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

In a randomized trial of 640 high‑risk infants, those who ate peanuts regularly from 4 to 11 months of age had a peanut allergy rate of only 1.9% by age 5, compared with 13.7% in the group that completely avoided peanuts. Among children already showing a weak positive skin test at enrollment, the rates were 10.6% versus 35.3%. Avoiding peanuts actually raises the risk of allergy. However, whole peanuts must never be given, as they can block the airway. A total of 530 infants had negative skin tests at entry, while 98 had weakly positive results.

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.

Peanuts must be given only as thinned peanut butter or powdered form mixed into food — never as whole nuts. The Health Commission clearly states: “Whole peanuts, nuts, jelly, and similar foods can be inhaled into the airway and cause choking; infants should avoid them.” For choking first aid, see Section 13, Item 26. This guidance applies only to high‑risk children with severe eczema or egg allergy. A medical assessment is mandatory before introduction; in the LEAP trial, children with a skin‑test reaction greater than 4 mm were excluded. Another study of 1,162 breastfed infants found no significant difference in overall food allergy rates between early‑introduction and standard groups, though a subset showed a clear benefit: 5.6% versus 7.1% (P=0.32) and 2.4% versus 7.3% respectively. Evidence for typical infants is far weaker. Early introduction appears safe, but Chinese official guidelines currently give no recommendation on this point; therefore this advice follows international trial evidence. Keep in mind that LEAP started at 4 months while Chinese practice recommends waiting until 6 months for solids — consult a doctor on timing and method for high‑risk children.

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）