New discoveries and scientific breakthroughs happen every day. Huge changes in the recommendations about when to introduce nuts to children have just come down the pipeline. With peanut allergies affecting 1-3% of all children, anything we could do to help prevent them would be monumental in improving quality of life.
Not that long ago, parents were instructed to delay introducing nuts (and foods that contain nuts) to infants until they were much older in an effort to reduce the number of kids who developed nut allergies. This is a hot topic because the number of kids who have developed peanut allergies have essentially doubled in the past decade. Recently, a large study: Learning Early About Peanut (LEAP), disproved that notion. In short, it took two groups of children: 4-11 months and 60 months and exposed them to nuts. The kids who were introduced at a younger age developed fewer nut allergies.
When the expert panel (allergy specialists), looked at the data, they came up with new guidelines that the American Academy of Pediatrics (the AAP) endorses.
Here’s the new guidelines in a (queue pun) nutshell:
Low Risk Kids
- Low risk meaning: No eczema or known food allergies.
- Feed your baby peanut products along with other foods when you child shows developmental readiness. For most kids, this is when they show they can tolerate other solid foods.
Higher Risk Kids
- Those with suspected or known peanut allergies already:
- They should avoid peanuts and consult with a specialist.
- Those who have family members with peanut allergies:
- Consult with your pediatrician to determine risks and benefits of peanut introduction (not all peanut allergies are anaphylactic in nature and an individualized plan is appropriate).
- Those with severe eczema or egg allergies:
- Test for peanut allergies BEFORE giving peanuts items (if testing is positive, see an allergist).
- Ideal test is a skin prick test (SPT), but blood tests are ok if an SPT test is unavailable.
- If negative SPT: Feed peanuts between 4-6 months either at home or in the doctor’s office.
- Those with Mild to Moderate eczema:
- Consult with your pediatrician about the ideal time or situation to introduce nuts.
- Generally, feed peanuts around 6 months.
What form of peanuts?
Due to the risk of choking, actual peanuts (either whole or pieces) should be avoided. Products like smooth peanut butter or things made with peanut butter are ideal.
How much do I give?
You may want to talk to your doctor about this. The actual study had a very specific amount, 6-7 grams a week over 3 or more feedings. For those of you who don’t usually measure in grams (few of us do), 6 grams is 1.2 teaspoons, or 0.4 tablespoons.
What does this mean in terms of other food allergies?
Absolutely nothing. The study didn’t look at any other possible food allergens, so we don’t know whether the same reasoning can be applied to other foods. As always, if you have concerns make sure and discuss them with your doctor. Good luck and enjoy those PB&Js!
Most people have experienced a bloody nose. This time of year they are particularly common with allergy season. The nose gets irritated and easily bleeds from the picking and rubbing that ensues. Bloody noses are particularly common in Utah where the air is so dry.
There is a surprising amount of misinformation out there on how to handle bloody noses. Here are the quick facts:
How to stop a bloody nose:
- Firmly pinch the end of the nose, so the nose is completely closed. The idea is to apply pressure to the area that is bleeding so the body can make a clot. Pinching the bridge of the nose is just an old wives tale. (That would be like applying pressure in your armpit to get a cut on the forearm to stop bleeding. It’s better to apply the pressure to the cut itself).
- Sit straight up or slightly forward. You do not want the blood to drain down the throat. Better to spit out any blood than to swallow it. Blood in the stomach is nauseating. The last thing you need is vomiting to compound the situation.
- If the bleeding is profuse and won’t stop, apply something cold to the nose (just above where you are holding it closed). This will constrict the blood vessels and help slow the bleeding. An ice pack or bag of frozen peas works beautifully.
- Hold the nose firmly for a long time. When you stop holding your nose (to check to see if the bleeding stopped), and discover you’re still bleeding, then hold your nose twice as long the next time before checking again. For example, if you held your nose for 5 minutes but it continues to bleed, then hold it 10 minutes the next time before checking again.
- Don’t shove anything up the nose to create the clot (like a wad of toilet paper). Yes, it will act like a dam and temporarily stop it, but when you pull it out, you will likely pull out the clot and the nose will start bleeding again.
- Don’t blow the nose right after having had a bloody nose. Blowing will also disrupt the clot and start the bleeding again.
How to prevent a bloody nose:
- Don’t pick the nose. I know it sounds elementary, but nose picking is the number one reason kids get bloody noses.
- Run a humidifier in the room at night. Dried out nasal passages bleed easily.
- Treat nasal allergies.
- Lastly, apply a large glob of Vaseline with a Q-tip to the inside of the nose (just barely up the nose all around and on that first fleshy bump). I know it sounds disgusting, but it really works, especially if your child is having recurrent bloody noses out of the same side. Usually, there is a friable blood vessel that just needs a little TLC to get it to heal up.
The next time you or your child experiences a bloody nose, you’ll be able to handle it like an expert. Good luck!
I noticed just this week that I am beginning to see a bump in the number of kids coming into my office with seasonal allergies. Seasonal allergies can range from a slight nuisance to completely miserable. Allergies can cause a runny, itchy nose, watery eyes, and sneezing. Since allergies tend to have a genetic component, be on alert for symptoms in children if either parent suffers from allergies.
How does my doctor know if my child has allergies?
- Your doctor will ask lots of questions about your child’s symptoms, triggers, and environmental influences. She will determine if the story of symptoms is consistent with allergies.
- Physical exam findings can include some or all of the following:
- Dennie’s line (a Dennie-Morgan fold to be exact): A small fold or line in the skin just below the eye caused by swelling from allergies.
- Allergic shiners: Dark circles (purple-grey discoloration) under the eyes caused by the accumulation of blood or fluid that happens with chronic nasal congestion.
- Allergic salute: The action of wiping the nose with the palm of the hand in an upward movement (called a “salute” due to the unintentional gesture). Technically, it can also be a back and forth rubbing of the nose with the back of the hand.
- Transverse nasal crease or groove: A white little line or crease seen across the bottom third of the nose; usually caused by the allergic salute (see above).
- Nose exam: The nasal turbinates (fleshy, little protrusions on the inside of the nose) will classically be pale and boggy (vs. when sick they are typically very red and inflamed).
- Red, watery eyes (your doc will examine them and help distinguish allergic red eyes from infectious red eyes).
What to do about allergies?
- Oral medications: It is reasonable to do a trial of the counter medications first (e.g., Zyrtec, Allegra, Claritin). If your child is under 3 years, you should probably consult with your doctor first to determine need for meds, dosing, and which one. (Note: I intentionally didn’t mention Benadryl. While it works, it tends to be a really sedating antihistamine, making it a poor long-term option).
- Symptom specific medications: If the problem is only itchy eyes, you may want just an allergy eye drop. The same holds true for the nose. If the symptoms are runny nose only, you may want an allergy nose spray. Most of the best symptom specific medications available are by prescription only, so make an appointment with your doctor for those.
- Change bath time to nights instead of morning. It helps to wash all the pollen off the body and hair before sleeping.
- Saline nose spray: This can help break up thick mucus if your child isn’t old enough to effectively blow her nose (especially important to get as clear a nose as possible before using any medicated nasal sprays).
It is hard to know what medications are safe to take when pregnant and breastfeeding. Ask anyone who has ever suffered from serious allergies and you know how miserable they can be without his or her allergy medications. The good news is that most allergy medications are safe to take. As for specific information about allergy shots, it appears (by the published literature) that they are generally safe. Most of my investigating into the matter has revealed that the injected allergens appear not to be transmitted into the breast milk. Consequently, there should be little risk to your baby regardless of when the shots are given or when the baby is fed.
When I did a quick search on The American Academy of Pediatrics published site, I could not find anything that would show a contraindication to breastfeeding and allergy shots. It is generally believed that shots should NOT be initiated for the first time when pregnant or breastfeeding (due to the risk of anaphylaxis and subsequent risk to the fetus), but are safe to continue.
As an aside, the “D” part of many allergy medications (e.g., Zyrtec-D, Claritin-D) is usually pseudoephedrine. This medication should NOT be used while breastfeeding because it will quickly dry up a woman’s milk supply.