of action is dependent on the severity of the reaction. “An allergist may recommend introducing peanuts to an infant in the clinic or avoiding them altogether if it’s a very large reaction,” Gupta said.
The new guidelines recommend that children at high risk of developing an allergy should be introduced to peanut-containing foods as early as 4 to 6 months.
Children who have mild to moderate eczema should be introduced to peanut-containing foods around 6 months old, while children who have a low risk of developing an allergy can have peanut-containing foods introduced to their diets at any time, according to the new guidelines.
Regardless of risk factor, peanuts should not be an infant’s first solid food: all infants should be consuming solid foods prior to their introduction to peanuts. “How you introduce peanuts is important,” Gupta said. “It doesn’t mean the whole peanut—that’s a choking hazard.”
Gupta recommends parents combine two teaspoons of peanut butter with water into a puree for a child’s first serving. “Take a little bit of that and put it on the child’s tongue, and wait a couple of minutes,” she said.
Hives and vomiting are the most common reactions children have to peanut butter. If a child doesn’t have a reaction, Gupta says to feed the rest of the puree to a child within an hour and then watch the child for the next two hours.
“You want to make sure after feeding them they don’t have a reaction or throw it up. If the infant is fine, you need to keep peanuts in their diet,” she said. “Don’t remove it. It’s recommended to be feeding them peanuts at least three times a week.”
If an infant has a severe reaction to the peanut butter, such as lots of vomiting or trouble breathing, parents should get immediate medical care and call 911, Gupta said. “If the reaction is mild, schedule an appointment to meet with your doctor, and at that point you’ll have to get some testing done.”
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