When can I give my child peanut butter? What are signs of an allergic reaction? | by Dr. Nick Krebs

Colorado Health & Wellness magazine, Ask The Dr

Posted on Wed, May 16, 2018

The answer to this question has been debated for the last several decades, and for good reason! By the turn of the millennium, anaphylaxis from peanuts became the number one cause of allergy-related death among children in the United States.

Dr. Nick Krebs
, Greenwood Pediatrics
, Centennial

Dr. Nick Krebs

Not surprisingly, medical professionals recommended avoiding peanut-containing foods in a child’s diet for the first three years of life, especially in those children at higher risk for developing anaphylaxis.

In 2015, however, a landmark study published in the New England Journal of Medicine showed that early introduction and regular consumption of peanut-containing foods to high-risk infants prevented the development of peanut allergies. New guidelines from the National Institute of Allergy and Infectious Diseases now risk-stratify babies into three groups:

  • Babies with severe/persistent eczema and/or an immediate allergic reaction to any food are considered “high risk” for developing a peanut allergy.” Ideally, peanut-containing foods should be introduced to these babies as early as 4 to 6 months after allergy testing for peanuts is completed by an allergist.
  • Babies with only mild to moderate eczema should be introduced to peanut-containing foods around 6 months of age with continuation in their diet to prevent a peanut allergy from developing. Allergy testing to peanuts may be completed prior to introduction.
  • Babies without eczema or other food allergies may start having peanut-containing products and other highly allergenic foods freely after a few solid foods have already been introduced and tolerated without any signs of allergy.

In general, families are encouraged to start solids with a few foods that are of low allergenic risk (e.g. infant cereal and pureed fruits and vegetables). Give your baby one new food at a time, and wait at least three days before starting another. Monitor their reactions:

  • Signs of an allergic reaction may include rash/hives, diarrhea, and upset tummy. If any of these occur, stop using the new food and consult your child’s pediatrician.
  • Signs of a life-threating reaction – also known as “anaphylaxis,” may include widespread hives, facial/mouth/throat swelling, wheezing, difficulty breathing, vomiting, flushing, and low blood pressure.

As with all infant foods, allergenic foods should be given in age- and developmentally-appropriate safe forms and serving sizes.

Centennial, Colorado
Greenwood Pediatrics

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