Should your infant be eating peanut butter? (You might be surprised at the answer!)

Feeding peanut butter to a baby used to be taboo. Not anymore.

According to new guidelines from the National Institute of Allergy and Infectious Diseases (NIAID), the answer to the question of whether or not you can feed your baby peanut butter is a resounding, “Yes!” This is true even if you have a baby who is at high risk for a food allergy.

Based on research from the Learning Early About Peanut Allergy (LEAP) study in the UK, researchers determined that high-risk children who ate peanut products between 4 and 11 months of age were less likely to develop a peanut allergy. In other words, introducing peanuts early in life significantly reduces the rate of peanut allergies in children.

Researchers have identified a critical window of opportunity for the introduction of peanut — a time when your baby is more likely to build immunity to peanut rather than be sensitized to it — and that time frame is four to six months of age.

The New Way

I distinctly remember feeding my second child, now a teenager, sandwiches of cream cheese and jelly so I could avoid peanuts. I was careful to avoid peanut butter, for fear of an allergic reaction, while wanting to stay in compliance with the current feeding recommendations.

The 2000 AAP recommendations warned of giving any peanut-containing foods to baby before three years of age. Around 2010, normal risk children were given the green light to have peanut products after one year of age, as long as it was developmentally age-appropriate (as well as any other potentially allergen-containing food, such as egg or milk).

In 2015, based on a ground-breaking study of allergy-prone or high-risk infants, recommendations changed further to allow the early introduction of peanut-containing products to baby.

Taking into consideration a child’s risk level for peanut allergy, more detailed recommendations have surfaced as follows:

Babies with Low Risk for Peanut Allergy

Infants who are at low risk for developing a peanut allergy (i.e., do not have an egg allergy and no eczema) or who have started solid foods with good tolerance, can eat peanut butter and other peanut products beginning at six months of age. Peanut products should be served in a manner that reduces the risk of choking (i.e., thinned peanut butter or peanut flour mixed into other foods). The offering of peanut-containing foods can happen within the home.

Babies with Moderate Risk

These babies may have mild eczema, but can eat peanut products beginning at 6 months old at home.

Babies at High Risk for Peanut Allergy  

Babies who are at high risk for peanut allergy (i.e., have an egg allergy or severe eczema) may also eat peanut products between four and six months of age, after they have been checked by a doctor.

Specifically, an allergist will look at your baby’s IgE level (a blood test) for peanut and do a skin prick test.

The new recommendations go into detail about IgE levels and wheal size (skin reaction to skin prick testing), using these values to further tease out the best ways to introduce peanut.

For example, an IgE level of > 0.35 warrants the involvement of an allergy specialist. The allergy specialist may do a skin prick test. If a child develops a wheal > 8, it is indicative of a likely peanut allergy. If a child develops a wheal between 3 and 7, this may indicate a supervised feeding challenge (e.g. peanut product eaten in an allergist’s office).

What’s important to mention is that even if your baby is sensitive to peanut based on these test results, he may not be allergic, and the early introduction of peanut may ward off a peanut allergy.

However, based on the results of these tests, your baby may be recognized as allergic to peanuts, in which case, avoidance of all peanuts is recommended.

Let’s Get Practical

As you can see, with the newest NIAID recommendations, there is a process to go through if your baby is at high risk for peanut allergy. Nevertheless, there are some practical things to think about when (and if) your baby is able to eat peanut products.

Young babies are at risk for choking. Their experience with eating solid food is limited, so caution is warranted. Young babies should not be eating whole or roughly chopped peanuts, or thick globs of peanut butter.

You still want to offer a variety of foods from all food groups — you’re not on a mission to single-handedly introduce peanut! Remember, you are establishing the foundation of a healthy diet, which includes all food groups.