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The Perspective
The Perspective

March 15, 2016

Peanuts for Babies!!! Stop! Wait a second!

Dr. Blake Papsin is Otolaryngologist-in-Chief at SickKids. He is also Professor in the Department of Otolaryngology – Head and Neck Surgery at the University of Toronto and the Jordan and Lisa Gnat Family & Bastable-Potts Chair in Otolaryngology at SickKids.

For the second time in the last few months I’ve read or heard in the media about the benefits of early exposure to peanuts with regard to reducing peanut allergy in children. Both times my hair got even whiter! This message needs interpretation. Here is the correct message: peanut “protein” exposure in infants may diminish allergy to these proteins in children. Not peanuts! This means exposing children to peanut butter and peanut-based snacks.   

I can’t comment on the merits of early of exposure, but I can talk about what I see as an ear, nose and throat doctor. At least twice monthly infants are sent to the Otolaryngology surgeons at our hospital because they have inhaled nuts, with peanuts being the most common villain. These nuts get stuck in the lungs and we remove them under an anesthetic using long metal tubes (bronchoscopes) through which we can employ camera systems, little grabbing instruments (forceps) and vacuums to clean up the the arachidic bronchitis, an inflammatory response to the oils in the nuts.  Although arachidic bronchitis is specific to peanuts we see a related inflammation from all nuts. The nuts can block and collapse lung segments and cause serious infection and pneumonia-like symptoms. This is not fun for the children or the team that cares for them at SickKids.  

Children should not be given whole nuts until they have their molars which are the grinding teeth in the back of their mouth. Even then, until they can control what they are eating and not run around with half chewed things in their mouth, nuts should be avoided. Nut butter and nut-based snacks would give the children the allergy preventing benefits without risking an airway foreign body.

Now… since I have your attention, give me another 30 seconds of your day. For the same reason, grapes, hotdogs, stone fruits with pits (i.e. nectarines, plums, peaches) and other easily inhalable foods should not be given whole to children until they have oral competence. Oral competence is the skill needed to manipulate food in your mouth and interestingly is also reduced in older patients with dentures (who also get airway foreign bodies more commonly). These circular shaped foods can even be worse than nuts because they can completely block the airway if inhaled. If you want to give young children these perfectly circular, airway cork-shaped foods please cut them into smaller pieces until the child can handle these foods by her or himself.    

Thank you…I feel better now…but unfortunately this has done nothing to stop my hair from going whiter.