These sections contain the same information as in the PDF handouts throughout this section but are formatted for easier placement within EMR systems to place in after visit patient handouts.
Helpful Tips and Tricks for Allergy Prevention
The dual exposure hypothesis is a belief that the ability to eat a food without a reaction (tolerance) is developed by having the GI tract see the food, whereas the potential for food allergy is developed by skin exposure to the food, which can be worsened by eczema or skin breakdown. It is important to try to prevent repeated skin exposure to foods that your child has not eaten yet. To try to limit skin exposure it is best to avoid eating allergenic foods in your child’s play area and restrict eating to the table. It is important to clean surfaces where food is prepared or eaten to help reduce your child’s environmental exposure to any food allergens. Limit snacking throughout the house to reduce the amount of food dust/particles that get on rugs, carpets, etc. It is best to wash your hands before applying lotions and creams and after handling foods.
Why should I introduce peanut products to my baby so early in life?
Introducing peanut products to your baby early in life can help prevent him from developing a peanut allergy later on. Ask your doctor when it is right to introduce peanut products for the first time.
What should I do before giving my baby peanut products for the first time?
Talk with your baby’s doctor about whether he is ready to try peanut products.
If your baby has other known food allergies or very bad eczema (dry, scaly patches of skin), ask your doctor if your baby should have an allergy test or see a pediatric allergist (allergy doctor).
How do I introduce peanut products?
Safety tips
Give the first taste when your baby is healthy. Do not give the first taste if he has a cold, fever, diarrhea or other illness.
Give your baby his first taste of peanut products at home. Do not give the first taste at daycare or in a restaurant.
Timing tips
Set aside at least 2 hours after the first taste to watch your baby for a reaction. Make sure you or another family member can give full attention to your baby.
For the very first taste, give a small amount, the tip of a small spoon. Wait 10 minutes between the first and second taste. If your baby does not have any reaction after 10 minutes, give the rest of the peanut butter at his normal eating speed.
Give your baby 2 teaspoons (6 grams) of peanut products at least 3 times per week. This will help prevent him from developing a peanut allergy later in life.
Tips while your child eats:
Prepare a full serving of peanut butter from the recipe below.
Offer the first taste on a small spoon.
For babies and children under age 4, mix peanut butter with 1 safe food at a time. Do not give plain peanut butter to any baby or child under age 4.
Do not push your baby to eat more than he wants.
Peanut recipes for babies
Option 1: Peanut butter puree
You will need:
2 tsp. smooth, all-natural peanut butter (with no added ingredients)
2-3 tbsp. of plain yogurt or pureed (smooth) fruit or vegetable that your baby likes
Mix peanut butter and yogurt or fruit or vegetable puree. Add more water if you want the puree to be thinner.
Option 2: Peanut butter powder sauce
You will need:
2 tsp. powdered peanut butter or peanut flour
2-3 tbsp. of warm water, oatmeal, applesauce or mashed banana
Mix peanut butter or peanut flour with the water, oatmeal, applesauce or banana.
Let the mixture cool.
Add more water if you want the mixture to be thinner.
Option 3: Bamba® peanut butter puffs
You will need:
21 Bamba® peanut butter puffs
For babies aged 7 months and under, soften puffs in 4-6 tbsp. of water. Feed your baby one puff at a time.
For babies older than 7 months or who can eat dissolvable solids, feed puffs one at a time as normal.
A note about choking
Only give your baby smooth peanut butter.
Never give your baby chunky or crunchy peanut butter. Your baby can choke on the small peanut pieces.
Never give your baby whole peanuts or pieces of peanuts.
A note about food allergies
When your baby is trying a peanut product for the first time, it is important to watch him for signs of a food allergy. An allergic reaction can happen up to two (2) hours after trying a new food.
What is a food allergy?
A food allergy is when your body mistakes a certain food for something dangerous or unknown.
What are common signs of a food allergy?
Rash or hives (swollen red bumps) around the mouth or on the face or body
Swollen lips, tongue or face
Itching
Vomiting
Coughing
Change in skin color (blue or pale)
Wheezing (whistling sound when you breathe in)
Trouble breathing
Suddenly feeling tired or drowsy
Feeling like your body is going limp
What to do if your baby has an allergic reaction
Call 911 or take your baby to the emergency room right away.
If your baby’s allergist (allergy doctor) has created a Food Allergy Action Plan, follow the steps.
Helpful Tips and Tricks for Allergy Prevention
The dual exposure hypothesis is a belief that the ability to eat a food without a reaction (tolerance) is developed by having the GI tract see the food, whereas the potential for food allergy is developed by skin exposure to the food, which can be worsened by eczema or skin breakdown. It is important to try to prevent repeated skin exposure to foods that your child has not eaten yet. To try to limit skin exposure it is best to avoid eating allergenic foods in your child’s play area and restrict eating to the table. It is important to clean surfaces where food is prepared or eaten to help reduce your child’s environmental exposure to any food allergens. Limit snacking throughout the house to reduce the amount of food dust/particles that get on rugs, carpets, etc. It is best to wash your hands before applying lotions and creams and after handling foods.
It is best to introduce new foods to your child in an age-appropriate and culturally appropriate manner. The foods should be free of choking hazards, such as whole nuts and thinned by mixing them with formula, breast milk, or pureed fruits or vegetables. There is no reason to delay the introduction of foods that are considered “allergenic” like, tree nuts, eggs, dairy, soy, wheat, sesame, fish, and shellfish beyond 4-6 months of exclusive breat feeding. We recommend that you start with a tip of a teaspoon and double this every 10 to 20 minutes until your child has reached about 2 grams of the allergen protein. The amount of protein can be found on the nutrition label. For example, about 2 teaspoons for nut-butters, and sesame tahini) and about 1/3rd of a large egg have 2 grams of those specific proteins.
This initial food introduction can also be done more slowly if you or your provider have any concerns. It is important to be aware of the signs of an allergic reaction or anaphylaxis. These symptoms include hives, swelling, wheezing, cough, shortness of breath, nausea, vomiting, difficulty breathing, or loss of consciousness. If you have any concerns it is important to call 911. Please let your provider know if there are any signs of a reaction because a referral to an allergist will be made. If foods are tolerated it is important to keep them in the diet in regular intervals.
What Parents Should Know [English]: https://players.brightcove.net/6056665225001/5cmMqFpv5_default/index.html?videoId=6216466727001
What Parents Should Know [Spanish]:
https://players.brightcove.net/6056665225001/5cmMqFpv5_default/index.html?videoId=6216471682001
When is an infant ready for solid food, and what foods are developmentally appropriate?
If serving purees, aim for a smooth, even texture for your baby’s first few foods. First finger foods given to an infant should be very soft and easy to smash between your thumb and forefinger. For thicker foods, such as nut butters, it is best to thin them out with warm water or mix them into something smoother, such as applesauce. Some signs that a baby is ready to try solid foods are:
Some infants may show developmental signs of readiness before age 6 months but introducing complementary foods before age 4 months – or waiting until after 6 months – is not recommended.
The American Academy of Pediatrics states that: “There is no evidence that delaying the introduction of allergenic foods, including peanuts, eggs, and fish, beyond 4 to 6 months prevents atopic disease.”
Why is infant nutrition so important?
During an infant’s first year of life, infants should receive adequate amounts of essential nutrients because these foods are needed for healthy brain development and overall growth. Also, establishing healthy dietary patterns early in life can influence eating behaviors and overall health throughout the course of life.
Key Recommendation
Between ages 0-4 months: Exclusive breastmilk and/or formula feeding
Between 4-6 months: When your child is ready, start to introduce complementary foods
Between 6-12 months: Introduce complementary foods no later than 6 months
How do I know if my child is at high risk of developing a peanut allergy?
Recommendations: age-appropriate, peanut-containing foods should be introduced to the diet as early as age 4 to 6 months.
Establishing Healthy Dietary Patterns in an Infant’s First Year of Life
Dietary Components to encourage:
Dietary Components to limit:
Dietary Components to Avoid:
Introducing your child to the 9 major allergens:
The 9 major potentially allergenic foods should be introduced as complementary foods. There is evidence that introducing peanut-containing foods in an infant’s first year of life can reduce the risk that s/he will develop a peanut allergy There is no evidence that delaying introduction of allergenic foods beyond 6 months prevents food allergy.
Dot phrases modified from PDF found at: https://famp-it.org/wp-content/uploads/aap-statement-FAMPIT_Nutrition-Education_less12mo.pdf
Nutrition Education Adapted from the 2020-25 Dietary Guidelines’ New Chapter on Infant and Toddler Nutrition
Following healthy dietary patterns early on is important for maintaining proper growth, and nutritional needs, and reducing the risk for chronic disease later in life. You can help your child establish healthy eating habits by encouraging them to eat a variety of nutrient-dense foods from all the food groups. You can start by replacing less healthy snacks and ingredients with nutrient-dense alternatives!
Dietary Components to LIMIT:
Dietary Components to AVOID:
It is important to choose nutrient-dense foods from each food group!
Dot phrases modified from PDF found at: https://famp-it.org/wp-content/uploads/FAMPIT_Nutrition-Education_more12mo.pdf
© 2024 MassGeneral Hospital for Children Food Allergy Center. All rights reserved.