When can you feed your baby peanut butter

When can I start giving my baby peanut butter?

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Amanda Cox, MD, FAAAAI

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​Many parents have questions and concerns about when peanut butter can be safely introduced, because it is the leading cause of fatal and near-fatal food allergic reactions in the United States.

New Guidelines on the Introduction of Allergenic Foods:

For many years, experts thought that the best way to fight peanut allergy was to avoid peanut products in the first years of life. At the time, it was thought that delaying introduction would possibly prevent the development of other allergic conditions, especially eczema. However, more recent guidelines show that there is no benefit to delaying the introduction of allergenic foods. In 2015, an important study showed that early introduction and regular feeding of peanut prevented the development of peanut allergy in infants at "high risk" for peanut allergy (meaning infants who had severe eczema and/or an egg allergy).  

Advice to Parents:

• Start solids with a few foods that are of low allergy risk—for example, infant cereal, puréed bananas, or puréed prunes. Give your baby one new food at a time, and wait at least 2 to 3 days before starting another. After each new food, watch for any allergic reactions such as diarrhea, rash, or vomiting. If any of these occur, stop using the new food and consult with your child's pediatrician.

• If there is no special reason to be concerned that your baby is at increased risk for food allergies, after a few first foods have been tolerated, you can start to introduce the more highly allergenic foods (milk, egg, soy, wheat, peanut, tree nuts, fish, and shellfish). It is important that these—and all foods—are in forms and textures appropriate for infants. For instance, while whole cow's milk is not recommended before 1 year of age; you may introduce processed dairy products such as whole milk yogurt or Greek yogurt mixed with a fruit that your baby has already had in his or her diet.

• If your baby has or had severe, persistent eczema or an immediate allergic reaction to any food— especially if it is a highly allergenic food such as egg—he or she is considered "high risk for peanut allergy." You should talk to your child's pediatrician first to best determine how and when to introduce the highly allergenic complementary foods. Ideally peanut-containing products should be introduced to these babies as early as 4 to 6 months. It is strongly advised that these babies have an allergy evaluation or allergy testing prior to trying any peanut-containing product. Your doctor may also require the introduction of peanuts be in a supervised setting (e.g., in the doctor's office).

• Babies with mild to moderate eczema are also at increased risk of developing peanut allergy. These babies should be introduced to peanut-containing products around 6 months of age; peanut-containing products should be maintained as part of their diet to prevent a peanut allergy from developing. These infants may have peanut introduced at home (after other complementary foods are introduced), although your pediatrician may recommend an allergy evaluation prior to introducing peanut.

• Babies without eczema or other food allergies, who are not at increased risk for developing an allergy, 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. As with all infant foods, allergenic foods should be given in age- and developmentally-appropriate safe forms and serving sizes.

Choking Prevention:

• Whole peanuts themselves are choking hazards and should not be fed to babies. They can block the air passages, and if whole or partially chewed peanuts are inhaled into the lungs, they can cause a severe and possibly fatal chemical pneumonia. Avoid whole peanuts until your child is old enough to be counted on to chew them well (usually at least 4 years and up). ​

• A good way to introduce peanut in infancy would be mixing and thinning-out a small amount of peanut butter in cereal or yogurt. Dissolving peanut butter puffs with breast milk or formula and feeding it by spoon is another good option.

Remember:

The highly allergenic foods should initially be given to your baby in small tastes at home, and the amount can gradually be increased in a developmentally appropriate manner if there are no signs of intolerance or allergic symptoms.

NOTE: The AAP recommends breastfeeding as the sole source of nutrition for your baby for about 6 months. When you add solid foods to your baby's diet, continue breastfeeding until at least 12 months. You can continue to breastfeed after 12 months if you and your baby desire. Check with your child's doctor about vitamin D and iron supplements during the first year. Remember that each child's readiness for solid foods depends on his own rate of development. 

Additional Information & Resources:

• Working Together: Breastfeeding and Solid Foods 

• Sample Menu for an 8 to 12 Month Old

• Infant Allergies and Food Sensitivities

• Peanut Allergies: What You Should Know About the Latest Research

• The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods (AAP Clinical Report)
  

Amanda Cox, MD, FAAAAI

​Amanda Cox, MD, FAAAAI is an Assistant Professor of Pediatrics in the Division of Pediatric Allergy and Immunology at the Icahn School of Medicine at Mount Sinai in New York and a practicing pediatric allergist at Jaffe Food Allergy Institute. She is a former president of the New York Allergy & Asthma Society and a fellow of the American Academy of Allergy Asthma & Immunology where she serves on the Adverse Reactions to Foods Committee. Dr. Cox is a contributing writer to The Pediatrician's Guide to Feeding Babies and Toddlers and has written several book chapters and review articles in the area of food allergy. ​

Last Updated

3/17/2019

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

When Can Babies Have Peanut Butter: A Guide

Peanut butter is a versatile food that’s both tasty andhealthy. You can enjoy it as a snack or meal. Scoop a spoonful of crunchy peanut butter on a celery stick, or make a peanut butter, jelly, and banana sandwich for lunch.

No matter how you spread it, peanut butter is delightful, and it can be a staple of any healthy diet.

The problem is, it also can’t be. That’s because about 3 million people in the United States are allergic to peanuts and tree nuts. In fact, a peanut allergy is the most common allergy among food allergic children.

But recent research found that early exposure to peanuts could significantly decrease the chances of your baby developing a nut allergy.

If you want to introduce your baby to peanut butter, but you’re nervous about allergies, read on for tips, tricks, and a few recipe ideas.

The American Academy of Allergy, Asthma, and Immunology recommends introducing peanut butter to your baby only after other solid foods have been fed to them safely, without any symptoms of allergies. This can happen between 6 and 8 months of age.

Avoid giving whole peanuts or peanut pieces to any child under 4 years old. Peanuts can be a choking hazard.

Peanuts are among the eight foods that account for 90 percent of all food allergy reactions. Peanut allergies, which usually develop in childhood, can be lifelong. If you do outgrow a peanut allergy, there’s still a chance it may return.

Children with other food allergies are at an increased risk of having a peanut allergy. The same goes for children in families where food allergies are common. Children who have tested positive for a peanut allergy should never be given peanuts.

You should also proceed with caution when introducing peanut butter to your baby if you think they are at risk for the allergy. First, speak with your doctor and ask about an allergy test. If you’re certain you want to introduce peanuts, it may be a wise idea to give your baby peanut butter while at the doctor’s office.

There are several ways to spot a food allergy. You child might experience:

• hives (red spots that mimic mosquito bites)
• sneezing and/or wheezing
• breathing problems
• swelling
• itchy rashes
• throat tightness
• swelling
• nausea
• vomiting
• diarrhea
• pale skin
• circulation symptoms
• lightheadedness
• loss of consciousness

Food allergy reactions can range from mild to severe. They can also happen shortly after the food is consumed. Normally, your child will experience an allergic reaction in one location of their body. But if your child suffers from anaphylaxis, a serious, life-threatening allergic reaction caused by foods like peanuts, they will experience multiple symptoms at once. Anaphylaxis requires immediate medical attention in the nearest emergency room.

If your child suffers a severe allergic reaction, they will need to see their pediatrician (and likely an allergist) to help determine the cause and treatment of their allergy.

You should serve babies peanut butter that’s smooth and thin. Thick peanut butter can be hard for a baby to eat. If it’s too thick to swallow, it can be a choking hazard.

Avoid buying chunky peanut butter and serving actual peanuts. Both of these can cause your little one to choke. To thin the texture of your peanut butter, mix in a little water so it’s more like a watered down paste.

Peanut Butter Teething Biscuits

This peanut butter teething biscuit recipe is a tasty and organic way to help your baby use their new chompers. The biscuits call for only eight ingredients, and it takes just 10 minutes to prepare and 20 minutes to cook.

The recipe yields 20 to 24 treats. You can serve them at room temperature or put them briefly in the freezer to help soothe your baby’s gums. Make sure they are not too hard and crumbly so pieces do not break off and cause a choking risk.

Peanut Butter and Butternut Squash

Add pizazz to the rotation of solid foods you feed your little one with peanut butter and butternut squash. This two-ingredient recipe calls for some peanut butter and frozen butternut squash puree, thawed and heated in the microwave.

It’s a quick and easy recipe that’ll take just 10 minutes to prepare.

PB&J Oatmeal Thumbprint Cookies

Weelicioushas a healthy twist on a childhood favorite: PB&J oatmeal thumbprint cookies. This delightful recipe only takes 15 minutes to make. They take just five minutes to prepare and 10 minutes to bake. You’ll need nine ingredients all together.

When it comes time to shape the cookies, have your toddler help. Let them use their thumb to press down on the cookies, then fill the indent with your favorite jam or jelly.

The recipe makes 60 cookies.

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When can children eat peanut butter?