Kids and Food Allergies: Expert Advice and When to Introduce New Foods

One bite from a chocolate chip cookie was all it took to send Jack Disney into anaphylaxis.

After that one bite, his face became blotchy, his voice was hoarse, and his eyes were closing from drowsiness. Jack’s mom, Allison Disney, surmised he was having an allergic reaction and gave him a Benadryl, but after 45 minutes knew that wasn’t enough. After a trip to urgent care where Jack was given medication and a breathing treatment, Allison was able to take in just how terrifying it was.

Pecans in the chocolate chip cookie were the culprit, and it was then, when Jack was 5 years old, that his tree nut allergy was discovered.

Many parents have been through similar scenarios after their young children eat peanuts, eggs, cashews or other food allergens. That first discovery is a heart-pounding whirlwind of thinking about what their child just ate, watching their breathing and feeling helpless while driving to a doctor’s office or hospital.

Jack is now 10 years old, a fourth grader at Council Oak, and he’s learned to live with his severe food allergy. He knows to read food labels and to ask if there are nuts in new foods he tries. Even his friends know to watch out for nuts around Jack.

“His classmates are aware of it. If there’s a birthday party, they’ll tell their parents, ‘Jack’s going to be here. He can’t have that,’” Allison said. “And they’re good about asking what he can have so he’s not excluded.”

Allison always carries an EpiPen, just in case. The safety net of the EpiPen is also a reassurance to Jack that in case he accidentally ingests a pecan, macadamia nut, walnut, pistachio or cashew, he’ll be protected.

“It’s always a worry, but I really try to not let it be a fear. Kids pick up on your energy. Gosh, he’s so young, and I don’t want him to live in fear of new foods,” Allison said.

Food Allergies Are On the Rise

Dr. Weyman Lam, allergy and immunology physician at Warren Clinic and Saint Francis Children’s Physicians, sees many young patients like Jack.

“Food allergies are on the rise in the last several decades,” Lam said. “We don’t completely understand it, and it’s more common in North America and Europe. But there’s definitely more hay fever, asthma and food allergies.”

Food allergies are typically not outgrown, Lam said, though there are exceptions, including some children outgrowing their allergies to milk, eggs, soy and wheat.

That said, Lam works with many young patients on desensitization from allergens, including peanuts. For those with peanut allergies, for example, the desensitization process may include starting with one milligram of a peanut solution ingested while in the doctor’s office to see how the patient handles it. If tolerated, the patient could then try the same process at home, eventually slightly increasing the amount.

Though desensitization can give parents trepidation, Lam said it can ultimately give parents more confidence about their children being around peanuts or other foods.

“We don’t like the word ‘cure,’ but we certainly have kids who have the procedure and can outgrow it,” Lam said.

Avoiding Allergens

A big worry for families with food allergies is one Allison Disney must often navigate, and that’s decoding food labels to see if the food was processed in a facility that also processes nuts.

“The FDA has no legal obligation. You still have to typically call a company if it says it may be cross-contaminated or made in the facility,” Lam said.

Of course you can avoid that food all together, but for families with children with multiple food allergies, eliminating foods can be a struggle when juggling gluten, nut and dairy allergies, for instance.

Lam suggests calling the company or doing research through sites like Food Allergy Diva, which has a guide for facilities with dedicated nut-free processing.

“People don’t realize how far this goes,” Allison said.

Simple things like going to get a scoop of ice cream aren’t possible because the ice cream scoop is typically only “cleaned” with a rinse of water. Utensils, including knives in kitchen restaurants, can also be the source of allergic reactions when cross contaminated with nuts in a restaurant kitchen.

When to Introduce Foods

“Introducing peanuts with water reduces the risk of anaphylaxis by fivefold. The only caveat is if the kid has severe eczema or an already proven egg allergy,” Lam said.

The American Academy of Pediatrics’ 2015 recommendation for early peanut introduction is counter to what many families followed for years. But after the Learning about Peanut Allergy study, a major study that followed more than 600 children for more than four years, it was recommended that early introduction can reduce the risk of peanut allergies.

Similarly, the AAP recommends introducing small amounts of eggs, wheat and dairy around 6 months of age.

Introducing Foods at 6 Months of Age

A 2023 update in the AAP’s journal Pediatrics states that early introduction (around 6 months old) of potential allergens may not be enough and recommends regular ingestion once that allergen is introduced.

So how do you introduce these foods?

Eggs: Offer a very small amount of well-cooked egg into baby’s usual food.

Wheat: Try cream of wheat or baby cereal. Try it consistently for 3-5 days before introducing other new foods.

Peanuts: According to the National Institute of Allergy and Infectious Diseases, babies with severe eczema are considered high risk for developing a peanut allergy. Talk to your doctor about introducing peanuts. For babies with mild or no eczema, a small amount (1/8 teaspoon) of peanut butter can be blended into water or breast milk and ingested. Watch your baby closely after doing so and repeat for 3-5 days to see how it is tolerated.

Tree Nuts: Tree nuts can be ground and then added to cereal. Start with 1/8 teaspoon and work up to feeding ½ teaspoon. Stay close to your baby to monitor them for 2 to 4 hours afterward.

Natalie Mikles is a mom of three. She writes about food, sharing recipes for busy families and picky eaters. She has been recognized for her food columns as well as features on families and issues affecting local children. Natalie loves pizza and movie nights with her family.