When babies can have peanuts and peanut butter

Let’s be honest, February and the COVID-19 pandemic feel like they are going on forever. Happily, people are beginning to be vaccinated and there is a light at the end of the tunnel.

In this edition of Ask the Pediatrician, we’ll talk about those e-scooters that are popping up everywhere; new guidance on when babies can have peanuts; and the many forms of the wonderful, loving American family!

When babies can have peanuts

What is the deal with peanut butter? Can giving my infant peanut butter help them avoid peanut allergies?

This is a great question because the scientific community is always learning new things about how our bodies work and updating their recommendations. Prior to 2015, doctors recommended that parents delay the introduction of peanuts. This was thought to reduce the chance of the infant developing allergic conditions like eczema.

A landmark study in 2015 changed this thinking and demonstrated that the early introduction of peanuts was a good thing because it decreased the chance of developing peanut allergies for high-risk babies (infants with severe eczema or egg allergy). As a result of this study guidelines have changed:

• First foods: Try purees that are low allergy risk. This includes puree bananas, prunes and cereal. Try new foods one at a time and wait a few days between introducing new foods. Monitor for any signs of allergic reaction.
• Next steps: If your baby has done well with initial foods, it is fine to start introducing more allergenic foods. This can include eggs, soy, wheat, peanut butter and fish. It is important that all of these are pureed and have an appropriate texture. Whole cow’s milk is recommended after one year, but processed milk such as yogurt can be given earlier.
o Infants who have severe persistent eczema or known allergic reactions to food are considered high risk. Talk to your medical provider about the right time to introduce peanut-containing foods. This is often done in a supervised setting, such as the physician’s office and may include allergy evaluation and testing.
o Infants with mild to moderate eczema are also at risk of developing peanut allergy. Introducing peanut containing products, starting around six months, can be helpful to prevent the peanut allergy from developing. Talk with your medical provider to discuss when to start this.
o Infants with no eczema or food allergies may start with products containing peanuts if they have been able to tolerate a few simple purees.

How to best introduce peanuts: Make sure to avoid anything that is a choking hazard, such as whole peanut. It is reasonable to give a small amount of peanut butter thinned out in cereal or yogurt. Another option to try is peanut butter purees that dissolve in breast milk or formula.

E-scooters sure look like fun

I have noticed e-scooters all over the place. Is this something my children can use?

E-scooters are certainly popping up all over Seattle. For those you not familiar with them, an e-scooter is a shared electric scooter you can unlock with an app. It can travel up to 15 mph.

Unfortunately, as e-scooters have increased in number, so have related visits to urgent-care clinics. Cuts, fractures and head injuries are common. One of the main concerns is that while most children wear helmets while biking, they often do not wear helmets when using an e-scooter. This is because e-scooters are frequently used on a whim and helmets are not provided. Severe injuries to the face and head from motorized scooters have tripled in the past decade and 30 percent occur with children between the ages of 6 and 12 years old.

I recommend that children under the age of 16 do not ride e-scooters in order to avoid injury.

The changing American family

Families have been a foundation of strength throughout the pandemic, and in my role as a pediatrician, I get to see up close all of the different forms a family can take. Family structures in the United States have grown more diverse every year, and I would like to take this time to celebrate family diversity.

Here are some numbers that tell us about what U.S. families look like in 2021:

About half of all families with kids under 18 live with two biological parents.
The next most common family structure is the single-parent family, which makes up approximately 25% of all households.
Roughly 140,000 children are adopted each year, and around 6 children out of every 1,000 live in foster care.
Grandparent families, in which children live with one or both grandparents, make up 2.5 million families.
290,000 children live in families with same-sex parents. The 2020 U.S. Census was the first to give respondents the chance to indicate that they are part of a same-sex couple, either married or unmarried, and I expect the results will give us even more information to guide how we recognize families.