Recommendations for taking care of infants and children seem to change all the time and it can be very frustrating. When I was a baby, my mother fed me rice cereal when I was 2 weeks old and put me to sleep on my tummy. I rode my bike without a helmet, rode in the car without a seatbelt, and never put on a drop of sunscreen. Can you even imagine doing this today? There were different regulations then, but with more research comes more knowledge, and over time recommendations change to serve the best interest of infants and children. These days, we know that starting solids around 4-6 months is better for digestion, that Sudden Infant Death Syndrome (SIDS) has decreased by 40% now that babies sleep on their backs, that injuries have decreased dramatically with helmet and seatbelt use, and that sunscreen can prevent skin cancer. Change is good.
There have recently been significant changes in the recommendations for the treatment of food allergies, which have risen over the past 20 years for reasons that are not completely clear despite many theories. Research shows that up to 15 million American people have food allergies, which includes 1 out of 13 children. Hospitalizations have increased and EpiPens are flying off the shelves. Having a child with a food allergy requires constant vigilance and is understandably a huge source of stress for parents and a challenge for schools, especially because it can be difficult to keep up with recommendation changes.
This is especially true for the prevention and treatment of peanut allergies, which have evolved recently. In the past, it was recommended that all parents delay exposing their children to peanuts in general, but especially if they have a child with a history or eczema or egg allergy (both of which are associated with peanut allergy), or if they have other children with a peanut allergy. These recommendations, however, have undergone dramatic changes based on recent research: Findings supported by the National Institute for Allergy and Infectious Diseases (NIAID) and the American Academy of Pediatrics (AAP) now show that exposing kids to peanuts early could prevent peanut allergies later. There are three guidelines for infants at different levels of risk for developing peanut allergy—all of which take into account whether or not the infants have eczema or egg allergy, because we know that these children have a higher rate of developing food allergies. The guideline recommendations are as follows:
- Infants with severe eczema or egg allergy should be fed peanut-containing foods as early as ages 4-6 months.
- Infants with mild or moderate eczema should have peanuts introduced to their diets at about 6 months of age.
- Infants without eczema or egg allergy can have peanut-containing foods freely introduced to their diets. This can be done at an age-appropriate manner together with other solid foods.
In all cases, other solid foods should be started before peanut-containing food.
And always remember that peanut-containing food does not mean whole peanuts, which are obviously choking hazards.
These recommendations changed in part due to a landmark study that was published in the New England Journal of Medicine in February of 2015, which reported that the infants with severe eczema and egg allergy who regularly consumed peanut-containing foods from infancy to age 5 were 81% less likely to develop a peanut allergy compared to infants who did not have peanut exposure in their diets. It is also interesting that in Israel, babies are exposed to a peanut-containing snack called Bamba and the incidence of peanut allergies in Israeli children is a tenth of what it is in the U.S.
These changes in recommendations might be hard for a lot of us to “digest” but we should always have an open mind when the changes are based on solid research. To learn more, you can go to: bit.ly/NIAID-food-allergy-guidelines. When it comes to your own child, however, all advice should come directly from your doctor and your conversations should be ongoing. There can be a lot of confusion and misinterpretation with new guidelines, so it is important to get your information from one source, your trusted healthcare provider.
Meanwhile, put your little ones to sleep on their backs, strap them into their car seats, teach them to ride a bike with a helmet, and load up on the sunscreen! When you’re old like me, perhaps you’ll be saying; “I remember when the peanut allergy recommendations changed” along with a lot of other things. However, I do know that hugging, snugging, talking, reading, and singing to your baby are all wonderful things that will never change! Enjoy these moments while you can because pretty soon you’ll be dealing with a teenager.