National Breastfeeding Awareness Month: Q&A with Dr. JJ Levenstein

Dr. JJ Levenstein is chair of the National Peanut Board’s Food Allergy Education Advisory Council and was not compensated for this article.

There’s no shortage of advice for pregnant and new mothers regarding diet, breastfeeding and introduction of complementary foods. It can be overwhelming to keep up with the most up-to-date recommendations. In honor of National Breastfeeding Awareness Month, we wanted to share the most current research on consumption of potential food allergens during pregnancy/breastfeeding and how it can affect your baby, as well as the proper guidelines for introducing potentially allergenic foods to your baby’s diet. Below are some common questions I receive from expectant and mothers of infants.

Is it safe to eat peanut products during pregnancy or while breastfeeding?

Current recommendations from the American Academy of Pediatrics state that there is no evidence that avoiding any foods prevent or delay the development of allergies. According to a study published in the Journal of the American Medical Association (JAMA) in December 2013, researchers found a lower risk of peanut allergy among the children whose mothers ate peanuts during pregnancy and breastfeeding.  Obviously peanut allergic pregnant women should not eat them and should seek medical advice about preventing peanut allergy in their children.  Peanuts are a terrific, healthy snack during those early months of morning sickness.

When is it safe to introduce foods to infants?

In 2017, the National Institute of Allergy and Infectious Disease (NIAD) – sponsored expert panel released recommendations about the early introduction of peanut foods as a means to prevent peanut allergy. NIAID’s new guidelines now recommend introducing peanut protein to infants as early as 4-6 months of age, depending on risk factors – including egg allergy and/or moderate to severe eczema.  The American Academy of Pediatrics reflects these recommendations for early introduction.

Because there is no convincing evidence that delaying the introduction of potentially allergenic foods to children prevents food allergies, foods considered at high risk may be introduced as well.

In fact, the Learning Early About Peanut (LEAP) study, published a couple of years ago in the New England Journal of Medicine,  convincingly demonstrated that introducing peanut protein to high risk infants (those with eczema, egg allergy or both) before a year of age reduced their potential risk for developing peanut allergy by up to 86%.

As the result of this groundbreaking research, our U.S. guidelines about introduction of peanut to infants are now guided by the results of this study. The guidelines do not suggest avoiding potentially allergenic foods and these may be introduced after 4-6 months. If your baby is at higher risk for peanut allergy, peanuts should be introduced certainly by 6 months of age.

But most importantly, always consult with your child’s pediatrician or pediatric allergist (if your baby is at high risk) before introducing new foods.

What are some tips on introducing potentially allergenic foods, such as peanuts?

  • Use diluted peanut butter, reconstituted peanut powder, or a weaning snack like Bamba, to introduce peanut protein to your baby.
  • Try new foods in the morning, so you have the light of day and time to observe your baby, especially when introducing higher risk foods.
  • Make sure you introduce a few other foods before trying peanut foods in order to make sure your baby is ready for solid foods.
  • Introduce one new food every 3-4 days, offering regularly over that period and monitoring for any reaction.
  • With high risk babies, the recommendation is to make sure that peanut protein is given regularly (at least 3x/week) and consistently from infancy through early childhood.

 

Recipes

 

For more tips on how families can introduce peanut protein to infants, check out this infographic.

Dr. JJ Levenstein, MD, FAAP, is a pediatrician, president and co-founder of MD Moms and chair of the National Peanut Board’s Food Allergy Education Advisory Council.