For children with severe eczema or egg allergy, don’t avoid peanuts — introduce them early under medical guidance, but never feed whole peanuts

A jar of peanut butter costs just a few dozen yuan. Feeding it a few times a week is easy to fit into a routine. Before starting, though, a doctor’s evaluation is required.

The LEAP trial involved 640 infants aged 4–11 months with severe eczema, egg allergy, or both. One group ate peanut products regularly while the other avoided them entirely; at 60 months, only 1.9% of the eaters had a peanut allergy versus 13.7% of avoiders (P<0.001). Among 98 children with a weak positive skin test at entry, 10.6% of eaters were allergic versus 35.3% of avoiders (P=0.004). No serious adverse events differed between groups.

Du Toit G, Roberts G, Sayre PH, 等 (2015). Randomized trial of peanut consumption in infants at risk for peanut allergy. New England Journal of Medicine, 372(9), 803-813. https://doi.org/10.1056/NEJMoa1414850；国家卫生健康委办公厅 (2020). 婴幼儿喂养健康教育核心信息. https://www.gov.cn/zhengce/zhengceku/2020-08/01/content_5531915.htm；Perkin MR 等 (2016). Randomized Trial of Introduction of Allergenic Foods in Breast-Fed Infants. New England Journal of Medicine, 374(18), 1733-1743. https://doi.org/10.1056/NEJMoa1514210（备注里那项一般婴儿试验 EAT）

The form can only be thinned peanut butter, or peanut flour mixed into complementary food. Never give a whole peanut. The Health Commission's core feeding messages say it plainly: "Whole peanuts, nuts, jelly, and similar foods are easily inhaled into the airway and cause choking, and infants and young children should not eat them." What to do if a child chokes: under 1 year of age, see Section 13, item 43 (an infant choking and unable to cry); at 1 year or older, see Section 13, item 26 (someone choking and unable to speak). This applies only to high-risk children: those with severe eczema, or those already allergic to egg. You must see a doctor for an assessment before adding peanuts. Do not try it at home on your own. The LEAP trial gave every child a skin test before enrollment. Children whose skin-test reaction was greater than 4 millimeters were kept out of the trial and were not given peanuts to eat. The evidence for ordinary children is much weaker. In another trial of 1162 ordinary breastfed infants, counted by the group they were assigned to, food allergy was 5.6% in the early-introduction group and 7.1% in the usual group, and the difference was not significant (P=0.32). It was significant only among the children who actually did it (2.4% against 7.3%). That way of counting tends to make the effect look larger. The authors themselves say the assigned-group count did not prove efficacy, but it does show that early introduction is safe. Official Chinese feeding documents currently say nothing on "introduce allergenic foods early, or avoid them," so this item follows the international trial evidence. The timing needs care too: LEAP started at 4 months, while in China complementary foods start at a full 6 months. See item 4 of this section (breast milk only for the first 6 months). For a high-risk child, at how many months to start, and how to start, follow the doctor.