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Question

When can I start giving my baby peanut butter?

Amanda Cox, MD, FAAAAI

Answer

​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 from the National Institute of Allergy and Infectious Diseases 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 diarrhearash, 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:

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
2/6/2017
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.
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