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Dr. Saad Saad Explains How to Introduce Peanuts to Children

Peanut allergy is the most common children’s allergy, and many parents are very afraid that their child will have a severe reaction. Most parents aren’t sure how to handle peanuts in a child’s diet. Is there a safe way to test your child’s tolerance for peanuts?

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A group of food allergy researchers, doctors, nurses, and other allergy experts have created a prudent, safe way for parents to introduce peanuts in an infant’s diet, reports Dr. Saad Saad, a noted pediatric surgeon based in New Jersey.

Dr. Saad is excited to offer this guidance to parents, which he describes as extremely critical.

In fact, this information has far-reaching implications for children. The incidence of food allergy has doubled among African American children in the past decade — which Dr. Saad calls “disturbing.”  He notes that some of these cases may be food intolerances, not allergies — which reinforces the need for the children to get tested for allergy.

Also, Dr. Saad cautions parents and caregivers to be aware of the anxiety that a food allergy causes for their children — and limits their quality of life.

Does your child have a peanut allergy?

Peanut allergy is a critical allergy, as the reaction can be life-threatening. It is crucial to take precautions when introducing peanuts to your baby.

First, you must learn if your child is at high risk for peanut allergy, says Dr. Saad Saad. Your primary healthcare provider will determine if your baby requires referral to an allergist for testing — and whether an in-office introduction of peanuts is necessary to ensure safety.

A high-risk infant should be introduced to peanuts as early as 4-6 months, after it has been deemed safe to do so. Doctors determine an infant to be at high risk if they have severe eczema and/or an egg allergy.

Even if a peanut allergy test shows a positive result, that is not conclusive. A positive test alone is not a strong indication whether a child has an allergy. Peanut sensitivity is not the same as an allergy.

Peanut allergy is diagnosed based on a positive allergy test AND a history of symptoms after eating peanut-containing foods, explains Dr. Saad Saad.

An infant with peanut sensitivity requires early in-office introduction of peanut-containing foods, he says. If a child has this in-office introduction and is found to have a peanut allergy, they will need to avoid peanuts altogether, and have an annual evaluation with an allergist.

Children with mild to moderate eczema — who have already begun eating solid foods — will not need an evaluation, says Dr. Saad Saad. At approximately 6 months of age, they can start having peanuts at home. Children without eczema or egg allergy also can safely have their first peanut-based foods at home.

Introducing peanuts to your child

The new guidelines illustrate how to safely introduce peanut-containing foods at the right age.

CRITICAL: whole peanuts are a significant choking hazard. Whole peanuts should NOT be given to children between 6 to 11 months old.

Peanut-containing foods:

  • Should only be introduced when the infant is healthy (doesn’t have a cold or other illness).
  • Should NOT be the first solid food an infant tries.

How to introduce peanuts to your child:

  • 2 teaspoons peanut butter + a little hot water = mix into a smooth puree
  • Feed just a little bit to the child — just the tip of the spoon
  • Wait 10 minutes and watch your child’s reaction –
    • Trouble breathing
    • Behavior changes
    • Hives or rash
  • If there’s no reaction, continue feeding the peanut butter puree slowly
  • Do this at home when you can observe the child for the next 2 hours

Talk to your doctor first to ensure you are safely addressing a potential peanut allergy in your infant.

Food allergies increasing among African American children

Overall, peanut and other food allergies are now more prevalent in our world. That includes allergies to milk, eggs and other foods. While children may grow out of some allergies, they typically have peanut allergy for life.

Significantly more African American children are reporting food allergies, one group of researchers found. They analyzed data on 452,237 children, and found that food allergy increased among African American children at a rate of 2.1% per decade, in Hispanic children at a rate of 1.2% and in white children at 1%.

These were so-called “self-reported” food allergies — which means, the child (or parent) reported an allergic reaction. Therefore, these may be food intolerances, not true allergies, as the children may not have had a proper diagnosis with an allergy test, the researchers noted.

That’s a problem, says Dr. Saad Saad. If a food allergy is not correctly diagnosed, the family may exclude certain foods from their diet unnecessarily, leading to malnourishment.

Also, researchers found that more than 10% of all children’s exposures to egg, milk products or peanuts were not accidental. The parent or caregiver was aware of the child’s allergy problem and the ingredients of the food, but gave it to the child just the same.

One-third of the allergic reactions were so severe they needed to be treated with epinephrine. Overall, there appeared to be lack of food safety. Or maybe the parents were testing their children to see if they had outgrown their allergy, researchers noted.

All caregivers must maintain a high level of vigilance — teachers, babysitters, grandparents, siblings, says Dr. Saad Saad. Everyone in the child’s life needs to know about the allergy and understand what to do to protect the child.

Allergies affect a child’s quality of life

There’s another issue that caregivers should realize, Dr. Saad Saad adds.

The difficulties of having an allergy takes a toll on children, as they suffer from anxiety and become increasingly lonely. One allergic child out of five never attends their friends’ parties, research shows. One in four always brings along “safe” food.

The risk that the allergy can escalate to life-threatening complications is especially heavy for children. Instead of being active and sociable, their lives can become limited and frustrating when constantly kept away from “dangerous” food.

Also, because anaphylactic shock can be triggered by physical activity after eating even a small amount of some allergenic foods, some kids stop exercising. The constant alarm surrounding them can affect their development and well-being.

Food allergies and yogurt: an unexpected help

Yogurt may be useful for the prevention and treatment of certain food allergies, says Dr. Saad Saad.

Probiotics are known to boost the immune system and restore the “good” intestinal flora. This can help the body to properly recognize the allergens without triggering an allergic response to the food.

Also, lactic acid bacteria is an excellent anti-inflammatory, so yogurt may help ease the symptoms of food allergies. Of course, this may not apply to all food allergies — but it may help ease certain allergic reactions.

Always talk to your doctor if you or your child has a food allergy, to ensure the best treatment and prevention.

About Dr. Saad Saad

Dr. Saad Saad performed thousands of complex pediatric surgeries on children of all ages, from infants to teenagers, during his 40-year career. Dr. Saad served as the Surgeon-in-Chief and the Co-Medical Director of K Hovnanian Children Hospital at Hackensack Meridian Health Care System in New Jersey. In the 1980s, he was asked to serve as pediatric surgeon for the Saudi Royal family. He has participated in eight Medical Missions to Jerusalem to perform free complex surgeries on poor children. He is now retired and lives with his wife in New Jersey.

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