Parents should begin feeding infants peanut products between four and six months of age, not waiting until 12 months, a practice that appears to be fuelling a rapid increase in peanut allergy in North America.
The new approach — released Thursday by an expert panel organized by the U.S. National Institute of Allergy and Infectious Disease — is a radical revision of the prevailing wisdom being doled out by doctors.
It turns out that waiting for the baby’s immune system and gut to mature is exactly the wrong thing to do, said panel member Edmond Chan, director of the allergy clinic at B.C. Children’s Hospital.
“These new guidelines contradict what many parents have been hearing — that they should be cautious about feeding peanut foods to infants,” said Chan. “Feeding peanut to children around six months is the best way to prevent an allergy to peanut.”
It is particularly important for infants at a high risk of developing peanut allergy — those with eczema or allergies to eggs — to consume peanut early, though they should be tested for a reaction first, he said.
The NIAID panel was convened to produce new guidelines for parents and physicians after a rigorous study published in 2015 showed that early introduction of peanut dramatically reduced the risk that a high-risk child would develop an allergy by age five.
Earlier flawed studies fuelled parents’ fears and encouraged doctors to preach caution. Surveys of Canadian physicians conducted by Chan found that 80 per cent are counselling parents to delay giving infants peanut until they are one year old.
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The Guidelines, in brief
- Children with severe eczema and/or egg allergy benefit from introduction of peanut between four and six months of age, in close consultation with a physician.
- Children without risk factors may be fed peanut at home.
How to Introduce Peanuts at Home
- Feed your infant only when she is healthy and do the first feeding at home. One adult should be able to focus all his attention on the infant for at least two hours.
- Recommended portion, three times a week: Two teaspoons of peanut butter or peanut flour mixed with two tablespoons puréed fruit, or two teaspoons peanut butter softened with two to three teaspoons hot water.
- Prepare full portion and offer infant a small amount on the end of a spoon. Wait ten minutes. If there is no reaction, continue feeding at the child’s normal pace.
What to Watch For
- Mild symptoms may include rash around mouth or face, while severe symptoms include lip swelling, face swelling, vomiting, hives, difficulty breathing, repetitive coughing, change in skin colour or sudden lethargy and limpness.
- If you have concerns about your infant’s response to peanut, dial 911 and seek medical attention.
Source: National Institute of Allergy and Infectious Disease
The confusion was compounded by a recommendation by the American Academy of Pediatrics that children at risk of developing a food allergy avoid certain foods until they were older that was widely misinterpreted so that even parents of low-risk infants became overly cautious.
Since then peanut allergy in children has soared.
In 1999, peanut allergy was estimated to affect 0.4 per cent of children in the United States, but by 2010 that figure had risen fourfold, to two per cent of all children. A study by McGill University — also released in 2010 — found that 1.93 per cent of Canadian children have a peanut allergy.
“Allergy is a difficult thing to pin down, but observational studies show that the rate of peanut allergy is at least three times higher now than it was a couple of decades ago,” said Chan.
Chan noted that Jewish children in Britain are ten times more likely to have a peanut allergy than genetically similar children in Israel. British parents typically delay introducing peanut to their infants, while in Israel many youngsters are given a popular peanut-flavoured snack called Bamba as one of their first solid foods.
“We understand now that consuming peanut by around six months of age educates specialized cells — regulatory gatekeepers — in the gut,” Chan said.
The new guidelines are being introduced Thursday by NIAID and 26 private, government and patient advocacy organizations across North America and published simultaneously in several scientific journals.
“We need to communicate with (parents) directly and put them at ease, otherwise the only place they will feel comfortable giving their baby peanut is in the parking lot outside the emergency room,” said Chan. “The irony is that the parents who are most afraid — those with a high-risk infant — should be introducing peanut earliest.”
Scientists and doctors face an up-hill battle convincing parents to overcome their fears.
“We had no intention of introducing peanuts or nuts of any kind to our first-born son until he was around a year old, because we knew that it was a common allergen and we were concerned about having a reaction,” said Andrea Stephens, whose son was at high risk of peanut allergy.
“Our pediatrician told us at six months to go ahead and try it and even then we waited another four weeks before we gave it to him,” she said.
Mardi Williamson was diagnosed at five months with a severe peanut allergy, before her mother Michelle even tried to feed her peanut.
“That came out of the blue for us,” said Michelle. “I walked out of the office with a prescription for an EpiPen that day and our lives were forever changed. It’s not a care-free childhood.”
Her school in Whistler is entirely nut-free, but Michelle worries that even peanut residue on playground equipment could trigger potentially deadly anaphylactic shock.
Mardi — who treated herself with the EpiPen during her first reaction — is always cautious in new places.
“It was scary to have a reaction, but I feel more confident having had the experience,” she said.