Should I Introduce Peanuts And Other Potential Allergens To My Baby During Quarantine?
EXPERTS RECOMMEND STAYING ON SCHEDULE TO HELP PREVENT FOOD ALLERGIES – BUT TAKE PRECAUTIONS DEPENDING ON A BABY’S RISK FACTORS
Introducing peanuts to babies (along with other potentially allergenic foods) can be stressful enough. We know, we’ve been there! Throw a global pandemic and an overwhelmed healthcare system in the mix, and it’s enough to make any parent panic.
Moms On Call and Mission MightyMe teamed up to bring you the latest recommendations from experts on this important topic. Please note that we are providing information, not medical advice. Talk to your pediatrician before introducing potentially allergenic foods to your child and avoid any foods to which they are already allergic.
CURRENT PEANUT ALLERGY PREVENTION GUIDELINES
First, it’s worth a refresher on the current guidelines, since they’ve changed pretty dramatically in recent years.
The American Academy of Pediatrics, the National Institute of Allergy and Infectious Diseases and many other organizations now recommend that most babies regularly consume peanut foods, starting in the first year of life, to help prevent peanut allergies. Just when and how to do that depends on a child’s risk factors, which we’ll come back to in a minute. The new guidelines also recommend against withholding other allergenic foods in infancy, as this may increase the risk of developing a food allergy.
The new guidelines were based on the groundbreaking LEAP (Learning Early About Peanut Allergy) Study, led by the world-renowned pediatric allergist and Mission MightyMe Co-Founder, Dr. Gideon Lack. The LEAP Study found that high-risk babies who avoided peanut foods were 5 times more likely to develop a peanut allergy than babies who regularly consumed peanut foods, starting as early as 4-11 months until age 5.
This discovery overturned decades of old medical advice that babies should avoid potentially allergenic foods in infancy – a practice many experts believe may be partially responsible for the 50% increase in food allergies and three-fold increase in nut allergies among children in the last two decades. All of which brings us to where we are today, with 6 million children (2 in every classroom) impacted by food allergies -- the most common being milk, eggs, peanuts, tree nuts, fish, shellfish, soy, wheat and sesame.
With that context, let’s take a look at the current NIAID feeding guidelines for peanut allergy prevention, based on risk factors:
High Risk Infants (If your infant has severe eczema, egg allergy, or both): Talk to your doctor before giving any peanut-containing foods to your baby. Your doctor may recommend allergy testing or introducing peanut foods under medical supervision. Once cleared, high risk infants should start peanut foods around 4-6 months of age and consume them regularly to help prevent peanut allergy from developing.
Moderate Risk Infants (If your infant has mild to moderate eczema): Introduce peanut foods around 6 months of age, at home without an in-office evaluation, to reduce the risk of developing a peanut allergy. Some caregivers or physicians may prefer an in-office supervised feeding, pre-introduction evaluation, or both.
Low Risk Infants (No eczema or existing food allergy): Freely introduce peanut-containing foods into your child’s diet. This can be done at home in an age-appropriate manner together with other solid foods.
Wondering why eczema makes a baby high-risk for developing a food allergy? It’s called the dual-allergen exposure hypothesis – the theory that exposure to food protein through breaks in the skin barrier (like eczema) can lead to allergy, while oral consumption at an early age may result in tolerance. According to the National Eczema Association, babies with eczema are 6 times more likely to develop food allergies.
A first degree relative with a food allergy also puts a child at higher risk, though only slightly.
We now know that feeding babies allergenic foods starting in the first year of life may help prevent food allergies. But what’s a parent to do during a global pandemic when the last place you want to end up is a hospital or doctor’s office, in the rare chance there is a reaction?
“Most babies can stick to the recommended schedule”, says Dr. Gideon Lack, Head of Pediatric Allergy at King’s College, London and Lead Author of the LEAP (Learning Early About Peanut Allergy) Study. “However, parents of high-risk children who have significant eczema, existing egg allergy or both should talk with their physician first.”
Dr. Lack says normally he would test high-risk children for peanut allergy first, but since that’s not an option due to COVID-19, he is talking with parents about the risks and benefits of withholding peanut versus early introduction, based on the child’s history and a risk-benefit assessment. Dr. Lack recommends that parents have this discussion with their child’s pediatrician or allergist.
“For parents of high-risk children with eczema”, Dr. Lack says, “there is a less than 2 percent chance that a child will react if introduced to peanut foods before 6 months of age. Whereas there’s a greater than 15 percent chance of developing peanut allergy if peanut foods are introduced after one year of age.”
Dr. Lack also points out that in general, the earlier peanut foods are introduced, the less likely it is that a child will have a reaction. "Reactions in the first year of life to peanut are uncommon and typically mild," says Dr. Lack. "At 4 months, virtually nobody has a peanut allergy. Even at 6 months, it is rare however the likelihood and severity of a potential reaction increases with age."
That’s why early introduction is so important, says Dr. Lack, because the window to prevent a peanut allergy is small and begins to close after the first year of life.
Dr. Brian Vickery, the Director of The Food Allergy Program at Children’s Healthcare of Atlanta, is also a proponent of early introduction but in the absence of allergy testing for high-risk patients, he encourages parents to talk to their child’s doctors first. “We know that early introduction is especially important for high-risk babies,” Vickery says, “however right now I recommend discussing with the child’s physician first, so they can make recommendations taking the child’s specific situation and medical history into account.”
“For low risk babies,” Dr. Vickery says, “parents can continue to introduce peanut foods at home, as the guidelines recommend. Though parents can always talk with their pediatrician or allergist first, if they have any questions or concerns.”
If you’ve made the decision to introduce peanuts or other potential food allergens at home now, how should you do it?
First of all, “introducing solids as well as potential food allergens should be enjoyable,” says pediatric nurse and Moms On Call Co-founder Laura Hunter. “Complementary foods (along with breast feeding or formula) are such an important part of your babies’ development – from learning fine and gross motor skills, to getting accustomed to different textures, tastes and smells. We want our children to experience a diverse range of foods early in life because it’s important to their development and their ability to eat a variety of foods later in life!”
Registered dietitian nutritionist and food allergy expert, Sherry Coleman Collins agrees, “Make sure you don’t let fear take the joy out of feeding your baby food,” she says.
Coleman Collins also shared these tips:
Start with a healthy baby! Don’t introduce new foods when baby is sick, teething, or fussy. You don’t want to mistake illness for a food allergy reaction.
Begin early in the day, well before a nap, when you can monitor baby during and for a couple of hours after feeding.
Start slow. Give baby just a small amount of the allergen to start and work up to a full (infant-size) serving if baby has no reactions. Wait a few days in between allergens.
Make sure to use infant-safe food forms. Whole peanuts and peanut butter off a spoon shouldn’t be given to babies or toddlers because of the choking risk. You can start with small amounts of peanut butter thinned with breast milk or formula, peanut powder mixed into purees or quick-dissolve peanut puffs like Mission MightyMe Proactive Peanut Puffs. See the NIAID Instructions for home feeding of peanut protein for more suggestions. And remember, potentially allergenic foods like peanuts should be introduced only after the successful introduction of other solids.
Avoid any foods to which a child has reacted before: If a child has had a suspected food allergy reaction, reintroduction should wait until evaluation by a doctor. AAAAI COVID guidelines state that food challenges are not considered essential and should wait until after the pandemic subsides.
It’s also a good idea to know the signs and what to do in the case of an allergic reaction. See National Allergy Strategy Australia for a comprehensive list of signs. (We like this website because it’s specific to babies).
In summary, most peanut allergies can be prevented with early introduction and the early introduction of other potential food allergens may reduce the risk of developing an allergy to those foods as well. The earlier peanuts are introduced in the 4-11 month window, the lower the likelihood of a reaction. During quarantine, experts recommend sticking with the schedule but taking precautions based on a baby’s risk factors for food allergies. Talk to your pediatrician before introducing allergenic foods if you have any questions about your child’s specific risk. And remember, as Moms On Call Founder Laura Hunter says, “Parent out of truth, not fear.” Happy feeding!
By Catherine Mitchell Jaxon, Co-Founder, Mission MightyMe.
We created Mission MightyMe to make it deliciously simple for parents to include peanuts and other potential food allergens in babies’ diets. As a food allergy family that knows the burden childhood food allergies, we’re passionate about helping other parents prevent them. You can read more about our story here.