We learned last March on The PediaBlog that, contrary to previous beliefs, holding off on certain foods like peanut butter as a first food, in order to avoid the development of food allergies, is no longer advisable:
For years, pediatricians have cautiously recommended that parents avoid giving certain foods — especially fish, eggs, and peanuts — until after the first birthday. Delaying exposure was thought to help prevent the development of allergies to these foods. Children thought to be at higher risk of food allergy (especially those with a strong family history of severe reactions, or anaphylaxis, to certain foods) were advised to delay the introduction of some of these foods until three years old. What we saw after those recommendations were implemented was a rise in food-related allergies…
Peanut allergy develops early in a child’s life and it is very rarely outgrown. The American Academy of Pediatrics (AAP) estimates that 1 in 50 children in the U.S., U.K., and Canada are now allergic to peanuts:
Peanut allergy is an increasingly troubling global health problem affecting between 1% and 3% of children in many westernized countries. Although multiple methods of measurement have been used and specific estimates differ, there appears to have been a sudden increase in the number of cases in the past 10- to 15-year period, suggesting that the prevalence might have tripled in some countries, such as the United States.
For most children, peanuts can be safely introduced in the form of soft peanut butter or finely ground peanuts as soon as solid foods are introduced at around six months of age. Whole or coarsely chopped peanuts should be avoided in infants and young children because of their choking potential. Caution must also be taken with children considered at “high risk” for developing a peanut allergy. High risk children, defined by the landmark British LEAP (Learning Early About Peanut Allergy) study, are those who have already demonstrated an allergy to eggs, or those who have severe eczema (atopic dermatitis). Last week, the AAP endorsed the early introduction of peanut products even for those children who fit the high risk profile. The AAP says these children “might benefit from evaluation by an allergist or physician trained in management of allergic diseases in this age group to diagnose any food allergy and assist in implementing these suggestions regarding the appropriateness of early peanut introduction.”
What’s clear is that parents now have a green light to introduce peanut products as first foods for their infants, and perhaps a yellow light for some infants who have already shown allergic (atopic) tendencies. Here are some examples of peanut-containing foods parents can introduce to their infants:
• Smooth peanut butter (1 teaspoon) mixed with milk or with mashed or pureed fruit
• Bamba snack* (Osem; approximately two thirds of a 1-oz (25 g) bag; 21 sticks of Bamba)
— For young infants (<7 months), softened with 20 to 30 mL water or milk and mixed with milk or with mashed or pureed fruit or vegetables
• Peanut soup
• Finely ground peanuts mixed into other foods, such as yogurt
*Other foods more customary to particular nations/cultures can be substituted.
Whole peanut is not recommended for introduction because this is a choking hazard in children less than 4 years of age.