When Can My Baby Eat Nuts?

Q: When can my baby eat nuts?

A: The advice on this has recently changed (in a big way!). It used to be that parents were told to hold off on peanuts and tree nuts such as almonds and walnuts until as late as three years of age because of food allergy risks. But the American Academy of Pediatrics (AAP) has adjusted their recommendations based on important research findings. It's now believed that delaying foods like tree nuts and peanuts doesn't protect against allergies—and introducing them early is actually best.

According to the AAP, you can feed your baby common allergens like fish, eggs, and nuts when starting solids because there's no evidence that avoiding them prevents allergies (it's always smart to talk to your child's pediatrician first).

In the case of peanuts, there's new specific guidance based on a landmark study showing that babies who were fed peanuts early had a lower risk of developing an allergy. It's now recommended that babies with a high risk for peanut allergies because of eczema or egg allergy be given peanut as young as 4-6 months—as long as allergy testing is negative (your doctor may also suggest doing the first feeding of peanut in the office). Babies with mild to moderate eczema should get peanut around six months of age. And babies without eczema or other allergy risk factors can have peanut anytime after starting solids.

Remember that whole nuts are a choking risk for small children, so avoid them until age four. Globs of nut butter can also be hazardous. Instead, mix peanut powder or nut butter into smooth purees for babies or serve thinly spread nut butter on strips of toast.

As with giving any new food, watch for these signs of food allergy:

• Hives
• A rash
• Vomiting
• Wheezing
• Runny nose
• Swelling of the lips and face
• Itchy eyes

If you spot these and suspect allergies, call your pediatrician. They usually clear up within a few hours with a little help from an antihistamine like Benadryl.

Severe reactions can trigger the above symptoms plus these:

• Trouble breathing
• Itchy mouth and throat
• Pale, bluish complexion
• Low pulse

For a serious reaction or if you suspect your child is going into anaphylactic shock, you should go to the emergency room right away. The sooner it's treated (with epinephrine and/or steroids), the better.

Updated February 2017.