By: Amanda Cox, MD, FAAAAI & Michael Pistiner, MD, MMCs, FAAP
Many parents have questions and concerns about when they can safely introduce foods like egg and peanut butter into their child's diet. Although these foods are common staples in the U.S. diet, they are also among those most likely to trigger allergic reactions.
Current guidelines for introducing potential food allergens to babies
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,
newer research found no benefit to delaying the introduction of allergenic foods.
In fact, what that newer research reveals is this: Once your baby is ready to start solid foods, it can actually be helpful to begin offering small amounts of foods that are more likely to cause allergies.
Early peanut introduction, lasting allergy prevention
In 2015, a major study found that early peanut introduction—with continued, regular servings—prevented peanut allergy in infants at "high risk" of developing it (those with severe eczema and/or an egg allergy). More recently, a follow-up study of the same group of children showed lasting protection. Studies have also found protective effects with the early introduction of eggs, as well as infant-appropriate forms of dairy like cow's milk-based formula.How to start feeding your baby allergenic foods
Babies get all the nutrition they need from
breast milk,
formula or a combination of both until they are around 6 months of age. That's when they are usually ready to try their first few bites of
solid food.
Once your baby is ready, here are some tips to begin introducing solid foods to your baby with food allergies in mind:
- 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 a day 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 your baby tolerates a few first foods, and there is no reason to think they are at increased food allergy risk, you can start to introduce the more highly allergenic foods. These include common foods like egg, nut products, yogurt or other dairy, wheat, sesame, soy, fish and shellfish. Ideally peanut-containing products should be introduced to these babies as early as 4 to 6 months. Studies suggest that waiting longer can increase the chance of developing an allergy.
- Start with small tastes. If your baby shows no signs of intolerance or allergic symptoms, the amount can gradually be increased. Then, keep in their diet routinely in developmentally appropriate portions (for example, 2 teaspoons of peanut butter, nut butters such as cashew and sesame tahini, about 1/3 of a well-cooked egg (like scrambles or hard-boiled).
- Only offer these—and all foods—are in forms and textures suited 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 their diet.
If your baby has or had severe, persistent eczema or an immediate allergic reaction to any food—especially a highly allergenic food such as egg—they are considered "high risk for peanut allergy." You should talk with your child's pediatrician first to best determine how and when to introduce the highly allergenic complementary foods.
How to prevent choking when introducing solid foods
Do not feed whole peanuts or tree nuts to babies or young children—they are choking hazards. In their whole form, 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).
To introduce peanut to an infant, one safe way is by mixing and thinning out a small amount of peanut butter in cereal, pureed fruit or yogurt. Dissolving peanut butter in breast milk or formula and feeding it by spoon is another good option.
Remember
Each child's readiness for solid foods depends on their own rate of development. Once they are ready, typically at about 6 months old, there is no evidence that delayed introduction of allergenic foods like egg, peanut, dairy and sesame prevents allergies. Don't hesitate to talk with your baby's pediatrician if you have any questions about your baby's diet.
Note: The American Academy of Pediatrics (AAP) recommends exclusive
breastfeeding as the sole source of nutrition for your baby for about the first 6 months. When you add solid foods to your baby's diet, continue breastfeeding for as long as you and your baby desire, for 2 years or beyond. Check with your child's doctor about
vitamin D and
iron supplements during the first year.
More information
About Dr. Cox
 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.
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About Dr. Pistiner
 Michael Pistiner, MD, MMSc, FAAP is a pediatric allergist and the Director of Food Allergy Advocacy, Education, and Prevention at Mass General for Children, Harvard Medical School. He specializes in food allergy prevention and management in infants and toddlers, with a focus on early introduction strategies and the development of clinician support tools. Dr. Pistiner's team has proposed modified criteria for identifying anaphylaxis in young children and developed the Food Allergy Management and Prevention Clinician Support Tool for Infants and Toddlers (FAMP-IT.org) to help primary care providers prevent and manage food allergies in this age group. Dr. Pistiner is a member of the American Academy of Pediatrics Section on Allergy and Immunology.
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