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There is a lot of conflicting advice out there about when you should introduce peanut butter to babies or toddlers, especially in light of concerns about food allergies. We cut through the confusion about when and how you can introduce this nutritious and delicious food to your infant.
When can babies have peanut butter?
Over the years, guidelines for introducing babies to peanut products has changed drastically. For many years it was advised that children avoid peanut products until after age 3. Unfortunately this mass population peanut avoidance actually contributed to more than doubling the rise in peanut allergies over the last 10 years.
In contrast to this outdated advice, the LEAP study from 2015 found that early introduction of peanut products before 1 year of age actually prevented the development of severe peanut allergies later in life. This study found that not only did this apply to children at higher risk of developing an allergy, but that children who were not introduced to peanut products were more likely to develop a peanut allergy in general. These remarkable findings led to a change in the current official health guidelines from the National Institute of Allergy and Infectious Diseases (NIAID), as well as the American Academy of Allergy Asthma and Immunology (AAAAI).
Currently there is no way to treat a peanut allergy, so the goal has to be to prevent the development of peanut allergies in the first place.
The new guidelines recommend introducing your baby to peanut containing foods within their 1st year of life to prevent development of peanut allergies. The new structure is not based on the child’s age, so much as it is based on their individual risk levels, with prescreening by a medical professional only recommended for those considered high risk (as defined below).
Assess your baby’s risk for a peanut allergy
The first step in introducing peanut butter to your baby is to asses their individual risk level in regards to developing a peanut food allergy. The 3 distinguished risk levels are defined as:
- High risk. Includes children who have a known family history of peanut allergies, who personally suffer from an egg allergy, or suffer from extreme eczema. Extreme eczema is defined as persistent or frequently recurring, and requiring prescription strength corticosteroids or other anti-inflammatory measures to control. Children in this group should first see their healthcare provider before being introduced to peanut butter at around 4 to 6 months. Infants in the LEAP study still demonstrated a benefit if peanut butter was introduced later, but the older the child’s age, the higher the likelihood of developing an allergy. Many doctors will be happy to allow you to have the initial peanut testing done while supervised in their office for children in this high risk group.
- Moderate risk. Includes children who have mild to moderate eczema, no family history of peanut allergies, and no known allergy to eggs. In this case the child can be introduced to peanut butter at home without a healthcare evaluation at around 6 months of age, but parents who are worried may request a supervised peanut introduction if needed.
- Low risk. Most children will fall in this group and it includes those who do not suffer from eczema, egg allergies, or have no known family history of peanut allergies. In this case there is no evidence to support restricting peanut butter so it can be introduced when age appropriate (around 4 months and up), without a visit to the healthcare provider.
After assessing your child’s individual risk level, it is important to keep a few other tips in mind when introducing peanut butter to your baby. Regardless of which group your child falls into, you should ensure that they have been introduced to other foods before testing for peanut allergies. This ensures that they are developmentally ready to eat solid foods in general, and any abnormal reactions observed can be identified.
What is the best peanut butter for babies?
Smooth peanut butter is best when first introducing peanut butter into the diet. Chunky or crunchy peanut butter is potentially a choking hazard and provides a different texture that babies may not like. An additional consideration is what ingredients are added into the peanut butter. Look out for high amounts of added sugar and try to find a natural sugar free option. Additionally each peanut butter can be made with different types of oil so always check the label if you are concerned about this.
While introducing peanut butter is encouraged, no child under 3 years old should have whole peanuts as they are a choking hazard. It is also important not to give your baby undiluted peanut butter as it is too thick and could stick to the throat and cause choking.
How to introduce peanut butter to your baby
Now that you have assessed your child’s risk level, and have obtained the right peanut butter, it is time to do the test. On the day you plan to test your child make sure they are healthy and feeling well. Ideally, this should be done on a day when you will be home with no plans, allowing you to remain alert and focused on the child. You will need to observe them both immediately while eating, as well as for up to 2 hours after the feeding.
The best approach to introduction is by mixing 2 teaspoons of smooth peanut butter with 2-3 teaspoons of hot water. Stir the mixture until the peanut butter is thinned, almost runny, and cooled. When introducing peanut butter for the first time it is best to not include any other foods. This helps ensure that any reaction is strictly from the peanut butter, and not another food.
Now that the mixture is prepared, give your child a small spoonful, and wait for 10 minutes, watching them closely for any symptoms of an allergic reaction.
Signs of peanut butter allergy in your baby
Symptoms can appear immediately (within minutes) or take hours to appear, so remain alert and watchful during this time. Mild symptoms can include a runny nose, sneezing, itchy mouth or tongue, or mild swelling of the lips or around the eyes. If your baby seems to have a slight reaction but is otherwise well, stop the test and speak to a health care provider explaining you believe your child to have a peanut allergy. They can arrange allergy testing to confirm your suspicions. Until your child has been tested for the allergy, avoid feeding your child peanut products. Children who are identified as allergic should practice strict peanut avoidance, including items that “may contain peanuts” or may be contaminated by peanuts.
In rare cases a child may show more severe symptoms, so be extra vigilant for any of the following:
- Swelling of the tongue or throat, shortness of breath, wheezing, persistent coughing, difficulty swallowing, speaking, or crying;
- Changes in complexion such as developing hives, itchy skin rashes, paleness, or blueness around the lips;
- Tummy issues including nausea, diarrhea, stomach cramps, or vomiting;
- A sudden sleepiness or floppiness in babies, loss of consciousness, or dizziness.
What to do if your baby has a reaction to peanut butter
If your child experiences any of these severe symptoms, seek medical attention immediately. When introduced to peanuts, a very small number of children can experience a severe allergic reaction called anaphylaxis, which can be life threatening. When phoning emergency services, it is helpful to inform them you believe the child is suffering from a peanut allergy.
If you have reached the 10 minute mark, and your child has shown no adverse reaction, it is okay to continue feeding the remaining peanut butter portion.
Assuming all has gone well following the first introductory feeding, and your child has shown no reaction, then it is advised to continue feeding peanut products around 3 times per week. Regular digestion of peanut containing foods during the first year of life is key to preventing the development of peanut allergies.
It is important to note that a peanut is actually a legume, and developing an allergy to peanuts does not mean that your child will necessarily develop an allergy to tree nuts (such as pecans, hazelnuts, etc.). However it is interesting to note that an allergy to peanuts is often associated with an allergy to sesame and lupin.
Peanut butter baby food ideas
If you find your child isn’t too keen on the taste or texture of peanut butter, you can hide thinned peanut butter in simple recipes, such as mashing 1 medium banana, with 2 tablespoons of smooth peanut butter. It’s great if you need to hide the taste or texture and your child has already been eating bananas. You can also blend the thinned down peanut butter or peanut powder into baby cereals, creamy porridge, apple sauce, or other mushy foods. As your child gets older you can make more interesting foods like these peanut butter pancakes, or for toddlers you can smear the thinned down peanut butter onto a piece of toast or rice cake and decorate with fruit into funny animal faces. Looking for peanut butter ideas for older kids, we’ve got a great list of international peanut butter recipes for you.
In conclusion, if you feel your baby is old enough and the risk is low enough, then introducing peanut butter early can help prevent the development of peanut allergy. While the process can be scary at first, it is better to find out if your child has a peanut allergy in a controlled environment while you are alert and aware, than by accident later in life.