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What To Do About Babies and Peanuts: New Study Finds Early Exposure Can Prevent Allergy

You’ve probably already seen headlines about a study showing that feeding children small amounts of peanut products in the first 5 years of life can prevent the development of peanut allergy. The study was conducted in the U.K., led by Gideon Lack of King’s College London, and was published this week in the New England Journal of Medicine (free full text available here).1

Why is this study important?

Food allergies are on the rise in Western countries, and peanut allergy is one of the scariest. In the U.S., more than 2% of children and their families are now living with a peanut allergy, representing a 5-fold increase in prevalence since 1997.2,3 And this allergy isn’t just an inconvenience; it’s now the biggest cause of anaphylaxis and death related to food allergy in the U.S.4 This is a huge concern to parents wondering when and how to introduce peanuts to their kids, but the advice on this matter has been really confusing over the last 15 years.

In 2000, the AAP recommended delaying the introduction of peanut and other commonly allergenic foods (i.e., wheat, eggs, fish, cow’s milk) until at least the first birthday and until age 3 for kids thought to be high-risk for allergy.5 While this advice may have seemed reasonable, it was never based on good evidence – just a best guess based on knowledge at the time.

Meanwhile, the incidence of food allergies continued to climb, and epidemiological evidence emerged that avoiding allergens might backfire. In 2008, the AAP issued new guidelines stating that there was no evidence that delaying introduction of solid foods, including common allergens, beyond 4 to 6 months of age would protect children from developing allergies.6 This document was intentionally vague, because at the time, there weren’t any studies to give more specific guidance on when to introduce what, in what amounts, etc. And this flip-flop in advice, which was also mirrored in many other countries, has left a lot of parents confused.

Gideon Lack and colleagues published a study in 2008 that found that the incidence of peanut allergy among Jewish children in the U.K. was 10-fold higher compared with those growing up in Israel.7 Comparing the mean age of introduction of peanut protein between the two countries, they found that babies in Israel were commonly introduced to peanut in their first year, while babies in the U.K. were not. This led them to their hypothesis that early exposure to peanut might help prevent the development of peanut allergy, and that’s what the current study tested.

How was this study conducted?

The researchers recruited babies between the ages of 4 and 11 months that were high risk for developing peanut allergy because they had severe eczema, egg allergy, or both. Before entering the study, the babies were tested using a skin-prick test to see if they were already sensitive to peanut. If so, they were excluded from the study. Those who showed no sensitivity (530 babies) or only mild sensitivity (98 babies) were included in the study and randomized to two groups. In the “avoidance” group, parents were instructed not to feed their children peanut at all. In the “consumption” group, parents were asked to give their children 6 grams of peanut protein per week, spread across at least 3 meals. Both treatments were continued through age 5, when all of the children were tested for peanut allergy.

bambaWhat does 6 grams of peanut protein look like? It’s the amount in about 25 peanuts, or 3-4 tablespoons of peanut butter. In this study, parents in the consumption group were encouraged to feed a snack called Bamba, made of puffed corn and flavored with peanut butter. (Think Cheetos but with peanut butter instead of neon cheese powder.) Bamba was chosen because it was reported to be one of the main peanut sources for Israeli babies in the previously mentioned study. Kids who weren’t into Bamba were given smooth peanut butter instead.

What were the results of the study?

The study found a striking reduction in peanut allergy in the kids that ate peanut during the first 5 years of life. Among the kids without peanut sensitivity at the start of the study, 13.7% of those that avoided peanut had peanut allergy, whereas just 1.9% of those who had consumed peanut were allergic by age 5. That’s an 86% reduction in peanut allergy, and yes, that’s a HUGE result.

Among the kids that had a mild reaction to the baseline skin prick test, peanut allergy was more common, but again, the prevalence was reduced by peanut consumption early in life (10.6% in the consumption group vs. 35.3% in the avoidance group). Thus, the researchers concluded that exposing kids to small amounts of peanut protein early in life could both prevent peanut allergy and even treat those already mildly sensitized. Remember that all of the kids in this study were already high-risk for developing peanut allergy due to having eczema and/or an egg allergy. Normally, about 15-20% of this group would end up with a peanut allergy

We don’t yet know what will happen beyond 5 years of age, but the researchers are conducting a follow-up study in which the same children have been asked to completely avoid peanut for a year to see if this impacts their development of peanut allergy.

What does this mean for parents feeding children?

We should always be cautious about changing practices based on the results of just one study. However, this is is a really strong study showing dramatic results. Although we’ve known for a while that avoiding peanuts early in life doesn’t help, this is the first study to test peanut exposure in high-risk kids, and it showed that this can actually prevent allergy. I think it is a game changer.

Still, there is a lot we don’t know. We don’t know if there is an optimal window for introducing peanut or how much is really needed, and we don’t know if early peanut exposure could help infants that have already developed a real peanut allergy. We need more studies to help clarify these questions, but at least we’re asking the right questions now.

In a Scientific American interview (well worth reading in its entirety), the lead researcher for this study, Gideon Lack, gave his advice to parents wondering what to do about peanuts (Note that in the U.K., the term “weaning” means the introduction of solid foods, not stopping breast or bottle-feeding.):

“Among low-risk kids that account for 80 to 90 percent of population—those that don’t have eczema in the first six months to year of life and don’t have any evidence of food allergies—I would recommend that these children eat peanut protein or peanut in various forms, depending on the culture. Low-risk children should start eating peanut butter as soon as weaning is established. You don’t want peanuts to be the first food because if the kid is gagging or choking, it could represent allergic manifestation but it may also just indicate the child hasn’t developed the coordination to eat solid foods.

Higher-risk kids, those with any manifestation of eczema or food allergy, should see an appropriate health care provider, which could be an allergist or a pediatrician, and have skin prick testing done for peanut as soon as these high-risk symptoms develop. If the child tests negative, the child should be encouraged to eat peanut at home. If the skin test is a small positive, like it was for some of the kids in our study, then the children should have their first exposure or consumption of peanut under medical supervision; and if they tolerate it they should be encouraged to continue to have peanut regularly in their diet for at least the first three years of life. Based on the evidence we have, one could arguably say the first five years of life.”

I think this advice makes good sense. If you’re worried that your baby might be high-risk for peanut allergy, definitely talk to your child’s pediatrician to make a personalized plan for introduction. Keep in mind that you should always pay close attention whenever your baby tries a new food for the first time so that you can be alert to a reaction. Also take care to ensure you’re introducing peanut in a form that your child can handle, like smooth peanut butter or peanut sauces, avoiding whole peanuts until you’re confident that your child can chew them without choking. (Anyone want to place bets on how long it will be until we see a Bamba-like product marketed towards babies and young kids in the U.S.? I’m not aware of one currently.)

The big question in my mind is whether or not this same strategy of early exposure will apply to other common allergens. We already have some evidence for this. For example, one study found that children first exposed to wheat between 4 and 6 months (vs. after 6 months) had a 4-fold decreased risk of wheat allergy.8 Another found that children who first had cooked egg at 4 to 6 months had the lowest incidence of egg allergy, whereas those starting egg at 10-12 months had a 6-fold increased risk.9 Interestingly, this protective effect only worked with cooked egg (boiled, scrambled, fried, or poached), not with egg in baked goods. (Maybe baking denatures the egg protein more?) However, these were observational studies – not randomized – and confounding factors could have influenced allergy risk and early feeding practices. We need more randomized studies like the current peanut one to know if the early exposure strategy will work for other allergens and to figure out optimal timing and amounts of exposure.

The peanut study adds to a growing body of evidence that there may be a kind of sweet spot for introducing food proteins, including those that can trigger allergy – not too early and not too late. Studies show that introducing foods before 4 months can increase the risk of allergy, but waiting too long might also be problematic. Introducing babies to these foods at the right time seems to give their developing immune systems a chance to learn to tolerate the protein rather than attacking it.

As parents, it can be frustrating to see the “official” advice on introducing allergens flip-flop so dramatically in just 15 years. I’m sure there are parents out there who diligently followed the AAP’s advice from 2000, avoiding giving their children peanut, maybe even avoiding it themselves during pregnancy and breastfeeding, whose kids ended up with peanut allergies. Now we know how wrong that advice was, and that’s just maddening. But this is an area where the science has rapidly advanced in the last couple of decades, and the AAP and other health organizations have just been giving the best advice they can based on what we know. Finally, I think we are headed towards true evidence-based recommendations in this area. As a parent who will be introducing peanut to my baby in a few months, I think that’s something to celebrate.

What advice were you given about introducing peanuts to your baby? Will this study change the way you do it with a new baby?

References:

  1. Du Toit, G. et al. Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy. N. Engl. J. Med. 0, null (2015).
  2. Sicherer, S. H., Muñoz-Furlong, A., Godbold, J. H. & Sampson, H. A. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J. Allergy Clin. Immunol. 125, 1322–1326 (2010).
  3. Bunyavanich, S. et al. Peanut allergy prevalence among school-age children in a US cohort not selected for any disease. J. Allergy Clin. Immunol. 134, 753–755 (2014).
  4. Sampson, H. A. Peanut Allergy. N. Engl. J. Med. 346, 1294–1299 (2002).
  5. Nutrition, C. on. Hypoallergenic Infant Formulas. Pediatrics 106, 346–349 (2000).
  6. Greer, F. R., Sicherer, S. H. & Burks, A. W. Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics 121, 183–191 (2008).
  7. Du Toit, G. et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J. Allergy Clin. Immunol. 122, 984–991 (2008).
  8. Poole, J. A. et al. Timing of Initial Exposure to Cereal Grains and the Risk of Wheat Allergy. Pediatrics 117, 2175–2182 (2006).
  9. Koplin, J. J. et al. Can early introduction of egg prevent egg allergy in infants? A population-based study. J. Allergy Clin. Immunol. 126, 807–813 (2010).
57 Comments
  1. Kelly #

    I’m curious if the research considered children who were breastfed during that time period, and whether breast milk affords some protection against peanut allergens, as they’re finding it does with gluten.

    Liked by 1 person

    February 25, 2015
    • Great question. Unfortunately, this paper didn’t mention breastfeeding status at all. I hope we’ll see that data in a follow-up paper, because they should have it, and it would be a lost opportunity if they didn’t analyze it. I’ll check the supplementary materials when I have the chance. So far, the studies are actually really mixed as to whether BF could prevent allergies, but they haven’t been this well-designed.

      Liked by 2 people

      February 25, 2015
  2. My son was breastfed but when he was a toddler we found out that he is allergic to nuts especially cashews. He is now 6 years old and I never tried giving him any kind of nuts. Maybe we will consult with his physician to check this allergy. He is also allergic to crustaceans. I hope that he will outgrow these. Thanks for sharing the article!

    Like

    February 25, 2015
  3. There was a study published last year in The Lancet that used a randomized trial to examine the effectiveness of peanut protein intake on allergy desensitization in older kids. Their findings were pretty impressive and suggest that you could potentially reduce the severity of a pre-existing peanut allergy by consuming peanut protein on a regular basis. Almost like rebuilding your tolerance of the allergen! Here’s the study: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2962301-6/fulltext

    Liked by 1 person

    February 25, 2015
    • Yes, this was also an exciting study! Thanks for linking to it here – other readers might want to learn more about this research on treating allergy.

      Like

      February 25, 2015
    • KT #

      My pediatrician just told me about this study at my 6 month old’s well check. I knew they’d changed the guidelines in the past 3 years from having a moderate sized list of “do not give these foods before these ages” to “anything but honey before 12 months is fine,” but she even said that they now say that parents should introduce at least 2 new foods a week starting at 6 months until the baby is eating whatever the family is eating. As a mom who loves the starting food process, I was overjoyed.

      Like

      March 10, 2015
  4. This is not about peanuts, but I have an adolescent-onset, true wheezing-and-hives-and-maybe-anaphylaxis dairy allergy… and so does one of my two sisters, and my mother. I know that many doctors and researchers think allergies aren’t heritable- which is doubtless true for most of them- but at least I would think we have a heritable predisposition to dairy allergy; it seems statistically improbable that three related cases could be random. (We are of Ashkenazi Jewish descent and very allergic in general.) I wonder -and there are no reputable studies because it’s so hard to measure – if early consumption is protective in situations like this – or if they’re just so rare that nobody knows (probably).

    My favorite allergist in Cold City mentioned a peanut-epitope-IgE chip that’s in development. Apparently reaction to certain epitopes is moderately predictive of an anaphylactic reaction (rather than discomfort, or hives, or other nonfatal though unpleasant reactions). However, I’d prefer to feed my baby Bamba. They even have it at our small-town (though very yuppie) Walmart! Although, all my children have had infantile eczema, so perhaps I should have Benadryl on hand and do it during business hours.

    Like

    February 25, 2015
    • Now that I’ve written this post, it seems that lots of people know about Bamba! I’m going have to have to look for it in local stores here. I’m intrigued… and it does seem like a good snack for older babies and toddlers.

      Like

      February 25, 2015
  5. If not Bamba, how about Multi Grain Cheerios Peanut Butter? 🙂

    Liked by 1 person

    February 25, 2015
    • We’d have to check how much peanut protein is in them. My guess is not much – probably just a little flavor. When I compare the nutrition facts label on the peanut butter vs plain Multigrain Cheerios, they both have just 2 grams per serving. Who knows – maybe it’s enough peanut exposure to do the trick. Either way, I bet they’re tasty. Now I’m going to check labels of other peanut-flavored stuff around the store:)

      Like

      February 25, 2015
  6. Lauren McKnight #

    I’m so excited to see the results of the LEAP study finally published! I heard Prof Lack speaking at a conference back in 2010 and suspected he would end up with results like these. I followed his protocol with my own kids (even managed to find someone that imported bamba for my first!) and have recommended similar to my friends so I’m feeling quite validated and relieved!

    Like

    February 25, 2015
    • How cool! Science in action! And I’m guessing no peanut allergy among your kids?

      Like

      February 25, 2015
  7. Meg #

    We were encouraged by our pediatricians to start our son on a wide variety of foods from early on and told the only thing we needed to avoid was honey until age 1. I had read about the study comparing British and Israeli kids, and I ordered some Bamba from Amazon and started giving them to my son around seven months or so, and I know some of my (science nerd) friends did the same!

    Like

    February 25, 2015
    • I have a feeling that the market for Bamba is getting ready to explode:)

      Like

      February 25, 2015
  8. Melissa #

    I also wish there was more info re: breastfeeding. My exclusively breastfed infant was allergy tested at 6 months because of severe eczema. She has a severe peanut allergy. I consumed peanut butter daily during pregnancy and while bf’ing as a protein source. I also have food allergies (not peanut, but anaphylactic to walnuts, soy milk, etc). I wish there were some info on how to lessen the severity for her since she’s still so young. Her eczema has improved since I eliminated peanut from my diet.

    Like

    February 25, 2015
  9. My daughter was diagnosed with an egg allergy during her second year. When she was 11 months, I fed her egg yolk on one occasion, egg white on another. She had mild pink splotches on her face and neck after trying the egg whites. In our course of learning about her allergy, the allergist we saw said that the egg protein does get broken down during baking due to the longer cooking process. She had no problem with eggs in baked goods (which we only discovered by accident). A month after her 2nd birthday she passed a skin test for egg and later a challenge test. Now she LOVES eggs. The allergist also told us at this follow up appt. that despite the tree nut allergy in our family, he didn’t see a need to wait on introducing tree nuts. I’d just personally feel more comfortable doing that when she and her twin brother are better able to describe how they are feeling – something that these studies with babies so young could not really communicate unfortunately.

    Like

    February 25, 2015
    • Good to know about eggs, and I’m glad that your daughter outgrew the allergy! I don’t know what we’d do without eggs in our house!

      Like

      February 25, 2015
  10. AEM #

    I read a while ago in the New Yorker about using baked goods to try to improve tolerance of allergens, specifically milk. http://www.newyorker.com/magazine/2011/02/07/the-peanut-puzzle

    It’s tricky introducing these things. My husband has a huge peanut reaction so we keep them out of our house. Fortunately both our kids seem to be fine, but we definitely wouldn’t feed it to them on a regular basis since it’s just not safe for my husband to have it spread all over the house, and the kids just wouldn’t keep it tidy!!

    Like

    February 25, 2015
    • I was thinking about that problem of introducing peanut with someone allergic in the house. That would require a lot of care – maybe eat your peanut products outside?

      Like

      February 25, 2015
      • AEM #

        Since it’s my husband and he doesn’t eat off the floor typically it wasn’t a big deal to do it once or twice, I did a mini skin test first, just put some peanut butter on their back where they couldn’t reach it for a few minutes, then I fed them a teaspoon a couple of days apart. I just put my finger in it and then put that directly into their mouth. Then washed my hands and their face. (I got a tablespoon or so from a friend to test with.) One thing that’s absolutely key to understand is that it is not usually the first exposure that elicits a reaction, so you have to test at least twice. Lucky for us both kids seem fine, but it still makes me a tiny bit nervous since they’ve both really only had it a couple of times!

        Like

        February 26, 2015
  11. heidirabbach #

    Thank you for spelling it out so well and looking at it from all angles – something I cherish this blog for!
    In Germany, the main advice has been to stay away from peanuts due to the choking hazard. Peanut butter is not yet as common as it is in the US, but we do have a very common snack product like Bamba, but not marketed specifically to small kids. I’ll be on the look out now if there are any new recommendations emerging, but as a Mom of three kids under the age of four with a newborn of only a couple weeks, I’ll be sure to include peanut butter along with other nut butters when we introduce solids (we have no food allergies of any kind in our family). I hope to keep it that way by following the advice to introduce small amounts of everything within the first year, which is what we did with our first and second born.

    The only confusion that still remains is about whole grain, to soak or not to soak, and whether babies are able to handle white flour better than whole grains. If you could find the time to write about this topic it would be MUCH preciated as the information out there is utterly confusing and contradicting!

    Like

    February 25, 2015
  12. This is a cute Blog

    Like

    February 25, 2015
  13. Rana #

    We were encouraged by our pediatrician to feed our little one anything we wanted except honey before 12 months – she just recommended that we space out new foods so that we could identify potential allergens more easily.

    We used Bamba, which has the advantage of being very easy for a small child with no teeth to eat – it dissolves readily and isn’t a choking hazard (unlike peanut butter can be).

    I would also like to point out a possible point of confusion in Gideon Lack’s recommendation, above. He advises, “Low-risk children should start eating peanut butter as soon as weaning is established.” American readers should note that weaning in the British context means introducing solids – it does not mean stopping breastfeeding, as we usually use it here. (This is also why “Baby-Led Weaning” doesn’t mean baby-led cessation of nursing, but rather baby-led eating of solid foods.)

    Like

    February 25, 2015
    • Yes, thanks for that clarification. I’ll add a similar statement in the text of the post to be sure that readers aren’t confused by the term “weaning.”

      Like

      February 25, 2015
  14. Reblogged this on monicaburato.

    Like

    February 25, 2015
  15. My son tested positively to peanut allergens. We made sure he had an epi pen with him at all times. After years of tip toeing around peanuts we discovered that he was allergic after all! Peanut allergy? Maybe not. Worth checking out!
    http://blog.growingthewholechild.com/peanut-allergy-maybe-not/

    Like

    February 26, 2015
  16. Auto correct is my friend and tormentor! Above comment should read: he was NOT allergic after all. My tormentor decided that NOT should ignored. Alas.

    Like

    February 26, 2015
  17. maggie #

    We have no history of any food allergies in our family, and our pediatrician stated (direct quote) “As long as you don’t feed her clay from the river bank, I’m ok”.

    Our daughter was riding very happily in Daddy’s arms at a Christmas party when she was 5 months old. After a surprisingly long period od calm, he looked closely at her and discovered she had grabbed a peanut butter cookie off one of the tables and was happily gumming it to death. When this study came out, hubby’s first reaction was “Oh, I didn’t have an epic parent fail, she was just self medicating!”

    I have to admit, as a verteran of allergy shots, desensitization treatment has long been the norm for everything except for food allergies, so I am not surprised to see that allergic reactions are the same regardless of the trigger.

    Like

    February 26, 2015
  18. This news comes at a great time for us, as our little guy has just started solids and we’re a family of peanut-butter-lovers. It makes a lot of sense to me that avoiding certain foods for too long would lead to oversensitivity, the same way that living in an overly-sterile environment leads to increased rates of allergies and asthma.

    Like

    February 26, 2015
  19. Garrett King #

    Hi – love the blog,

    I was actually quite surprised by the result of this study when I read about it, although it does appear to be a very strong result. The reason I was surprised is that the result appeared to fly directly in the face of the two randomized, controlled studies regarding gluten allergies you wrote about on October 3, 2014. In those studies, which followed ~1600 kids, withholding gluten appears to either 1) have no impact on or 2) possibly delay, but not prevent, the onset of Celiacs disease. There certainly was not a dramatic reduction in the incidence of Celiacs disease in the group that was eating gluten.

    It seems to me that the peanut study and the two gluten studies advocate opposite approaches for the different allergies. You want to feed your kids peanuts early, but not gluten. I suppose it’s possible the allergies work in different ways, but I am surprised nonetheless.

    Any thoughts?

    Like

    February 26, 2015
    • Hi Garrett – I think each of these conditions really have to be investigated separately – we can’t apply what we know about one to the other. Food allergies are an overreaction of the immune system – producing IgE antibodies in response to specific food proteins. Celiac is an autoimmune condition that causes inflammation in the small intestine (not an allergy). It wouldn’t be surprising to me if early exposure affected risk to the two conditions differently. Also, we haven’t seen a randomized study testing introducing gluten at 12 months vs 3 years (as some have waited to introduce peanut that long) – maybe a longer delay would increase celiac risk. Definitely an area of research that I like to follow, because it’s so interesting!

      Like

      February 26, 2015
  20. Thank you for the great breakdown of the new study. We waited until one year to introduce peanut butter to our first little one and he did fine with it, but also was low risk for a peanut allergy to begin with. Our next little one is due in May. While I can’t imagine giving her creamy peanut butter at 6 months old I will keep this study in mind and not hold back when she is capable of handling the texture.

    Like

    February 27, 2015
  21. b #

    Do you think this study on peanuts would also apply to early lactose intolerance?

    Like

    February 27, 2015
  22. Reblogged this on Wise Words for Miss I and commented:
    This research is of particular interest to me as my DD has a likely Cow’s Milk Protein allergy and possible egg allergy. We have her allergist appointment this Friday, as she has turned 4 months and will be ready to start solids soon. She will have a skin prick test to test for CMP and egg sensitivities, among other common allergens. Depending on the results, she will see a dietitian who will determine what foods to commence and when.

    As I have a background in dietetics and clinical coding, I’m not concerned if she has a confirmed allergy as I am able to interpret the results and manage her dietary needs.

    It continues to be an interesting journey, particularly when it comes to accessing medical professionals who have the relevant skills and expertise in the area of allergy management. If it had not been for my professional background, I don’t think I would have been able to successfully navigate the ‘medical system’ to get the help we needed with her allergy. Especially as a first time mum, some health professionals are quick to put the symptoms of allergies, such as refux, colic, eczema, failure to thrive, as just things that the baby will grow out of. In the meantime, these poor infants and parents endure countless sleepless nights, worry and stress seeing their little one in pain and discomfort.

    Like

    March 2, 2015
  23. maggie #

    Several people have mentioned that doctors are recommending that honey not be given to infants. Yet all the recent research point to honey being antibacterial and antimicrobial. (“Through millennia, the archeologists discover, the food remains unspoiled, an unmistakable testament to the eternal shelf-life of honey.” http://www.smithsonianmag.com/science-nature/the-science-behind-honeys-eternal-shelf-life-1218690/#pGTtYxGKS7viE3pE.99)
    Is their any real research behind the ban?

    Like

    March 2, 2015
  24. Thanks for your reply, b. The days are getting away from me, though I’ve been meaning to respond to Maggie’s question. The evidence behind the honey ban is just based on case reports of infant botulism linked to honey. I wrote about it briefly in my book but now need to go back to look at those sources. I think the research is solid enough to justify the ban – even though botulism is pretty rare, it’s also really serious and not that hard to avoid honey (IMO). A more interesting question is why is botulism such a problem with honey vs other foods, particularly given honey’s antimicrobial properties. Anyway, I don’t know, but I’d like to know more! I’ll let you know if I find more info.

    Like

    March 5, 2015
    • maggie #

      If you boiled the honey in water would it be ok? I ask because we found honey water to be a very effective cure for the raw throat that comes from post nasal drip and teething-drool.

      Like

      March 9, 2015
  25. Shumaila #

    Thanks so much for writing on this topic, Alice. Very interesting for me as we have a family of food allergies. My 3yo has anaphylaxis to peanuts, eggs, and cow’s milk protein (she has outgrown a wheat and sesame allergy, but we have been advised to avoid tree nuts for the time being). I was following the old AAP guidelines by delaying allergenic foods but it didn’t do us much good. My 5mo has just started on solids and my approach to her weaning will be overwhelmingly different! I of course have the added challenge of messy-baby-feeding with my same foods that can land my oldest in hospital… may have to do this when the oldest is at daycare or at her grandparents. Thanks again!

    Like

    March 7, 2015
  26. Roxanne Henderson #

    Do you have an opinion on starting solids at 4 months verses 6? I noticed that many of the studies on allergy include babies in the 4-6 month range but the current recommendations are to wait until 6 months. I can’t find anything really definitive as to why 6 months ( if in be US and low chance of infection). I ask because my baby WILL NOT drink out of a bottle while I’m at work. He is miserable all day. I’m only gone 8-3 including travel time so if he could just get a little something at 11am I think he might actually nap and not cry all day. We have tried everything. If you know of any studies please let me know. I have his 4 month well baby visit in 3 days, I will ask the doc about it too. He is 18 weeks old.

    Like

    March 27, 2015
    • I researched this question a lot for my book, because it’s really interesting! So much conflicting advice on this, and it’s hard to tell what the evidence is to back the different recommendations. I’ve been wanting to write a post on this and will try to tackle it for next week. Short answer is that there’s really not good evidence for waiting until 6 months in a developed setting where you have access to clean water and refrigeration. There is one study (in Belarus) showing a slightly increased risk in gastrointestinal infection for starting solids at 3-4 months vs. 6 months, but others have found no impact on health. The majority of the evidence points to starting between 4 and 6 months. Personally, I think that we should be working within that time frame and looking for developmental signs that your baby is ready and interested. I wrote about some of those signs here (just ignore that first paragraph about starting around 6 months – guess I need to update it!): https://scienceofmom.com/2012/02/27/10-tips-for-starting-your-baby-on-solid-food/

      Here’s a link to the Cochrane Review on this question: http://www.ncbi.nlm.nih.gov/pubmed/22895934. The increased risk of GI infection comes out to about 1 more case per 42 babies starting solids/formula at 3-4 months vs. 6 months. That’s based on just one study (others found no increased risk), and who knows – it could be driven by those 3-month-olds or could be avoided by more careful food preparation technique.

      There was also a recent randomized controlled trial of this question in Iceland that was published after the Cochrane review showing no difference in growth between 4 and 6 months (including tracking overweight and obesity out to age 3). Also no difference in development or behavioral outcomes to age 3. Infants started solids earlier had slightly better iron status at 6 months. Several papers have come out of that trial:

      http://www.ncbi.nlm.nih.gov/pubmed/23147979
      http://www.ncbi.nlm.nih.gov/pubmed/24117808
      http://www.ncbi.nlm.nih.gov/pubmed/24284608

      Hope this helps! If your baby seems developmentally ready and is eager to eat solids, then I don’t think there is a compelling reason to wait. And you have a compelling reason to give it a try: a hungry baby!! He would likely get substantial benefits from being well-fed and able to nap well during the day, and I imagine it would help you feel better about his care during the day:)

      Like

      March 27, 2015
      • Roxanne Henderson #

        Thanks for your opinion AND the links. You have confirmed my gut feelings on the matter. The only studies I found against were really vague or really only applied in situations where feeding food could take away from nutrition (nursing) – not really the case for us, oral motor readiness (? very individual to a baby) and as birth control – also not an issue for me.

        Like

        March 28, 2015
        • Yeah, I often see general statements about how we “know” there is a dose response for benefits for duration of exclusive breastfeeding, but those studies are often comparing EBF to formula-feeding or partial formula-feeding, which is probably displacing far more breast milk than what you’re proposing.

          Like

          March 28, 2015
    • Tom Adams #

      The AAAAI recommendation is 4 to 6 months:

      https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Libraries/Preventing-Allergies-15.pdf

      I have read elsewhere that this 4 to 6 month just translates to “as soon and the baby can handle solid food”. Some babies don’t have the motor development or reflexes to take in solid food at 4 months. So the recommendation to the general population has to be somewhat vague.

      This recommendation is for exposure, not for trying to wean the baby the early.

      Like

      April 2, 2015
  27. Reblogged this on East Alabama Breastfeeding Support and commented:
    A very interesting read for the Science of Mom. Things to consider if you are introducing foods. I would add though that it is best to wait till after 6 months to add any foods until more research is done. Early intro of food brings risks such as early weaning.

    Like

    April 2, 2015
  28. How have others introduced peanuts to a 7 month old besides Bamba?? Do others mix peanut butter with other food?

    Like

    May 14, 2015
  29. Reblogged this on ika2man.

    Like

    May 17, 2015

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