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The AAP also recently changed its guidelines for introducing peanuts to babies based on a study [1] showing a pretty dramatic decline in the development of the

The AAP also recently changed its guidelines for introducing peanuts to babies based on a study [1] showing a pretty dramatic decline in the development of the allergy with early exposure vs total avoidance. [1]http://www.nejm.org/doi/full/10.1056/NEJMoa1414850#abstract http://www.nejm.org/doi/full/10.1056/NEJMoa1414850#abstract

giarc 9y ago
We've created this fear in parents that they must keep peanuts away from their child. My colleague wouldn't bring peanuts into the house with her first child and by age 3 her son still hadn't eaten peanut butter or any other peanut products. She wanted to introduce peanut butter to him and went as far as bringing him to the Children's Hospital emergency department and gave him a tiny amount of peanut butter while sitting in emergency waiting room. The idea being that she'd be able to get help quick if he went into anaphylactic shock. I thought, and tried to explain to her, that a 3 year old in daycare probably has been exposed to peanuts already, and therefore was very unlikely to have a severe reaction. But you can't always use that logic on worried parents. This idea of introducing the food in an ED waiting room is probably something spread on mommy forums such as BabyCenter. One mom shares it, then there is social pressure to do the same thing. A parent probably thinks "Does it make me a bad mom if I don't do it." Very unfortunate.
- nsxwolf 9y ago
  We gave our kids peanut butter as soon as they were eating solid food. We live right next to the emergency room so we figured, let's just get it over with. Sounds like it's the right approach to introduce it as early as possible, anyway.
  - giarc 9y ago
    My wife is a dietitian and we gave our first daughter peanut butter (natural, no sugar added) starting at 6 months. The only other concern with PB is choking hazard, so we just spread it really thin on toast or crackers. At 6-9 months, they usually just suck on food or handle it. Rarely do they get a ton down anyways.
- gehwartzen 9y ago
  I agree. And the study actually points out that "There was no significant between-group difference in the incidence of serious adverse events." It's important to remember how vital early introduction to both beneficial and harmful environmental agents are to human development. Its easy to have the mindset that I will wait until my child is 3+ years old before I introduce anything potentially harmful with the idea being that they will be bigger and stronger. The immune system is actually quite strong and adaptable early in development which is precisely why vaccines work better at an early age That being said the parent (esp mother) also plays a large roll in the first introduction of helpful bacteria that break down various foods. The bacteria that are transferred during a vaginal birth give the baby a leg up in establishing its early gut flora. Additionally there is a direct transfer of antibodies through the placenta and breast milk which help protect the baby. I would imagine a mother eating peanuts during both those times would help pass some of these antibodies to her offspring. https://en.wikipedia.org/wiki/Passive_immunity https://en.wikipedia.org/wiki/Passive_immunity
- ccleve 9y ago
  Instead of feeding our baby peanut butter, I smeared a small amount on his arm first. The skin got red and bubbled up. We took him in, got him tested, and found that he had the allergy. Thank God I didn't feed it to him.
  - adrr 9y ago
    Curious if you hand wash or use a dishwasher for the baby bottles? There's a hygiene hypothesis to explain why allergies are more prevalent in 1st world countries.
  - blakeholl 9y ago
    My son has a peanut allergy which manifested in the same way. We were then told to have a component test done on his blood to determine which proteins he was actually allergic. It was explained that some are more commonly related to anaphylaxis while others tend to just cause rashes, etc. He ended up testing positive to one that is considered "bad", and he has been in OIT for awhile. So far so good - but I recently heard of a child doing the same with milk OIT and the child passed away. Very scary stuff.
- dragonwriter 9y ago
  > I thought, and tried to explain to her, that a 3 year old in daycare probably has been exposed to peanuts already Prior to the recent AAP recommendation (and possibly still after it) many daycares had nut-free policies as a selling point. > This idea of introducing the food in an ED waiting room is probably something spread on mommy forums such as BabyCenter. Introducing an allergen with ready access to medical care may be an overreaction, but is hardly problematic. It's the delay in introduction which is problematic, and which research suggest drove the big upswing in incidence of peanut and some other allergies.
ashark 9y ago
Huh. My wife and I deliberately did the opposite of the "avoid exposure to allergens (especially nuts)" guidelines for kids because it seemed like obviously ass-backwards, stupid advice, considering that rates of kids with serious food allergies seemed to have gone up like 10x under those guidelines vs. when we were kids and everyone just fed their kids peanut butter (and everything else) ASAP and serious food allergies were a thing that a couple kids per school had, rather than a couple per classroom now. Looks like we guessed right on this one.
- philsnow 9y ago
  > [we] did the opposite of the [...] guidelines [...] because it seemed like obviously ass-backwards, stupid advice > Looks like we guessed right on this one. You conclude that the advice is wrong because of your sample size of however many kids you have? You didn't explicitly say "our kids" but merely "kids"; God help you if you feed nuts to other peoples' kids based off your conclusion.
  - ashark 9y ago
    Did you read the linked page? Or google for how recommendations re: feeding kids peanuts have changed since 2015? We concluded the advice was wrong because very few of our peers in school had food allergies, but now a crazy percentage of the kids who've grown up under the no-peanuts-for-kids-or-even-for-pregnant-women advice are allergic to peanuts. And it turns out we got that one right.
    - philsnow 9y ago
      What I'm saying is: do what you want with your own kids. Feel free to discuss your ideas/concerns with other parents and censure them like anti-vaxxers if you want. BUT if you either 1) don't ask them first and give their kids peanuts or 2) disregard their concerns and give their kids peanuts, and a kid dies because of it, you are culpable and responsible for that kid's death.
      - 9y ago
azernik 9y ago
For a bit of extra anecdotal evidence - in Israel a common easily-digested semi-junk food is Bamba, peanut puffs. Rates of peanut allergy are very low there. What you have instead is milk allergies, and briefly doctors recommended delaying introducing milk to infants. (This advice has also changed.)
- dragonwriter 9y ago
  That's actually, according to something I read a while back (sorry, don't remember the source), not just an extra anecdote, it's the observed fact which motivated the study that led to the AAP changing it's recommendation.
- compsciphd 9y ago
  with that said, sesame is also a huge product in Israel (techina, chummus....) and rates of allergies to it are higher than average. With that said, sesame is not something little kids are going to be eating as much of or creating dust in the air.
  - dvirsky 9y ago
    Israeli here - not sure how common it is, but sweet tahini (with honey usually) is a toddler favorite, and young kids also eat hummus a lot. Not sure it's as popular as Bamba, but pretty commonplace.
    - compsciphd 9y ago
      right, but its not exposed in the same way. I agree that chummus is a staple (with pita), just that bamba produces dust / stickiness on fingers in a way sesame based dishes don't. i.e. even if not eating it, one probably have low level of exposure to it.

giarc 9y ago

We've created this fear in parents that they must keep peanuts away from their child. My colleague wouldn't bring peanuts into the house with her first child and by age 3 her son still hadn't eaten peanut butter or any other peanut products. She wanted to introduce peanut butter to him and went as far as bringing him to the Children's Hospital emergency department and gave him a tiny amount of peanut butter while sitting in emergency waiting room. The idea being that she'd be able to get help quick if he went into anaphylactic shock. I thought, and tried to explain to her, that a 3 year old in daycare probably has been exposed to peanuts already, and therefore was very unlikely to have a severe reaction. But you can't always use that logic on worried parents. This idea of introducing the food in an ED waiting room is probably something spread on mommy forums such as BabyCenter. One mom shares it, then there is social pressure to do the same thing. A parent probably thinks "Does it make me a bad mom if I don't do it." Very unfortunate.

nsxwolf 9y ago
We gave our kids peanut butter as soon as they were eating solid food. We live right next to the emergency room so we figured, let's just get it over with. Sounds like it's the right approach to introduce it as early as possible, anyway.
- giarc 9y ago
  My wife is a dietitian and we gave our first daughter peanut butter (natural, no sugar added) starting at 6 months. The only other concern with PB is choking hazard, so we just spread it really thin on toast or crackers. At 6-9 months, they usually just suck on food or handle it. Rarely do they get a ton down anyways.
gehwartzen 9y ago
I agree. And the study actually points out that "There was no significant between-group difference in the incidence of serious adverse events." It's important to remember how vital early introduction to both beneficial and harmful environmental agents are to human development. Its easy to have the mindset that I will wait until my child is 3+ years old before I introduce anything potentially harmful with the idea being that they will be bigger and stronger. The immune system is actually quite strong and adaptable early in development which is precisely why vaccines work better at an early age That being said the parent (esp mother) also plays a large roll in the first introduction of helpful bacteria that break down various foods. The bacteria that are transferred during a vaginal birth give the baby a leg up in establishing its early gut flora. Additionally there is a direct transfer of antibodies through the placenta and breast milk which help protect the baby. I would imagine a mother eating peanuts during both those times would help pass some of these antibodies to her offspring. https://en.wikipedia.org/wiki/Passive_immunity https://en.wikipedia.org/wiki/Passive_immunity
ccleve 9y ago
Instead of feeding our baby peanut butter, I smeared a small amount on his arm first. The skin got red and bubbled up. We took him in, got him tested, and found that he had the allergy. Thank God I didn't feed it to him.
- adrr 9y ago
  Curious if you hand wash or use a dishwasher for the baby bottles? There's a hygiene hypothesis to explain why allergies are more prevalent in 1st world countries.
- blakeholl 9y ago
  My son has a peanut allergy which manifested in the same way. We were then told to have a component test done on his blood to determine which proteins he was actually allergic. It was explained that some are more commonly related to anaphylaxis while others tend to just cause rashes, etc. He ended up testing positive to one that is considered "bad", and he has been in OIT for awhile. So far so good - but I recently heard of a child doing the same with milk OIT and the child passed away. Very scary stuff.
dragonwriter 9y ago
> I thought, and tried to explain to her, that a 3 year old in daycare probably has been exposed to peanuts already Prior to the recent AAP recommendation (and possibly still after it) many daycares had nut-free policies as a selling point. > This idea of introducing the food in an ED waiting room is probably something spread on mommy forums such as BabyCenter. Introducing an allergen with ready access to medical care may be an overreaction, but is hardly problematic. It's the delay in introduction which is problematic, and which research suggest drove the big upswing in incidence of peanut and some other allergies.

ashark 9y ago

Huh. My wife and I deliberately did the opposite of the "avoid exposure to allergens (especially nuts)" guidelines for kids because it seemed like obviously ass-backwards, stupid advice, considering that rates of kids with serious food allergies seemed to have gone up like 10x under those guidelines vs. when we were kids and everyone just fed their kids peanut butter (and everything else) ASAP and serious food allergies were a thing that a couple kids per school had, rather than a couple per classroom now. Looks like we guessed right on this one.

philsnow 9y ago
> [we] did the opposite of the [...] guidelines [...] because it seemed like obviously ass-backwards, stupid advice > Looks like we guessed right on this one. You conclude that the advice is wrong because of your sample size of however many kids you have? You didn't explicitly say "our kids" but merely "kids"; God help you if you feed nuts to other peoples' kids based off your conclusion.
- ashark 9y ago
  Did you read the linked page? Or google for how recommendations re: feeding kids peanuts have changed since 2015? We concluded the advice was wrong because very few of our peers in school had food allergies, but now a crazy percentage of the kids who've grown up under the no-peanuts-for-kids-or-even-for-pregnant-women advice are allergic to peanuts. And it turns out we got that one right.
  - philsnow 9y ago
    What I'm saying is: do what you want with your own kids. Feel free to discuss your ideas/concerns with other parents and censure them like anti-vaxxers if you want. BUT if you either 1) don't ask them first and give their kids peanuts or 2) disregard their concerns and give their kids peanuts, and a kid dies because of it, you are culpable and responsible for that kid's death.
    - 9y ago

azernik 9y ago

For a bit of extra anecdotal evidence - in Israel a common easily-digested semi-junk food is Bamba, peanut puffs. Rates of peanut allergy are very low there. What you have instead is milk allergies, and briefly doctors recommended delaying introducing milk to infants. (This advice has also changed.)

dragonwriter 9y ago
That's actually, according to something I read a while back (sorry, don't remember the source), not just an extra anecdote, it's the observed fact which motivated the study that led to the AAP changing it's recommendation.
compsciphd 9y ago
with that said, sesame is also a huge product in Israel (techina, chummus....) and rates of allergies to it are higher than average. With that said, sesame is not something little kids are going to be eating as much of or creating dust in the air.
- dvirsky 9y ago
  Israeli here - not sure how common it is, but sweet tahini (with honey usually) is a toddler favorite, and young kids also eat hummus a lot. Not sure it's as popular as Bamba, but pretty commonplace.
  - compsciphd 9y ago
    right, but its not exposed in the same way. I agree that chummus is a staple (with pita), just that bamba produces dust / stickiness on fingers in a way sesame based dishes don't. i.e. even if not eating it, one probably have low level of exposure to it.