In recent years, a child’s first peanut exposure has turned into a major milestone, the cause of much parental fretting and planning. I remember reading on one parenting forum that I should feed my daughter her first smear of Skippy in a car parked outside a hospital emergency room, just in case. For many years, medical experts advised parents to wait until high-risk children were at least three years old to even try giving them peanuts.
New guidelines from federal health authorities are completely upending that wait-and-fear approach. On Thursday, the National Institutes of Health announced that parents should feed babies their first foods containing peanuts when they are as young as four months old—which is the earliest that they should be eating any solid foods at all. Children who are at the highest risk of developing a peanut allergy because they have severe eczema or an egg allergy should try peanuts in that early window. Children with moderate eczema can wait until around six months, while children without any risk factors can have peanuts “freely introduced into their diets” once they’ve adjusted to other solid foods. “There is this magic window of opportunity, where you can introduce peanut-containing foods,” David Stukus, a pediatric allergist who coauthored the new guidelines, told Stat News. When “we introduce peanut-containing foods early, the immune system can get used to it.” Up is down, down is up, peanut products are for babies.
The old conventional wisdom did not come out of nowhere. Nut allergies can be deadly, prompting reactions including severe tongue and throat swelling that block the airway. They are also on the rise. The prevalence of peanut allergies in children more than tripled between 1997 and 2010, rising from .4 percent to 1.4 percent according to one study; the peanut allergy rate in adults barely changed over the same period. Some schools now ban peanut products outright, and many food labels now state not just whether they contain nuts, but whether they were prepared in the vicinity of nuts. Severe reactions can occur the very first time a child is exposed to a peanut product, so you can understand how some parents find themselves idling outside the E.R. with a toddler and a jar of Jif.
Expert advice on children and peanut exposure has effectively reversed within just a few years. As recently as 2000, the American Academy of Pediatrics issued a recommendation that high-risk infants should not be fed peanuts and tree nuts until age three. The same recommendation suggested some women whose infants were considered at risk of developing an allergy should avoid eating peanuts if they were breastfeeding, and that some women should even avoid peanuts during pregnancy. The assumption was that avoiding exposure to potential allergens would help a child’s gastrointestinal and immune systems mature until he was old enough to handle it.
Alas, the research didn’t bear out the intuitive notion that avoiding allergens leads to avoiding allergies. Over the last several years, several major studies have made clear that early exposure was actually good for children at risk of developing food allergies. As Melinda Wenner Moyer summed it up in Slate almost two years ago in a helpful piece that collected much of the relevant recent research, “Scientists now believe that exposing the gastrointestinal system to an allergen early in life is unlikely to cause an allergy. It probably does the opposite.”
There are important caveats to the new recommendations. Children with severe risks, or who have an older sibling with a serious peanut allergy, should see an allergist first. Parents should still keep a close eye on how children react to their first exposure. And don’t feed infants whole peanuts or even big spoonfuls of peanut butter, which remain a choking hazard. When conventional wisdom flies out the window this dramatically, it’s worth restating the obvious. But the big takeaway from today’s announcement isn’t fear, but freedom. As it goes with peanuts, so it goes with parenting and life in general: An overabundance of caution doesn’t always make us safer.