A reader asks:

What about the choking hazard of peanut butter? I have read that it is not recommended before age 3 due to the possibility of choking as young children cannot generate enough force to cough out a bolus of peanut butter crackers, for example, if it is in their airway.


I suspect in the case of peanut butter crackers, the risk of choking in very young children lies more with the dryness of the crackers rather than the small schmear of peanut butter. Still, the point is a good one as it makes us think of how to incorporate peanuts (or peanut butter) into an older infant’s or toddler’s diet in order to help prevent the development of peanut allergies.

In the NEJM study we looked at earlier today, participants were given six grams of peanut protein per week. One serving (2 tablespoons) of natural, creamy peanut butter provides about 7 grams of peanut protein. That’s less than a teaspoon per day, which isn’t much. How to incorporate this into the diet of an older infant and toddler is the challenge. All I know is that I wouldn’t put it on a saltine cracker until they are old enough to handle it! Three years old sounds about right!

Also, I can’t stress enough how important it is NOT to give infants and toddlers (and even preschoolers) whole nuts, for these are truly choking hazards.