Children's Nutrition Food Allergy

Remove Barriers to Starting Allergenic Foods in Infants

Fear of an allergic reaction to food—especially peanuts—is a significant issue for many new parents. But the reality is that most children don’t have food allergies, and less than 2% of children have peanut allergy. So while parents should be aware of the risks, signs, and symptoms to watch out for, in general they shouldn’t be afraid of food allergies. What’s more, the latest research and guidelines from the National Institute of Allergy and Infectious Diseases recommend introducing peanut foods as early as 4 to 6 months of age, depending on risk of food allergies. The groundbreaking Learning Early About Peanut (LEAP) allergy study showed a reduction in the risk of developing peanut allergy of up to 86% in infants at highest risk (eg, those with egg allergy and/or severe eczema). Early introduction of peanut foods and potentially other major allergens, including egg, dairy, and others, isn’t just about adding nutritious foods; it’s about preventing long-term health conditions.

RDs need to be aware of the latest guidelines about introducing solid foods to infants. Here are some of the basics:

  • Research doesn’t support withholding any potentially allergenic food as a means to prevent food allergies beyond 4 to 6 months of age. As such, the American Academy of Pediatrics no longer recommends withholding potentially allergenic foods.
  • All foods should be introduced in safe forms to reduce the risk of choking.
  • Once foods have been safely introduced, they should be kept in the diet.
  • There are guidelines specific to peanut introduction, which can be found at the NIAID website and which I’ve detailed in a previous article for the RD Lounge. There are three risk categories with corresponding recommendations.

Practitioners also need to be aware of the barriers to early introduction of allergenic foods. A recent consumer study conducted on behalf of the National Peanut Board showed that nearly one-half of millennial parents are unaware of the latest recommendations to introduce peanut foods in infancy. Moreover, they don’t understand why the changes occurred, are confused about what the guidelines say, and want more information. In addition to parents’ own concerns, pediatricians are adding to the confusion. A recent survey showed that many pediatricians aren’t yet on board with encouraging compliance with the latest recommendations for introducing peanut foods. Of the pediatricians who responded, only 11% were fully compliant with the NIAID guidelines for introducing peanut foods to infants to prevent peanut allergy.

As the experts in food and nutrition, RDs have the opportunity to help educate other health care professionals as well as clients and patients. According to NIAID Director Anthony S. Fauci, MD, in a recent press release, “We expect that widespread implementation of these guidelines by health care providers will prevent the development of peanut allergy in many susceptible children and ultimately reduce the prevalence of peanut allergy in the United States.” By being aware of the barriers to introduction and fully understanding the recommendations, RDs can be the go-to resources for implementing these transformative guidelines.

— Sherry Coleman Collins, MS, RDN, LD, maintains a private practice in the metro-Atlanta area with a focus on food allergy, whole-health wellness, and nutrition communications. She serves as an expert consultant and spokesperson for the National Peanut Board. Keep up with Sherry at and by following @DietitianSherry on TwitterFacebook, and Instagram.

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