When can smooth peanut butter be safely introduced to an infant who is developmentally ready for solid foods (approximately 4–6 months of age) and has no personal or strong family history of peanut allergy?

When to Introduce Peanut Butter to Your Baby

For infants without eczema or food allergies, introduce smooth peanut butter (thinned or mixed with other foods) around 6 months of age when they are developmentally ready for solids—no allergy testing is needed, and you can do this at home. 1

Risk-Stratified Approach Based on Your Baby's Health

The timing and method of peanut introduction depends entirely on your infant's allergy risk profile:

Low-Risk Infants (No Eczema, No Food Allergies)

• Introduce peanut-containing foods around 6 months of age (but not before 4 months) when your baby shows developmental readiness: good head control, ability to sit with support, and interest in solid foods 1, 2
• No pre-introduction allergy testing is required 1
• Introduction can occur at home without medical supervision 1
• Introduce peanut at the same time as other complementary foods—there is no need to delay allergenic foods 2, 3

Moderate-Risk Infants (Mild to Moderate Eczema)

• Introduce peanut around 6 months of age at home without requiring specialist evaluation or allergy testing 1
• First introduce other solid foods to demonstrate your baby can safely consume solids before adding peanut 1
• While office supervision is not necessary, some parents and providers may prefer an in-office supervised feeding based on comfort level 1

High-Risk Infants (Severe Eczema and/or Egg Allergy)

• Introduce peanut between 4-6 months of age, but only after evaluation by an allergist 1, 3
• Severe eczema is defined as requiring prescription topical corticosteroids or calcineurin inhibitors for at least 12 of 30 days on two occasions 3
• Allergy testing is required before introduction: skin prick testing (SPT) is preferred over blood IgE testing because IgE results in unnecessarily high rates of false positives 3

Interpreting skin prick test results for high-risk infants: 1

• Wheal ≤2 mm: Low allergy risk—introduce peanut at home
• Wheal 3-7 mm: Moderate to high risk—requires supervised feeding in office or oral food challenge in specialized facility
• Wheal ≥8 mm: High likelihood of peanut allergy—refer to allergist for ongoing management and avoid peanut

How to Safely Introduce Peanut at Home

When introducing peanut for the first time at home (for low and moderate-risk infants), follow these specific steps: 1

Preparation requirements:

• Feed only when your baby is healthy (no cold, vomiting, diarrhea, or other illness) 1
• Give the first feeding at home, not at daycare or a restaurant 1
• Ensure one adult can focus entirely on the baby for at least 2 hours after feeding 1

Safe peanut-containing food options (choose one): 1

1. Thinned smooth peanut butter: Mix 2 teaspoons (9-10g) of peanut butter with 2-3 teaspoons of hot water, stir until dissolved and thinned, let cool, and adjust consistency as needed
2. Peanut butter puree: Mix 2 teaspoons of peanut butter with 2-3 tablespoons of pureed fruit or vegetables your baby has already tolerated
3. Peanut puffs (like Bamba®): For infants under 7 months, soften with 4-6 teaspoons of water; older infants who manage dissolvable textures can have unmodified puffs
4. Peanut flour or powder: Mix 2 teaspoons (4g) with 6-7 teaspoons of pureed tolerated fruit or vegetables

Feeding protocol: 1

• Offer a small amount on the tip of a spoon
• Wait 10 minutes and observe
• If no reaction occurs, slowly give the remainder at your baby's usual eating pace

Maintaining Tolerance After Introduction

Once successfully introduced, peanut must be consumed regularly to maintain tolerance—aim for approximately 7.7g of peanut protein per week (roughly 2 teaspoons of peanut butter 3 times weekly) 3. The LEAP study demonstrated that regular consumption between 4-11 months of age reduced peanut allergy risk by up to 80% in high-risk infants 3.

Warning Signs Requiring Immediate Medical Attention

Stop feeding and call 911 if you observe: 1

• Mild symptoms: New rash or a few hives around mouth or face
• Severe symptoms: Vomiting, diarrhea, difficulty breathing, wheezing, persistent coughing, facial swelling, or lethargy

Critical Timing Considerations

Do not delay peanut introduction beyond 6 months unless medically indicated—delaying introduction does not prevent allergies and may actually increase allergy risk 2, 4, 5. The evidence from the LEAP trial and subsequent epidemiological data from Israel (where early peanut consumption is common and peanut allergy is rare) strongly supports early introduction 1.

If you miss the 4-6 month window, infants can still benefit from peanut introduction up to 11 months of age, though older age at screening is associated with higher likelihood of established allergy 1.

Breastfeeding Compatibility

Continue breastfeeding while introducing peanut—data from the LEAP study demonstrates that peanut introduction does not affect breastfeeding duration, frequency, infant growth, or nutrition 1, 3. This recommendation aligns with exclusive breastfeeding guidelines through 6 months 1.

Common Pitfall to Avoid

The most significant error is delaying allergenic food introduction based on outdated 2000 guidelines—these recommendations were reversed in 2008 and definitively contradicted by the 2017 NIAID guidelines based on Level 1 evidence 5. Current evidence unequivocally supports early rather than delayed introduction for allergy prevention 4, 5.