Introducing peanut butter to infants

Introducing peanut butter to a baby can be both exciting and nerve-wracking due to the potential for allergies. With infants and babies, it’s best to introduce peanut butter before peanuts and to test how they respond. Parents will want to be prepared for the possibility of unknown allergies and to have a plan in place before beginning to introduce peanut butter to their babies.
Although babies can have peanut butter, it’s important to mindfully introduce peanut butter into their diets. If your baby is extra sensitive or prone to allergies, it’s especially important to know the best practices for introducing peanut butter safety to a child. Below, Dr. Sara Anvari, Director of Research, Food Allergy Program at Texas Children’s and Associate Professor of Pediatrics at Baylor College of Medicine, answers some common questions about peanut butter and babies.
The American Academy of Pediatrics (AAP) recommends that parents introduce allergenic and non-allergenic foods — including peanut butter — to infants without a history of allergic disorders, such as eczema or food allergies, starting around 4-6 months of age. This recommendation was made based on the increasing prevalence of food allergies among babies and infants. The evidence suggests that earlier rather than delayed introduction of more allergenic foods, such as peanut butter, could potentially help prevent the development of food allergies.
Infants without eczema or food allergies can be introduced to age-appropriate peanut-containing foods, along with other solid foods, starting at 4-6 months of age.
Recent guidelines by the National Institutes of Health strongly recommend that infants who have severe eczema, egg allergy or both should undergo a food allergy evaluation before being introduced to peanut butter at home. If your baby has shown signs of sensitivities and food allergies, it’s best to see an allergist when they are about 6 months old, before they try peanut butter or other allergy-prone foods.
Based on test results, peanut-containing foods could potentially be introduced at 4-6 months of age.
“It’s typically recommended to start with peanut butter that’s been diluted with either breast milk, formula or water,” said Dr. Anvari. “If your baby has any allergic condition — like severe eczema or egg allergies — it’s recommended that you first obtain a peanut allergy blood test from your pediatrician.”
Before introducing peanut butter to babies, ensure they are well (i.e. do not give peanut butter for the first time when they have a cold) and that you are available to observe them for a few hours after introduction in the home environment. Introducing peanut butter to babies around 4-6 months is an ideal time to test.
To introduce peanut butter, we recommend mixing 1-2 teaspoons of peanut butter with 2-3 teaspoons of water, breast milk or formula to thin it out.
“I would recommend picking a peanut butter without too many fillers in it,” said Dr. Anvari. “And always choose smooth rather than chunky peanut butter to avoid choking hazards. Otherwise, the specific type of peanut butter is not important — whatever brand you would regularly keep in your house is fine.”
First, offer your infant a small serving of peanut butter puree (e.g., the tip of a teaspoon) and observe for 15-20 minutes. If there are no symptoms after the first dose, slowly give the remaining doses, watching for any signs of an allergic reaction. Avoid giving whole peanuts or thick lumps of peanut butter, as this can be a choking hazard.
If your baby likes the taste of the peanut butter, you may see positive reactions, such as a smile, opening their mouth for more or reaching for the spoon. However, if babies spit up, spit it out, turn their heads or show disinterest, it may be a sign that peanut butter is not yet for them. Although babies may not enjoy the taste of peanut butter upon first introduction, remember that babies’ taste preferences are frequently evolving, so it may take several tries before they begin to like it.
“If a baby has tolerated the full dose, I recommend keeping two teaspoons of peanut butter in the diet at least twice a week to make sure they don’t lose that tolerance,” said Dr. Anvari. “Peanut butter offers a good source of protein and nutrients for babies, so it’s perfectly healthy to make it a regular part of the diet. As they become toddlers and beyond, the dosage can increase accordingly.”
When introducing peanut butter to a baby for the first time, it’s important to know what reactions to watch for. These include:
The immediate development of rash, hives or swelling. Swelling may appear around the eyes, lips or tongue.
Respiratory symptoms, including coughing, persistent wheezing and/or breathing difficulties of any kind.
Vomiting that is projectile and/or persistent.
“If your baby shows any sign of a reaction to peanut butter, take them immediately to the nearest urgent care or the nearest emergency room, where doctors will administer treatment,” said Dr. Anvari.
Find resources and learn more about the Food Allergy Program at Texas Children’s Hospital.