Help me introduce my peanuts to peanuts.
September 28, 2010 7:56 AM   Subscribe

My kids are now 2 yrs and 7 months and we're going to be introducing them to peanut butter for the first time. Their pediatrician says it's safe. If you have direct experience with this can you please tell me at what age you introduced your kids to nuts and how it went? I'm specifically trying to figure out what possible allergic reaction warning signs we should be looking out for and how we should react to them.

Obviously, we'll make sure to do this during the day when the pediatrician is open and we can get them there quickly. How severe does a reaction have to be before we rushing them to a doctor? To the emergency room? Also, how long should we keep an eye on them for a possible allergic response?

Is there anything else we should keep in mind in case one of them has a reaction?

Anything you might be able to share to help calm a couple of nervous parents would be appreciated!
posted by zarq to Human Relations (34 answers total)
Delaying peanut introduction is an outdated recommendation -- not that that helps you, but I'll throw it out there for future thread-browsers.

Do you have any history of allergy in your family, any reason to be worried? If not -- it's just food -- relax. I think we tried peanuts around 8 or 9mo, as part of ice creams and in sauces. Nuts are fantastic toddler snacks, so relax and enjoy.
posted by kmennie at 8:01 AM on September 28, 2010

Best answer: Is there a reason why your kids might be especially susceptible to peanut allergies? I remember chowing down on salted peanuts before I knew how to read. I believe severe food allergies manifest fairly quickly. Also, can you have an allergist just do a test panel?

I think I would take them to the doc at the first sign of a rash. Barring that, if their throast closes up or something, then go to the ER.
posted by anniecat at 8:03 AM on September 28, 2010

My pediatrician told us not to introduce any peanut products to our children under the age of 2. I think it's a controversial subject. To peanut butter or not to peanut butter . . .

So, we waited until they were two. My best friend growing up had an allergy to nuts so I knew the hassle, life hazard that nuts presented and wanted to avoid that. My BF would get hives all over her face and her throat would constrict. A trip to the ER was always necessary.

If you are quite nervous about this, please contact your pediatrician and ask them what warning signs you should look for and when you should take them in.
posted by Sassyfras at 8:05 AM on September 28, 2010

My kids both had intact protien allergies as infants. My girl will be two on Friday and I introduced peanut butter about three months ago with no problems. Is there a history of food allergies in the family? Is that why you're anxious?

You're doing the right thing to ease your fears by doing the trial while doc is open. Why not call and ask the nurse for signs of allergy and what actions you should take? Good luck!! (Cashew butter is yummy too!)
posted by PorcineWithMe at 8:05 AM on September 28, 2010

We introduced peanut butter accidentally to our 9? month old when a 4 year old nephew gave her an actual peanut (yes, I realize that the choking hazard here was outrageous and the nephew got a talking to. he was trying to share!). She was fine. We gave her peanut butter on a cracker a few days later. Still fine.

Our ped. basically said that because we have no allergies in either of our families, she wasn't very worried. She also said (I think?) that the reaction tends to show up the second time. So, do what you're doing and do it twice.
posted by dpx.mfx at 8:07 AM on September 28, 2010

Response by poster: Do you have any history of allergy in your family, any reason to be worried?

Yes. Their paternal grandmother is allergic to a ton of foods which induce anaphylaxis, including corn and nuts. I'm allergic to a small number of foods as well.

We waited because we were advised to.
posted by zarq at 8:09 AM on September 28, 2010

Best answer: Here's the Mayo Clinic's list of symptoms. This site from the University of Chicago provides percentages associated with each reaction.

If you're really worried that they'll suffer an extreme reaction, like anaphylaxis--perhaps because you or your spouse react to peanuts this way--then go on a picnic next door to a hospital and serve peanut butter and jelly sandwiches so you know help is available quickly. Do you know if they've ever ingested any peanut oil? If so, and they had no problems, that's another clue that everything will be just fine.
posted by carmicha at 8:09 AM on September 28, 2010

We never really considered holding off and doing it as a test. I can say that with my middle child, he turned out to be allergic to strawberries (he ate one from the plant on our deck) and he started to swell and get hives. We gave him benedryl and monitored him for a few hours on advice of dr.
posted by JohnnyGunn at 8:09 AM on September 28, 2010

Best answer: My son threw up any time he had peanut products and got a rash whenever he touched tree nuts. After a while we put 2+2 together and had him tested. Turns out he had "severe peanut and tree nut allergies." We now carry an Epi-pen everywhere we go. We were very lucky his throat didn't close up. There is no history of allergies in our family.

I don't mean to scare you though. There's any number of foods kids can be allergic to and I don't think it needs be a production every time you introduce a new one.

I don't think we consciously kept him away from nut products. One time he had a bite of some Chinese food with peanuts in it, another time he took a bite of my sundae, and then another time his cousin gave him some peanut butter. He might have been 2 or 3.

Keep an eye out for vomiting, rashes, or if he says his throat is itchy. Keep some Benedryl on hand.

Don't worry about it. Lots of kids have allergies but most kids still don't. You drive him around in the car all the time and that's probably a bigger risk than feeding him peanut butter.

I am not a doctor or your doctor or anybody's lawyer or allergist or record producer nor am I related to George Washington Carver.
posted by bondcliff at 8:12 AM on September 28, 2010 [5 favorites]

Best answer: We introduced peanut butter to our daughter when she was around one, maybe a little earlier. We have some food allergies in the family, but not extensive.

Again maybe for posterity, the trend seems to be swinging back towards introducing foods earlier (pubmed abstract). Clinicians of course, (usually rightly, IMO) trend towards the more conservative.
posted by gaspode at 8:13 AM on September 28, 2010 [1 favorite]

My oldest is 12, so it was just before the peanut allergies really started getting coverage. And when the twins were born 7 years later, I figured that since their brother never had a reaction, they probably wouldn't, either. And they didn't. So now I have no recollection of how I introduced it.

A friend of mine said that often the allergy isn't to the nuts themselves but to a specific mold created during farming, between that and pesticides lodging in fats, I tend to buy only organic peanut butter . . .
posted by MeiraV at 8:14 AM on September 28, 2010

Best answer: (oh and remember that allergies are weird and not really that well understood. Kid might have a bad reaction on the 3rd or 4th or 10th time when you think you're in the clear. Just be aware of the warning signs.)
posted by gaspode at 8:16 AM on September 28, 2010 [1 favorite]

Best answer: We fed my 2 year old charge peanut butter while she was in the doctor's office in case she had any bad reactions (she also has a family history of severe tree nut allergies). All was well, but we figured a pediatrician's office is second only to a real ER if she actually went into anaphylactic shock. Since peanut butter is a choking hazard nearly as much as peanuts themselves, I'd recommend spreading a thin layer on toast and baking it into cookies. Plain peanut butter clogs little throats pretty easily.
posted by zoomorphic at 8:21 AM on September 28, 2010 [1 favorite]

Best answer: Do you have reason to believe they will be allergic to nuts? Unless you have reason to believe they are i wouldn't freak out so much. I also wouldn't give my 7 month old peanut butter, but i assume your pediatrician knows much more than me. There are many many levels of peanut allergy. Full blown need an epi pen attacks are not the status quo. I don't think this is a red alert situtation for you unless there are indications an allergic reaction is imminent. If you truly have anxiety over introducing a food, just hold off. They won't die from no peanut butter, but they will be able to sense your unease if your are really that nervous over them eating it.

If you decide to go ahead with it, watch for rash, wheezing - the same reactions to any allergen.

Initial reactions are unlikely to be anaphalactic. They are unlikely to react at all the first time. THe one child i know that has a truly deadly allergy to nuts had very minor reactions at first. No reaction on first contact, subtle reactions (skin rash) on next contacts. It wasn't until indirect (not consuming) multiple exposures that he had an anaphalactic event that was caused by another child in the room ingesting peanut butter and getting a tiny bit of PB on the allergic child. They now have no peanut butter at home, carry epi pens and the local schools have banned peanut butter at each site as he progresses through the system - love those small towns!

My own daughters peanut allergy manifests as skin rash only and was first diagnosed at 18 months or so via blood test. She is now 11. She doesn't eat peanuts or peanut butter, but does eat other nuts and the rest of us consume as much PB as we want at home and in her presence. She has had absolutely no problems.
posted by domino at 8:21 AM on September 28, 2010

Best answer: A food allergy probably won't show up until the second time they eat the food, so be cautious for a while if you're concerned about allergies. Also, the first reaction will typically be more mild than subsequent reactions.

What you can expect to see in a mild reaction would be some swelling - probably in the face, but could be anywhere, really. Redness, puffyness, that kind of thing. Rashes are also common. If this happens, take note of it and don't give them peanuts again. The next reaction could be much, much worse.

If your kiddo's throat starts closing up or they start having trouble breathing, don't try to get them to a hospital on your own. Allergic reactions can kill within 2 minutes. Just call 911. Don't take them to the pediatrician, just get them straight to the ER if they look like they're having a severe reaction - even if they can still breathe, if they're complaining that their throat is closing up or start gasping - just call the paramedics immediately. I've been trained as an EMT and first responders carry Epi-Pens in their packs for exactly this reason - it honestly only takes two minutes for anaphylaxis to set in.
posted by sonika at 8:23 AM on September 28, 2010

Best answer: Zarq, it's something that worried me too. We did it cautiously, just the way you described, and had no problems. As it turned out, one of our kids does have a food allergy - to salmon. After tasting a small amount he quickly got a rash on his chest and blushing around his mouth. We rang our GP who told us to bring him in immediately - but the only treatment he gave was Benadryl, which I could have done myself.

If something similar happened again and my child did not seem to be in any form of distress I would just give a dose of Benadryl and keep observing them until the symptoms eased. I'd only take them to an emergency ward or a doctor if the symptoms seemed more severe. But I'm not a doctor, and I'm sure people here will tell me that I'm being horrifyingly casual about this.
posted by Joe in Australia at 8:29 AM on September 28, 2010 [1 favorite]

I was allergic to peanuts as a kid and we found out kind of by accident - my babysitter fed me trail mix one night and then put me to bed. When my mother came home later that night to find me still awake, squirming, and not too happy she turned on my bedroom light and saw that I had a rash/hives, we went to the ER. So, it wasn't life threatening but certainly uncomfortable.

Later, as a kid, I had an allergic reaction again (to a peanut) and developed hives on my back, sweated profusely, and vomited. This took several hours to happen, again, and only at that point did we realize is was a reaction.

On the other hand, I can now eat peanut flour and peanut oil, so I am thinking the whole peanut allergy thing is something I grew out of...
posted by hepta at 8:30 AM on September 28, 2010

With severe food allergies in the family, it sounds as though you should have an Epi-Pen in the house anyway; some allergies do worsen over time, so this might be a useful safeguard for you as well as for your kids. Perhaps you could speak to your allergist/GP and get a kid-sized and an adult-sized one just to have around-- that might set your mind at ease as your kids explore new foods.
posted by Bardolph at 8:31 AM on September 28, 2010

Best answer: I have a kid with a peanut allergy, and another one we don't know about yet.

Since there is a family history of food allergy, I think you should delay introducing nuts, especially to the baby -- not because it's going to be less risk to the child sooner rather than later, there's no good scientific consensus on that. But because a 3 or 4 year old is going to be able to communicate to you if they have a problem (my throat hurts) vs. requiring you to observe a problem (baby gasping for air).

Also, sonika, my daughter experienced a reaction the very first time she was fed something with peanuts in it, when she was about 15 months old. The babysitter swears she didn't even eat a bite, either, just touched it to her lips. Broke out in hives. (And didn't call me, and only barely mentioned it when I came to pick her up that afternoon; but that's another story.)

My point is, exposure through the environment without actually consuming the allergen is plenty enough for a child to become sensitized. (And, as it turns out, plenty for her to break out in the hives and itchy eyes, too. She's contact-allergic. We've got no idea what would happen to her if she ever ATE peanuts.)

Meanwhile, zarq, if there's a nutritional gap you need to fill, why don't you start buying sunflower seed butter? It's got a slightly better nutritional profile than peanut butter, and has the fun side effect of turning baked goods a faint green color.
posted by Andrhia at 8:49 AM on September 28, 2010

Response by poster: Meanwhile, zarq, if there's a nutritional gap you need to fill, why don't you start buying sunflower seed butter? It's got a slightly better nutritional profile than peanut butter, and has the fun side effect of turning baked goods a faint green color.

Wanna laugh? I'm allergic to sunflower oil. Gives me migraines if ingested, and I get hives if I handle the flowers. But it IS a good idea, thank you. Both kids have already eaten foods containing sunflower oil and showed no ill effects, so we know they should be okay with it.

I just won't be able to share their sandwiches. ;)
posted by zarq at 8:55 AM on September 28, 2010

Response by poster: And I apologize... in retrospect I should have written the kids' ages more clearly in the FPP.

My kids are twins. They're both 2 years and 7 months old. (31 months.) So they're both toddlers.
posted by zarq at 8:58 AM on September 28, 2010

Allergies are very strange, and not well understood in their causes. Our elementary school cafeteria often served popcorn shrimp (tiny little fried shrimp), and I had always enjoyed them. But one day, in fifth grade, my throat felt kinda weird and tight after eating them. I went to the nurse and she gave me... Tums. So I guess it's fortunate that my allergies aren't (or at least weren't, I havent tested lately) very severe. But it was pretty much overnight; just a normal week passed between not being allergic, and being allergic.
posted by Hargrimm at 9:08 AM on September 28, 2010

If they complain of an itchy tongue, that's probably a sign of an allergy. Two different children, exposed to two different allergens, have made that complaint to me.
posted by epj at 9:13 AM on September 28, 2010

We have a history of food allergies in our family (on my husband's side), but out baby never had any trouble with peanut butter (or strawberries, or any of those other things that they tell us could cause problems). I think we started giving our baby peanut butter around the time he turned one, and it's his favorite food now. We never had any trouble with it. Chances are, your kids will do fine. :-)
posted by I_love_the_rain at 9:38 AM on September 28, 2010

I know parents that introduced peanuts while AT the pediatrician's office just to be safe. I don't think that much caution is necessary but if you have a family history of allergy it's okay to be worried. I think we introduced peanuts after 1 year and had no issues. At 2 years, 7 months, I think it's fine to try it out. They're old enough to express discomfort if there's a reaction.
posted by otherwordlyglow at 9:50 AM on September 28, 2010

Best answer: Oh! An age where they can communicate, then. Please allow me to give a more helpful answer to the original question. ^_^

For a fast reaction, be on the lookout for hives or welts, especially around the mouth; itching, esp. of throat or eyes; upset stomachs, from either end; signs that breathing is impaired or blood pressure is dropping, such as breathing too fast, gasping for air, glassy eyes, a general sense of being Not With It At All (confusion, lack of responsiveness).

The general rule of thumb is that if just one major organ is involved (just the skin, so hives, for example) then give Benadryl and observe. If it's two or more, such as hives AND vomiting, it's a systemic reaction, and you should call for an ambulance. But your parenting instincts will serve you well, here. If you think something is wrong, it is. If you think nothing is wrong, odds are it's fine. You'll know.

There can also be more subtle reactions: Cheeks that are a bit too red, eczema a few days later. We had these from milk and it took us ages to work out what the problem was. Peanut doesn't generally manifest like that, but allergies are weird so you never know.

Two more things: At that age, if these are allergic children, so to speak, you probably already know; my allergy-prone kids were afflicted with Mystery Hives throughout baby and toddlerhood.

And finally: Feed them the peanut butter at breakfast or an early lunch on a weekend so you can keep an eye on them all day. If they're fine by bedtime, they're fine for that exposure. You'll want to keep watching for a reaction for the next several times you feed it to them, just in case.

That's too bad about your sunflower seed allergy. It would have been such an easy solution, too!
posted by Andrhia at 9:54 AM on September 28, 2010 [2 favorites]

I have been and still am, at 50, very allergic to peanuts. I've told this story here before: when I was a little under 2 my mom took the leftover peanut butter that was on a knife that she'd used to make a sandwich for my older brother and spread it on a cracker and handed it to me. She turned to the sink to rinse the knife and turned back to see me all broken out in hives with my lips obviously swelling. I don't remember any of this, but this is the story I've been told. There was absolutely no history of food allergies on either side of the family (apparently in this case, I am a special snowflake).

I don't think taking this slowly and carefully is "overreacting" perhaps the people who are making such statements have never experienced a severe allergic reaction. Follow the advice of your doctor.
posted by agatha_magatha at 10:30 AM on September 28, 2010 [3 favorites]

We waited with our kid until after two years, and then did the whole dab-of-peanut-butter-on-skin-check-for-rash routine before trying any eating, followed by picking a day when it'd be a quick trip top the nearby hospital if we needed it for the actual noming of peanut butter.

And yeah, with a family history of food allergies, I don't think you're beng unreasonable; like agatha_magatha, I feel some of your respondants are being a touch cavalier.
posted by rodgerd at 10:58 AM on September 28, 2010 [1 favorite]

Best answer: I waited till age 3 with the first child and till 1 with the second, because recommendations from the health professionals we knew changed. HOWEVER, the gold standard for high risk families around these parts (Vancouver, BC) is to go have a picnic outside the local children's hospital and eat a cracker with just a tiny smear of peanut butter. Wait X days. Do it again, but with more peanut butter. Then eat a whole cracker. There is a Starbucks right across from the ER here, so it's a non-medical looking setting and you can give your kid a drink or enjoy a coffee and then go on your way. (Depending on your feelings about eating nut butters in public, you can eat in your car.) So you can have all the medical resources at your disposal, which would make it really the safest setting you can be in. It may sound ultra paranoid, but I know more than a few people have done it, so that they could feel more relaxed around the whole situation.
posted by acoutu at 11:45 AM on September 28, 2010

Yeah-- during the early years of injectable triptans for migraines, people were occasionally advised to do their first dose in the ER parking lot just in case. Administering peanut products could certainly work the same way.

I have epic drug allergies and oral allergy syndrome; my parents introduced peanuts around age 2, and the only problem occurred when I ate an entire can of them a year later. I produced some astonishing poop and cried a lot, but no reaction.

When I do react to a food or a med, though, the giant welted hives hit about three minutes after the initial " my MOUTH itchy? The hell is going on?" episode. That's enough time for me to grab 50mg of Benadryl (I am a grownup; ask your doc about toddler dosage) and literally run to the ER across the street from my apartment just in case.
posted by fairytale of los angeles at 12:04 PM on September 28, 2010

I would wait until the kids are old enough to tell you if they feel funny. Peanut butter isn't like eggs or milk, something you are going to pretty much need them to eat. You can probably go your whole life without eating peanut butter, so what's your hurry?

We gave our son some scrambled eggs on his first birthday. His eyes swelled shut immediately, and he spent his party in the ER. He didn't have eggs again till he was 8 (and he was fine then). If there's a history of food allergies, there's no downside to withholding known allergens until the kid is 4 or 5.
posted by pippin at 8:13 PM on September 28, 2010

Best answer: Late to the party here, but hoping I'll be able to help.

Has your pediatrician suggested doing food trials? My twins are a few months older than yours and we wanted to introduce them to peanuts before their third birthday. Mainly, we wanted them to be able to trick or treat a little and actually eat their candy. My husband's father was allergic to peanuts, and my father had tons of food allergies as an infant, so we had some real trepidation. However, everything's worked out fine.

To do a food trial, you feed one serving per day of the trial food to each child for four days running. I ran food trials on everything my boys have ever had to eat, introducing just one thing at a time. I'm planning the last food trials for after their third birthday. We'll be trying shellfish and tree nuts (one type at a time), and then I think we'll be done.

Be sure to try the trial foods early in the day. That way, if there's a reaction that takes some time to hit, everyone will be up and active for it, rather than having it happen in the middle of the night.
posted by terrierhead at 12:42 PM on September 29, 2010

Response by poster: To do a food trial, you feed one serving per day of the trial food to each child for four days running. I ran food trials on everything my boys have ever had to eat, introducing just one thing at a time. I'm planning the last food trials for after their third birthday. We'll be trying shellfish and tree nuts (one type at a time), and then I think we'll be done.

Our pediatrician hadn't suggested this, but I her about it and she likes the idea. So we're going to discuss it at their appointment tomorrow. Thank you for that suggestion!
posted by zarq at 2:03 PM on October 4, 2010

Response by poster: First, I'd like to thank all of you who answered. You really helped us keep this in perspective, and I'm quite grateful for that. agatha_magatha and rogerd, thank you as well for saying we weren't being paranoid. With food allergies in the family we were a bit jittery.

Follow-up: Saturday morning (thank you Andrhia) they got their first dose of peanut butter at the pediatrician's office: half a home-made peanut butter cookie. (zoomorphic, that was a fantastic suggestion. Thank you for that!)

No reaction.

12 hours later, my daughter became ill (vomiting) at a restaurant over dinner. Yesterday, she had additional tummy issues. Pediatrician doesn't believe that was an allergic reaction (too long a delay, doesn't quite fit the "profile,") but would like them to have allergen blood tests just in case. So they're going to the lab this afternoon to have their blood drawn and we'll bring them to medical appointments this week and probably next week to the allergist (as you suggested anniecat,) to determine the results.

I flagged some best answers and favorited a few other comments. Going to keep this thread open, and will continue updating as we have additional news just in case it's helpful to anyone who stumbles across this thread in the future. Thank you again, folks.
posted by zarq at 2:16 PM on October 4, 2010

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