Katie Ferraro (1s):

So for doing almonds as the way to introduce the baby to tree nut protein, the thinned out almond butter approach or almond flour and unsweetened baked goods that's a much better bet than almond milk, which almost has no almond protein in it. Hey there, I'm Katie Ferraro, Registered Dietitian, college nutrition professor, and mama of seven specializing in baby led weaning. Here on the Baby-Led Weaning Made Easy podcast I help you strip out all of the noise and nonsense about feeding, leaving you with the competence and knowledge you need to give your baby a safe start to solid foods using baby led weaning.

Katie Ferraro (40s):

Hey Guys! Welcome back to another episode of the baby led weaning made easy podcast. Today. We're talking all about tree nuts. How to introduce your baby to this potentially allergenic food. Now tree nuts are one of the big eight allergenic food categories. The big eight foods. Those are the foods that account for about 90% of food allergy. So tree nuts are a food that we want to feed our baby early and often, but we need to do so safely. So that's what we're going to cover in today's episode. And as I do in every episode, I want to start you out with a baby led weaning tip of the day for tree nuts. When it comes to feeding your baby intact, nuts and thick globs of nut butters can be a choking hazard and they should not be fed to babies, especially early on in baby led weaning, but hang tight because there are some safe ways to feed your baby food forms of tree nuts.

Katie Ferraro (1m 35s):

And they explained to you how to do that in this episode. And I'm also going to talk about why almond milk is not an ideal way to introduce your baby to tree nut protein. So let's go ahead and get started talking all about tree nuts and how to introduce your baby to this potentially allergenic food. Now I mentioned tree nuts are one of the big eight allergenic foods, but it's not the most prevalent of the food allergies by any stretch of the imagination. There's an rough estimate that somewhere between a half of a percent and 1% of the us population has a tree nut allergy. And it's one of the ones that tends to be a lifelong allergy. So some references say 9% others say 10% of kids with tree nut allergy will eventually outgrow it, but that leaves 90 or 91% of the children for whom it's going to be a lifelong allergy.

Katie Ferraro (2m 20s):

And if you're allergic to one type of tree nut, it means you're at higher risk of being allergic to the others, but you won't necessarily be allergic to them. So for example, some of the tree nut allergies are closely related. If you have a cashew allergy, you tend to also have a pistachio allergy. So cashews and pistachios are linked and also pecans and walnuts are linked. So if you have pecan allergy, you're more likely to have a walnut allergy and vice versa. I don't know if you guys remember the mom, Meg Mason from episode 34. That was the episode where we talked about using a dairy ladder for milk introduction. Well that mom, Meg, her daughter, Camila has a number of different food allergies and she's allergic to some tree nuts, but not all. So Meg was telling me that Camila does have an allergy to cashews and pistachios because those two are linked, but she does not have an allergy to almonds.

Katie Ferraro (3m 7s):

So the mom will spread a thin layer of almond butter on pancakes or toast, or she'll mix it into oatmeal. We'll talk about why that's safe for an older baby in a second. But her daughter, Camille has recently turned one. So that's okay for older babies, that daughter Camila, interestingly enough, she's also allergic to peanuts. Now we think of peanuts. We think, oh, that's a nuts, but peanuts are actually in a different category. Peanuts are legumes, but there is a high risk for people with tree nut allergy or because of the cross contamination, even though peanuts, which are legumes and tree nuts, which are nuts, are not botanically related. If you have a tree nut allergy, you are at higher risk for having a peanut allergy and vice versa, about 30% of people with peanut allergy will be allergic to tree nuts.

Katie Ferraro (3m 47s):

But again, just because you have one doesn't necessarily mean you'll have the other. Okay. And then having another sibling. So many times parents like we'll have an older child who has a tree nut allergy that does elevate the risk for the baby to have a tree nut allergy. But again, of course, it's not certain that the baby will have that. So if you keep hearing tree nut tree nut, and you're like, what is that? I haven't heard the term tree nuts, not surprisingly grow on trees. Okay. Peanuts grow under the ground. They're legumes. Some of the tree nuts. You might commonly recognize that a person may be allergic to. But again, this is not one of the most prevalent food allergies that include things like almonds, Brazil, nuts, cashews, chestnuts, pecans, pistachios, prey, liens, walnuts. There's a few other ones. And then there's kind of some areas where parents sometimes question, well, what about seeds?

Katie Ferraro (4m 29s):

Are they in the same family? Generally seeds are not a problem. You certainly can be allergic to seeds, but most people who have tree nut allergy can usually safely eat things like Sesame seeds and sunflower and pumpkin seeds, macadamia nuts, and pine nuts. Botanically, they're also seeds. The FDA lists some of these foods as tree nuts, but generally people with tree nut can tolerate things like macadamia and pine nut. And then people always ask about coconut. So in 2006, the FDA listed it as a tree nut, but you should know that very minimal number of people who have tree nut allergies are actually allergic to coconut and you can be allergic to coconut, but it's much more rare. Okay? And then some other things that sometimes get confused as tree nuts that certainly have nothing to do with tree nuts or things like nutmeg, the spice, which we use to season, for example, cooked or roasted carrots for your baby.

Katie Ferraro (5m 14s):

You can sprinkle nutmeg on there. You're not exposing them to the tree nut protein, water, chestnut, butternut squash, shea nuts. All of these things are not problematic. They're not trained nuts. They're not potentially allergenic. So when it comes to introducing tree nuts, at what age should we do that? Well, if you look at the research, we see that if a baby or person is going to be allergic to tree nut will generally present by the time the baby is two back in 2000. Okay. If we look at older guidelines, the American academy of Pediatrics suggested delaying the introduction of highly allergenic foods, including tree nuts until babies were three years old. Okay. That was 20 years ago in 2008, the AAP amended their statement to affirm that there's really no evidence to suggest that delaying the introduction of any allergenic foods had a significant protective effect.

Katie Ferraro (5m 59s):

So as a result, we've kind of switched gears because there's no evidence that waiting prevents allergy. We now look at, okay, let's introduce earlier because for other certain allergen that appears to be protected. Okay? So whether adding tree nuts early actually prevents food allergy development to tree nuts, it's unknown. But if we look at the leap study that was learning early about peanut allergy leap showed that in high risk infants, the early introduction of peanuts compared to avoiding it was actually protective of peanut allergy. So it's not known if a similar approach to tree nuts is protective, but it's a theoretical possibility.

Katie Ferraro (6m 39s):

And if you look at the study, sometimes it's frustrating. We'll say things like research, additional research is needed, or studies are needed to determine whether an early feeding prevention approach is safe and effective. What we're concerned about is safety, right? Because we're concerned that whole nuts are a choking hazard and nut butters are too difficult for babies to clear from their palette. So we need to find a safer way to introduce tree nuts. And how can you do that? I have two ways that I like to introduce tree nuts to babies. One of my favorite ways is to do Almond flour. Almond flour is just really, really, really, really finely ground up almonds. You could take your own almonds and make almond flour, but I prefer to buy the super fine one, especially earlier on it's a much, much smoother grain, which is easier for babies to eat.

Katie Ferraro (7m 21s):

So you can buy almond flour. Two tablespoons of almond flour has about four grams of protein. Okay? So you can bake it into no added sugar or low sodium muffins or pancakes. And actually the mom I was telling you about Meg Mason, who has the daughter with the dairy intolerance and the different food allergies, but some tree nuts. She's not allergic to she's sharing a great almond flour pancake recipe that she created using a number of different recipes that she likes, but no added sugar and no sodium. If you go to the show notes page for this episode, I will link to Meg's almond flour pancake recipe. In case you want to use that to try out tree nut protein in the form of almond flour for your baby to get to that recipe, go to the show notes page for this episode, which is blwpodcast.com/39.

Katie Ferraro (8m 9s):

They're all link up some of the different research about, and the different articles and the references that I talk about in this episode, I'm also sharing a link on that show notes page. If you want to sign up for my free online baby led weaning workshop, it's all about how to introduce your baby to a hundred different foods before turning one, without you having to spoon-feed purees or buy pouches. So if you want to get the free online baby led weaning workshop, I also talk a lot more about Allergan introduction in that you can sign up for that as well as grab that almond flour pancake recipe. Again, that URL is blwpodcast.com/39. So almond flour is one way that I like to introduce almonds safely or drain it.

Katie Ferraro (8m 51s):

Another one is you can do almond butter. Now I mentioned at the top of the podcast, that thick gloves of nut butter are more challenging for early eaters to clear from their mouth and palette. And it can potentially pose a choking hazard, but you can thin out almond butter. You always want to do the all natural, no added sugar. You don't want to do chunky nut butters ever make sure it's smooth, but you can take a food. For example, unsweetened applesauce and thin out the almond butter. That way you can also mix it with formula or breast milk to thin it out. That way you can preload it on a spoon, pass that spoon to the baby and allow the baby to sell feed. Or you can then out the almond butter with yogurt. my Yogurt of course has dairy in it.

Katie Ferraro (9m 31s):

So it's milk protein. You want to make sure your baby's already been introduced to that. You don't do two new allergenic foods together, right? If you did almond butter for the first time and yogurt for the first time and the baby had an reaction, how would you know which allergenic food it was? So make sure you've already done yogurt once your baby's good on yogurt. After trying for a few times with no reaction, you can mix the almond butter into full fat that's whole milk, unsweetened yogurt, and thin it out that way. Again, put it on this boon and pass the spoon to the baby. The spoons that I like to use for baby led weaning, it's called the tiny spoon. It's from a company called ezpz. So if you go to the website ezpzfun.com, the tiny spoon is designed by a feeding specialist for babies age six to twelve months of age, you can get 10% off all of the feeding gear on that site.

Katie Ferraro (10m 16s):

If you use the code Katie10, again, that's ezpzfun.com and check out their tiny spoons as a great way to help facilitate independent eating. When you're doing naturally pureed foods like almond butter, mixed with applesauce or almond butter and mixed with yogurt. Again, if that almond butter is thinned out, great ways to introduce your baby to almond protein or tree nut protein. Rather people say, well, how much should my baby have? Like how many grams of this protein do we need to get to have it count essentially as an exposure? And just so you guys know that answer is not known. The guidance is to introduce these foods early, but there's no specific number of grams or number of times you need to do it. So I like to do the new allergenic food on a Friday.

Katie Ferraro (10m 59s):

I do five new foods per week in my five step feeding framework on Monday and do a new fruit Tuesday, a vegetable Wednesday, a starch Thursday, a protein. And on Friday I do a challenge. Food challenge. Food category includes the big eight allergenic foods of which tree nuts are one. So let's say it's the fourth or fifth week of baby led weaning. It's Friday time to do our allergenic food. Oh, tree nuts are up. Let's do do almonds with almond flour. You make the almond flour pancake from Meg, and you're going to feed it to your baby, do it on Friday, do it twice on Saturday and offer a different form of tree nut on Sunday. If you can do it two times each day, Friday, Saturday, Sunday, there you have six exposures. Don't do any other new foods over that period of time.

Katie Ferraro (11m 41s):

You're building in a pad of two or three days to observe for any potential reaction. And then on Monday, you can go right back to introducing a new food. Another fruit. It is perfectly safe to introduce one new low risk food per day. Okay? The low risk foods are all the other foods in the a hundred first foods program that are not the allergenic foods, but when it comes to the allergenic foods, yes, you do want to build in a little pad to observe for reaction. If you want to learn more about that five step feeding framework. Again, my free online workshop, baby led weaning for beginners has everything you need to know about how to set your baby up on this routine, where you're introducing a hundred foods before the baby turns one. And you can sign up for that free workshop at blwpodcast.com/39.

Katie Ferraro (12m 26s):

All right. So if you look at the comparison, people say, well, what's better than almond flour, almond butter, almond flour. Two tablespoons has four grams of protein, almond butter. One tablespoon has about three and a half grams. So a smaller portion size, but then again, you're going to be thinning it out. They're probably comparable. I like to do both of them over the course of that weekend. A few times, a few different ways. And again, always observing for reaction. Now what about almond milk? Now? Almond milk is not a great way to introduce almond protein to your baby. People be like what? I thought it was just like squished up almonds. It's not, if you actually look at the nutritional facts or the components of almond milk, even though almonds are considered to be a relatively high protein food, right?

Katie Ferraro (13m 7s):

Plant protein in nuts, all almond milk, almost all of the protein has been removed. Okay. You have an eight ounce cup of almond milk. You only have one gram of protein. Remember in two tablespoons of almond flour, one tablespoon of almond butter, you have almost four grams, very small amount, lots of protein, almond milk, lots of volume, which babies can't drink an eight ounce cup of almond milk. Anyway, for the most part, only one gram of protein, not worth your time. All right, so don't waste your time on almond milk because there's very little protein in there to begin with and stick to almond flour or almond butter. All right. Now, what if you suspect an allergy, observe an allergy? It is important to know that there are tree nut specific skin tests, as well as serum immunoglobulin E levels, which can help diagnose tree nut allergy.

Katie Ferraro (13m 52s):

So you'd need to, you talked to your pediatrician or your pediatric allergist about testing for, and getting a diagnosis for tree nut allergies. And of course, tree nut allergy is very severe peanuts plus tree nuts account for about 70 to 90% of reported food-related anaphylactic. So if there is a true tree nut allergy, this is something very serious. Okay. And for those that have a confirmed allergy epinephrin is the first line treatment for anaphylaxis. It has to be administered promptly. And in the case of anaphylaxis, you do that with an epinephrine auto-injector. So this is something that if your baby is to be diagnosed with food allergy, you would need additional education and information about to ensure that you're offering your baby, the other potentially allergenic foods safely and safely avoiding the foods that your baby is allergic to.

Katie Ferraro (14m 40s):

But remember, tree nut allergy only affects about a half to 1% of the population. All right? So it is a food that the good majority of you will want to be introducing to your baby. And I hope that this was helpful in showing you a number of different ways of how you can safely introduce tree nuts, a potentially allergenic food for your baby. Again, all of the links and references, as well as that almond flour recipe and how to sign up for the free baby led weaning workshop. They're all linked up for you on the show notes for this episode at blwpodcast.com/39. Thanks for listening. Bye now!