Peanut allergy is one of the most common food allergies, affecting up to 3 percent of the population. It is a leading cause of anaphylaxis and death and the allergy is seldom outgrown. It causes affected families to carry a psychological as well as an economic burden. Finally, the diagnosis is on the rise, increasing almost three times in the last 10 years.
Epidemiological observations of lower rates of peanut allergy among Jewish children in Israel, as opposed to Jewish children in the UK, allowed researchers to hypothesize that peanut allergy may be related to the age at which peanuts are first introduced. Children in the UK, similar to the US, did not consume peanuts during the first year of life, whereas those in Israel commonly ate them starting at 7-8 months. Based on these observations, feeding recommendations changed about three years ago to include the early introduction of foods previously considered allergenic including peanuts and eggs. A randomized control study recently published in the New England Journal of Medicine confirms this hypothesis by demonstrating that the early introduction of peanuts significantly decreases the frequency of peanut allergy in at risk children.
Parenting advice is constantly changing. Now we advise parents to put babies on their backs to sleep. We brush with fluoride toothpaste at an early age and keep car seats rear facing until at least 2. The results of this study will now influence how we have parents introduce solid foods.
The American Academy of Pediatrics advises exclusive breastfeeding until 6 months when solid foods are then introduced. Breastmilk or formula will remain the main source of calories and nutrients during the first year, but solids are also introduced as a way of teaching a baby to eat. Rice cereal is often a good choice as the first solid food since it can be diluted in breastmilk or formula to a very thin consistency and it is a good source of iron. Once baby has mastered cereal, pureed fruits and vegetables are a good next step. There are no rules about the order in which these items can be offered, but it is often a good idea to wait a few days between new foods to ensure there is no reaction. As the baby becomes more experienced, I advise parents to offer any food that the baby will not choke on. Honey is the only exception. Honey should never be offered to a child under a year.
When the baby is sitting well and has developed a good pincer grasp, he is ready for finger foods. Bamba, the peanut containing product used in the above study, is a great finger food and a good way to introduce peanuts early. A small amount of peanut butter mixed with bananas or another fruit, would be another option. Now is also a good time to begin to feed baby from the table. She can eat any food that is small and soft. Again, choking is a much bigger risk than allergy.
I am hopeful that the findings of this study will be the first step to reducing peanut and other food allergies in the future.
Lisa Ryan, MD, is a board-certified pediatrician at Way to Grow Pediatrics. She can be reached at 636.344.2214.