Hey, Peanut…A look at new guidelines for introducing peanut-containing foods to infants.

One thing I like to do for my patients is simplify information. In a world where we’re inundated with articles on what to do and what not to do for our children, it’s important for pediatricians to stay on top of the latest medical guidelines and developments to help parents make informed decisions. So, let’s talk peanuts.

If I had to guess, your mom introduced you to peanuts differently than you introduced them to your baby, but now your friend is telling you that there’s another age range to introduce peanuts and peanut-containing foods. Deciphering what’s right is tricky, because there’s not always a one-size-fits-all approach to this process.

shutterstock_689822554.jpg

Recently, the National Institute of Allergy and Infectious Disease (NAID) released new guidelines stratifying infants into risk categories for peanut introduction based on findings from the LEAP (Learning Early About Peanut) study.  Some infants in the study were introduced to peanut-containing foods as early as four months. The researchers also took the severity of eczema and presence of egg allergy into consideration in its stratification. The study found that the early introduction of peanuts was overwhelmingly safe for most infants and could even prevent a peanut allergy from developing.

Safety is always the primary concern when introducing any new food group, but especially peanuts, due to the threat of anaphylaxis. According to the study by the NAID, the “landmark clinical trial and other emerging data suggest that peanut allergy can be prevented through introduction of peanut-containing foods beginning in infancy.” So, parents can begin to introduce these types of food to their infants earlier than they may have thought. Of course, I encourage anyone to speak to their pediatrician to find out what’s right for their baby, but this study is a watershed moment for peanut allergy prevention and should be considered by all pediatricians.

Further, according to an article on MedPageToday, “A preliminary survey showed that a little under two-thirds of pediatricians [said] they do not counsel parents on introduction of peanut into infant diets, and almost 60% didn't feel confident doing so,” often citing a lack of time and proper resources as a hurdle. While there is more research to be done, I want all of my patients to be aware of any changes in medical guidelines and policy as it relates to their children. Part of why I decided to offer concierge pediatrics was to spend meaningful time with my clients, which allows me thoroughly review these guidelines and explain them to families, ensuring they make the right decisions for their children.  

As always, I’m here to answer all of your questions and if needed, tailor a peanut introduction plan specific to your child. Nothing is more important to me than my patients’ well being, so I welcome the chance to speak with your family about this important topic.

Below you’ll find the General Instructions, Feeding Instructions and How To Monitor For Symptoms of the Allergy as well as Four Recipe Options all in accordance with the study.

To read the study in its entirety, click here.

General Guidelines:

  1. Feed your infant new foods only when he or she is healthy; do not do the feeding if he or she has a cold, vomiting, diarrhea, or other illness.

  2. Give the first peanut feeding at home and not at a daycare facility or restaurant.

  3. Make sure at least one adult will be able to focus all of his or her attention on the infant, without distractions from other children or household activities.

  4. Make sure that you will be able to spend at least two hours with your infant after the feeding to watch for any signs of an allergic reaction. 

Feeding Your Infant:

  1. Prepare a full portion of one of the peanut-containing foods from the recipe options below.

  2. Offer your infant a small part of the peanut serving on the tip of a spoon.

  3. Wait 10 minutes.

  4. If there is no allergic reaction after this small taste, then slowly give the remainder of the peanut-containing food at the infant's usual eating speed. 

What are symptoms of an allergic reaction? What should I look for?

  1. Mild symptoms can include:

    • a new rash

    • few hives around the mouth or face.

  2. More severe symptoms can include any of the following alone or in combination. If any of these symptoms occur, seek medical attention immediately:

    • lip swelling

    • vomiting

    • widespread hives (welts) over the body

    • face or tongue swelling

    • any difficulty breathing

    • wheeze

    • repetitive coughing

    • change in skin color (pale, blue)

    • sudden tiredness/lethargy/seeming limp

Four recipe options, each containing approximately 2 g of peanut protein

  1. Bamba, 21 pieces

    • Note: Bamba is named because it was the product used in the LEAP trial and therefore has proven efficacy and safety. Other peanut puff products with similar peanut protein content can be substituted.

    • For infants less than 7 months of age, soften the Bamba with 4 to 6 teaspoons of water.

    • An FYI, I’ve had an easier time finding these on Amazon than in local stores.

    • For older infants who can manage dissolvable textures, unmodified Bamba can be fed. If dissolvable textures are not yet part of the infant's diet, softened Bamba should be provided.

  2. Thinned smooth peanut butter, 2 teaspoons

    • Measure 2 teaspoons of peanut butter and slowly add 2 to 3 teaspoons of hot water.

    • Can also be added to oatmeal (my kids’ favorite!)

    • Increase water amount if necessary (or add previously tolerated infant cereal) to achieve consistency comfortable for the infant.

    • Let cool.

    • Stir until peanut butter is dissolved, thinned, and well blended.

  3. Smooth peanut butter puree, 2 teaspoons

    • Measure 2 teaspoons of peanut butter.

    • Add 2 to 3 tablespoons of pureed tolerated fruit or vegetables to peanut butter. You can increase or reduce volume of puree to achieve desired consistency.

  4. Peanut flour and peanut butter powder, 2 teaspoons

    • Note: Peanut flour and peanut butter powder are 2 distinct products that can be interchanged because they have a very similar peanut protein content.

    • Measure 2 teaspoons of peanut flour or peanut butter powder.

    • Add approximately 2 tablespoons of pureed tolerated fruit or vegetables to flour or powder. You can increase or reduce volume of puree to achieve desired consistency.

Source: http://www.annallergy.org/article/S1081-12...