What’s the right age to introduce babies to peanuts? Many parents don’t know

CHICAGO — In 2017, the National Institutes of Health announced a shocking reversal in its approach to preventing peanut allergies. They now recommend that parents expose infants as young as four months to peanuts in order to prevent an allergy from developing later.

Now, parents and caregivers are hopping on the wave. However, there’s more work that needs to be done to effectively communicate guidelines on a broader scale, especially to those with limited access to health information. According to a new study by Northwestern University and the Ann & Robert H. Lurie Children’s Hospital of Chicago researchers, which that surveyed parents and caregivers in the United States, just 13 percent of parents are aware of the guidelines and yet 48 percent believed feeding peanuts early prevented peanut allergy.

“There was general awareness of ‘If I give these foods early, it will help,’ even if families didn’t know it came from the NIH guidelines,” says Dr. Waheeda Samady, associate professor of pediatrics at Northwestern University Feinberg School of Medicine and director of clinical research at Northwestern’s Center for Food Allergy and Asthma Research, in a media release. “There’s still a lot of room for growth in terms of educating families and clinicians about these guidelines.”

The study found that having a pediatrician who recommended early peanut introduction was the strongest indicator for whether a parent or caregiver knew about the guidelines.

“This study is taking a look at something still so new to health systems in the U.S.,” says senior author Dr. Ruchi Gupta, director for the Center for Food Allergy and Asthma Research, professor of pediatrics and a pediatrician at Lurie Children’s Hospital. “As a pediatrician, I’m sensitive to the fact that there is a lot to juggle during a four- or six-month appointment. We need to find ways to support pediatricians in their workflows to incorporate the prevention guidelines.”

Woman's Hands Full of Peanuts
Photo by Yaroslav Shuraev from Pexels

The team of researchers say that the findings help the public better understand what American parents think about peanut feeding, and where the gaps in knowledge are. They report:

  • Access to care barriers and systemic racism are at play, preventing those who aren’t white, with less education, and/or are lower income from getting this information.
    • Of the 13% of parents and caregivers aware of the guidelines, they reported being white, between the ages of 30 and 44, educated and high income, or cared for a child with food allergy or eczema.
  • Supporting primary care providers to give this information in a timely manner is key.
  • Public health messaging about reactions to peanuts needs to be clearer, given that this is the main fear reported in the survey.
    • 33% of those who waited to introduce peanuts reported being fearful of the reaction as the most common reason why. Interestingly, there were only 1.4% of actual reported reactions of infants and children during introduction.

The survey asked the scientists if they exposed their children to peanuts before seven months (around 4 to 6 months-old) and after seven months (between 7 to 12 months). Interestingly, 17 percent of all parents first offered peanut-containing foods before the age of seven months and 42 percent did after that. Those aware of the guidelines also introduced peanuts earlier on, with 31 percent doing so before seven months.

“Previous studies have found that, on average, infant reactions are much milder than older kids’ reactions,” says Samady. “Based on this, I would say you should be more concerned about your older child, not your five-month-old. Statistically, reactions are much milder younger in life.”

“The perception amongst U.S. parents/caregivers about how common reactions are in children is much higher than the reality.”

The findings show that there has to be a much more organized approach to reaching a wider net of parents and caregivers about these guidelines, and making the information available at WIC clinics (women, infants, and children), community centers, and daycares.

“We have to get to all the pediatricians, not just those who work in academic or affluent areas,” Samady concludes. “But we need to think outside that box as well.”

The findings are published in the journal Pediatrics.

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About the Author

Shyla Cadogan, RD

Shyla Cadogan is a DMV-Based acute care Registered Dietitian. She holds specialized interests in integrative nutrition and communicating nutrition concepts in a nuanced, approachable way.

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