Introducing Peanuts

Reducing risk of peanut allergy through early introduction of peanut-containing foods

At around 4–6 months, children are developmentally ready to start complementary feeds. Signs that your baby is developmentally ready include the following:

• Your baby can hold their head up steadily and sit with some support
• Your baby shows interest in foods others are eating and opens their mouth when food approaches
• Your baby does not push food out of their mouth with their tongue

Start by introducing one new food at a time, and wait 3 days before introducing another new food. Start with lower allergy risk foods, such as pureed fruits, vegetables, and infant cereal. If your baby is breast-fed, it is a good idea to start with infant cereal to provide a source of iron.

Monitor for allergic reactions such as rash, trouble breathing, or vomiting and/or diarrhea. If a reaction occurs, stop offering the new food and consult your infant’s pediatrician.

Infants with moderate to severe eczema and other food allergies are at higher risk for peanut allergy. Infants whose parents or siblings have a peanut allergy also may be at higher risk. Earlier introduction of peanuts can help prevent peanut allergy.

Much advice from the past decade regarding when to introduce peanuts into the diet has been revised. Research over the past five years shows that early introduction and regular consumption of peanuts decreases the risk of developing a peanut allergy. It is no longer recommended that parents delay introducing peanuts in most children, as delay beyond 12 months actually may increase the risk of peanut allergy.

Infants with moderate to serve eczema are at a higher risk for peanut allergy. If your child has moderate to severe eczema, a significant family history of peanut allergy, or other food allergies, speak to your doctor before introducing peanuts. Your doctor may recommend testing, such as blood allergen or skin prick testing, to peanuts before introduction.

If your child does not have moderate to severe eczema, has no family history, and does not have other food allergies, introduce peanuts after 4 months and by 6 months of age. No testing is needed before introduction. Once your baby has tolerated a few other foods, peanuts may be introduced.

If your child has moderate to severe eczema and/or other food allergies, do not introduce peanuts without permission from your pediatrician or allergist.

When feeding your infant peanuts for the first time:

• Prepare a full portion of one of the peanut-containing recipes below.
• Offer a small amount on the tip of a spoon.
• Wait 10 minutes.
• If your infant has no allergic reaction (see symptoms below) after this small taste, then slowly offer the remainder at the infant’s usual feeding speed. Follow your baby’s cues—it is okay if your baby does not finish the full portion.

Peanut butter itself can be a choking hazard for infants. Whole peanuts are choking hazards and are not recommended until at least 4 years of age. Below are some ways to mix or thin peanut butter to a safe consistency for your infant. Choose smooth peanut butter rather than crunchy peanut butter, and choose a product without added sugar, salt, and oils.

• Thin peanut butter by mixing 2 teaspoons peanut butter with 1 tablespoon warm water.
• Mix 2 teaspoons peanut butter with 2–3 tablespoons of fruit or vegetable puree.
• Mix 2 teaspoons of peanut butter powder, PB2®, or peanut flour with 2–3 tablespoons of fruit or vegetable puree.
• Use a commercial product. Note the amount of peanut protein varies by product, and generally a serving appropriate for an infant will contain less peanut protein compared to peanut butter or peanut butter powder. For example, 2 teaspoons of peanut butter contain the recommended dose of 2 grams of peanut protein per serving. However, the serving of puffed snacks such as Bamba® to provide 2 grams of peanut protein is large for an infant, about 20 pieces.
  • Snacks: Bamba®, Gerber Organic Baby Pops® (peanut flavor), Earth’s Best Organic Peanut Butter Puffs®
  • Purees: Happy Baby Organics Nutty Blends® (banana peanut)
  • Powder: Lil Mixins®

Offer a serving (see above for serving size) to your infant 2–3 times per week as tolerated.

Some common signs of a food allergy or intolerance may appear immediately or within a few hours of eating. Mild symptoms of an allergic reaction may include a new rash or a few hives around the mouth or face. More severe symptoms may include any of the following, alone or in combination:

• Lip swelling
• Vomiting
• Full body hives
• Face or tongue swelling
• Difficulty breathing or wheezing
• Coughing
• Changes in skin color (pale, blue)
• Sudden fatigue

It is important to feed your infant new foods only when they are healthy (without a cold, vomiting, diarrhea, or other illness) and when an adult is available to monitor for any adverse reactions.

It is helpful to have liquid diphenhydramine (Benadryl) on hand to be prepared to treat potential allergic reactions. Since the dose is based on your child’s weight, ask your child’s pediatrician for the recommended dose at each healthcare visit.

If you think your infant is having a serious allergic reaction to a new food and appears ill, call 911.

Written by: Anthony Porto, MD and Wendy Elverson, RD, LDN
Edited by: Athos Bousvaros
June 2021