Preventing Peanut Allergies During a Pandemic

Parenting during a pandemic is full of challenges. Preparing three meals a day, plus snacks, schooling from home, and keeping kids engaged, entertained, and educated are just some tough tasks parents are juggling – often while also working from home.

New parents may be additionally stressed with 24/7 infant care on their plates and little or no outside help. Sleep concerns, immunizations, feeding, and the many normal questions and concerns of parents are usually answered during well-baby visits. Although some parents may be hesitant to get out of the house, the American Academy of Pediatrics is encouraging their members to continue to provide in-person visits for these parents during the pandemic. Likewise, parents are encouraged to continue to stay in contact with their child’s pediatrician.

One question parents may be asking is, “Should I introduce potential allergens to my baby right now?” While it’s important to remain in contact with your child’s pediatrician, it may be helpful to understand the available guidelines on allergen introduction.

The National Institute of Allergy and Infectious Disease (NIAID) published guidelines for the introduction of peanut foods to infants that recommends introduction based on a child’s specific risk factors. Parents of infants with severe eczema and/or egg allergy should discuss the introduction of peanut foods with their pediatrician early, since the recommendations suggestion starting as early as 4 months could be protective. Physicians may recommend allergy testing and/or in-office introduction for baby’s first bites of peanut foods.

For infants with mild to moderate eczema, parents may want to discuss when to introduce with their pediatrician first, but it is not necessary. If an infant doesn’t have eczema or any signs of food allergy, peanut foods can be introduced at home, in an age-appropriate way, starting around six months of age. There are great resources for caregivers at PreventPeanutAllergies.org, including guides for assessing risk, feeding babies peanut foods, and infant and toddler peanut recipes.

Feeding a baby peanut foods is not complicated yet knowing a few tips for safe introduction can help. Always start when your baby is healthy, without a fever or any obvious illness. Begin the feeding early in the day and well before a nap, so that you can observe for any signs of illness for at least two hours.

Choose age-appropriate forms of peanut, such as thinned peanut butter or powdered peanut butter mixed into infant cereal. Start with just a small amount on the tip of a spoon. Wait 10 minutes, then feed a little more. After several more minutes without a reaction, feed the rest of the food to get to a full infant portion. One easy way to feed baby peanut foods is to mix two teaspoons of peanut butter with equal parts warm water, breastmilk or formula. Two teaspoons of powdered peanut butter can be mixed into infant cereal as an alternative and infant-appropriate peanut puffs are another easy way.

Most parents want to know what to look for in case of a reaction when new foods are introduced. The most common food allergy reactions in babies are vomiting and hives. Other signs that may happen with a food allergy include swelling of the lips and mouth and coughing. If wheezing, difficulty breathing, or lethargy occur, seek emergency medical attention. It is uncommon for infants to have anaphylaxis, but it can happen. In the event that a baby needs an in-office oral food challenge, the American Academy of Allergy and Immunology has recommended those be postponed until after the pandemic has subsided.

When asked his thoughts on introducing peanut foods during a pandemic, Dr. Gideon Lack, lead author on the ground-breaking LEAP (Learning Early About Peanut Allergies) study said, “[Even now] introducing peanut foods early is essential for preventing peanut allergies.”

Likewise, Dr. JJ Levenstein, pediatrician and chair of the National Peanut Board’s Food Allergy Education Council says, “Parents should not be afraid to introduce peanut foods and other allergens to their infants at around six months, possibly earlier if their pediatrician recommends that, since the risk of reactions is low and the potential for preventing a peanut allergy is high. I would suggest making a plan for introduction with your healthcare provider on a day when the office is open.”

It is important to remember peanut allergy affects only about two percent of American children, which means 98 percent of children will not develop peanut allergies. Even in the context of a pandemic, regular preventative care for babies is essential, including efforts to prevent peanut allergies. Dr. JJ says it best, “Know that you’re doing something beneficial for your baby by introducing a wide variety of foods, including allergens, early and often!”