To peanut or not to peanut? In a nutshell: New guidelines say it’s good to introduce them early in life.
The updated guidelines—from a heavy-hitting expert panel from 25 different organizations, sponsored by National Institute of Allergy and Infectious Diseases—explain how and when to introduce peanuts to your baby.
For years, peanuts were excluded from infant diets because they were thought to cause food allergies. Then the results of the landmark Learning Early About Peanut Allergy (LEAP) trial, published in early 2015, plus related studies, strongly suggested the opposite: that peanut allergy can be prevented when peanut-containing foods are introduced early in infancy—and withholding nuts was actually spiking the allergy epidemic.
The new guidelines put babies into three groups, based on their risk level for peanut allergy:
Identified as: Those with severe eczema and/or egg allergy. These are cases that require frequent prescription-strength topical corticosteroids or other anti-inflammatory meds. These babies should see an allergy specialist, who may conduct peanut allergy testing (though a positive result is considered a poor predictor of whether your baby has an allergy to peanuts).
When to introduce peanuts: As early as 4 to 6 months is best, after your baby has shown that he or she is developmentally ready for solids and has already started on other solid foods. Most high-risk babies who have a positive peanut-sensitization skin test aren’t truly allergic to peanuts (especially when they show a mild reaction to the test) and are less likely to develop allergies when they’re fed peanuts early in life. High-risk babies should first try peanuts in a specialist’s office, though, because some will be allergic and will be advised to avoid them.
Identified as: Those who have mild to moderate eczema. These babies don’t need to see a specialist and are unlikely to have peanut allergy. If your baby has an older sibling with an established peanut allergy (or you or your baby’s other parent is allergic) you should discuss the benefits of peanut exposure with your baby’s doctor.
When to introduce peanuts: Around 6 months, after starting other solid foods. Home introduction is suggested, though it’s best to consult a doctor if you have any questions.
Identified as: Those who have no eczema or allergy.
When to introduce peanuts: Whenever you prefer, although peanuts shouldn’t be among the very first foods given to any baby.
- Best way to start: Mix 2 teaspoons of smooth peanut butter with hot water until it forms a thin puree, and give your baby a taste. (Thick-spread peanut butter is a choking risk.) Wait 10 minutes and watch for any skin rashes, trouble breathing, or other changes.
- Never give a baby whole peanuts or tree nuts. In fact, you’ll want to grind them up pretty well until ages 4 or 5 since nuts are a top choking hazard.
- The American College of Allergy, Asthma, and Immunology shows how to introduce peanuts to babies in this video.