Introducing Peanut and Allergy Foods to Babies

Not long ago, parents were told to hold off on peanut, egg and other allergy foods until children were older. That advice has changed. Research now shows that giving these foods early, once your baby is ready for solids, can lower the chance of a food allergy, especially peanut allergy. Waiting does not prevent allergies. Here is how to start, which babies need a talk with the pediatrician first, and what a reaction looks like.

Which foods cause most allergies?

A small group of foods causes most food allergies in children:

• Peanut
• Tree nuts, such as almond, cashew and walnut
• Egg
• Cow's milk products, such as yogurt and cheese
• Wheat
• Soy
• Sesame
• Fish and shellfish

When to start

Most babies are ready for solid foods around 6 months old. Signs of readiness include good head control, sitting up with support, showing interest in your food, and opening their mouth when a spoon comes near. The American Academy of Pediatrics advises that allergy foods can be part of those first foods. There is no need to wait until age 1 or later.

Start with a few simple first foods, such as iron-fortified infant cereal or a pureed vegetable or fruit. Once your baby handles those, begin adding allergy foods one at a time. Give each new allergy food on its own, and wait a day or two before adding the next, so you know what caused any reaction.

Babies who need a plan first

Some babies are at higher risk of peanut allergy. Talk with your pediatrician before giving peanut if your baby has:

• Severe eczema, especially eczema that keeps coming back even with regular care
• An egg allergy
• A reaction to any other food already

For these babies, guidelines from the National Institute of Allergy and Infectious Diseases suggest introducing peanut even earlier, around 4 to 6 months, but only after talking with the pediatrician. Your pediatrician may suggest allergy testing or refer you to an allergist, and some babies have their first taste in the doctor's office. Do not try a "test taste" at home on your own first.

Babies with mild to moderate eczema can usually start peanut at home around 6 months. Babies with no eczema or food allergy can have peanut whenever they start solids. If your baby has a brother or sister with a food allergy, mention it to your pediatrician.

How to offer peanut safely

Whole peanuts and spoonfuls of peanut butter are choking hazards for babies and toddlers. Never give them. Safe ways to offer peanut include:

• Stirring a small amount of smooth peanut butter into warm water, breast milk or formula until it is thin, then mixing it into infant cereal or a fruit or vegetable puree
• Mixing peanut powder or finely ground peanut into a puree
• Using a peanut puff snack softened with water for younger babies

Other allergy foods can be offered in forms like well-cooked scrambled egg, plain whole-milk yogurt, soft pieces of wheat toast or pasta, or thinned tahini for sesame. Make sure any fish is fully cooked and boneless.

Tips for the first taste

• Pick a day when your baby is healthy, not fighting a cold or a stomach bug.
• Offer new allergy foods at home, early in the day, so you can watch your baby for a few hours afterward.
• Start with a small amount on the tip of a spoon. If there is no reaction after about 10 minutes, offer the rest at your baby's usual pace.
• Have an adult watch your baby closely during and after the meal.

Keep it on the menu

Once your baby eats an allergy food without trouble, keep offering it regularly, a few times a week. Giving it once and then stopping for months may not give the same protection. Ask your pediatrician how often and how much to offer your baby.

Also keep in mind other first-year rules: no honey before 12 months, and no cow's milk as a main drink until age 1, though yogurt and cheese are fine.

Signs of an allergic reaction

Most reactions happen within minutes to 2 hours after eating. Mild signs include:

• A few hives or a red rash around the mouth or face
• Itching
• Mild swelling of the lips

Stop the food and call your pediatrician if you see these. A little redness where food smeared on the skin is common and not always an allergy, but mention it.

Signs of a serious reaction, called anaphylaxis, include:

• Coughing, wheezing, a hoarse cry or trouble breathing
• Swelling of the tongue, face or throat
• Hives spreading over the body
• Repeated vomiting
• Pale or bluish skin
• Becoming floppy, very sleepy or unusually fussy and hard to soothe

If your baby has any trouble breathing or seems very ill after eating, call 911 right away. If your child has a prescribed epinephrine auto-injector, use it first, then call 911. Read the AAP's guide to anaphylaxis in infants and children.

For more on starting these foods, see the AAP article on when to introduce egg, peanut butter and other allergy foods.

When to call us

Call your A thru Z Pediatrics office before starting peanut if your baby has severe eczema, an egg allergy or another food reaction. Also call if your baby gets hives, a rash, vomiting or diarrhea after a new food.

Call 911 if your baby has trouble breathing, swelling of the face or throat, turns pale or blue, or becomes limp or hard to wake after eating.

Want a plan for starting solids? You can request a visit.