Protocol for introducing peanut to your infant
I wanted to build off of a couple very nice posts from Dr. Poel and Dr. Egelmeer that were done previously regarding Introducing Solid Foods and Introducing Allergenic Foods to your Baby. I obtained this protocol specifically for peanut introduction from Children’s Mercy Hospitals and Clinics in Kansas City, Mo where I completed my pediatric residency training in the 2002.
Over my years in practice, there has been a dramatic shift regarding the introduction of more highly allergenic foods at a much earlier age. The changes have been a result of more research being done on the topic. Initially, it was thought that it would be helpful to delay introduction of foods such as peanuts but what we found was that by doing so we were increasing the occurrence of peanut allergy. In 2015, research showed that early introduction of peanut was helpful at decreasing the risk of developing peanut allergy.
This protocol used the information from these studies to provide helpful guidance for families with infants.
If your child is:
Low risk for food allergy
- This means your child does not have eczema or any food allergy. He or she may begin peanut-containing foods around 6 months of life.
Medium risk for food allergy
- This means your child does have mild to moderate eczema but no food allergy. He or she should begin peanut-containing foods around 6 months of life.
High risk for food allergy
- This means your child has severe eczema, egg allergy or both. You will want to discuss doing blood testing or being referred to an allergist for evaluation before introducing peanut-containing food. Pending these test results and/or the allergist’s evaluation, peanut-containing food may or may not be able to be introduced. If it can be done, It should be done between 4-6 months of life.
How to introduce:
- Feed it to your infant on a day they are well and you are going to be with them.
- Start small, offer a tiny bit of peanut serving first.
- Wait 10 minutes and if no reaction is noted then continue feeding him or her at their normal feeding pace.
- If child is allergic they will generally show a reaction during the first or second feeding.
- Maintain peanut in your infants diet 3 times per week, especially if they are considered medium or high risk.
What type of peanut-containing food should you give them:
Thinned smooth peanut butter
- Mix 2 teaspoons of creamy peanut butter with hot water or breastmilk (2-3 teaspoons).
- Stir until the peanut butter is dissolved and well blended.
- Let cool, more liquid can be added if still too thick.
Smooth peanut butter puree
- Mix 2 teaspoons of peanut butter with fruit or veggie baby food (2-3 teaspoons) that he or she has already tolerated. Add more baby food if too thick.
Peanut flour or peanut butter powder
- Mix 2 teaspoons of peanut flour or powder to fruit or veggie baby food (6-7 teaspoons) that has already been tolerated. More baby food or water can be added if too thick.
Bamba peanut puffs
- Can be purchased in specialty grocery stores or ordered online.
- 21 pieces will need to be eaten.
Ready.Set.Food! is a new product that contains peanut and egg powder that you can add to a bottle or food.
There are also newer ready made purees that have peanuts in them such as HappyBaby and MyPeanut.
What symptoms should I be looking for after they have eaten the peanut-containing food:
Mild symptoms
- A new rash or a few hives around the mouth or on face.
More severe symptoms
- Lip swelling
- Vomiting
- Diffuse hives
- Face or tongue swelling
- Difficulty breathing
- Wheezing
- Persistent coughing
- Change in skin color to pale or blue
- Sudden tiredness, lethargy or seeming limp
For mild symptoms, please contact our office. If having severe symptoms please call 911.
I hope you have found this information helpful and enjoy all the fun times and experiences you will have with your son or daughter.
Information was obtained from the Journal of Allergy and Clinical Immunology January 2017 and Children’s Mercy Hospital and Clinics Kansas City, MO.