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Peanut Consumption in Infancy Could Prevent Peanut Allergies, Study Finds (article)


Chicago Health Magazine, online article

Peanut Consumption in Infancy Could Prevent Peanut Allergies, Study Finds

By Heidi Kiec

When it comes to preventing a peanut allergy, it might be best to fight fire with fire. Most young children at high risk of developing a peanut allergy may be able to ward off the allergy by consuming peanut protein starting in infancy, according to the results of a recent study.

Peanut allergy is one of the most common food allergies for children, and it is not usually outgrown. Affecting about 1 to 2 percent of American kids, the allergy is the leading cause of anaphylaxis and death due to food allergy.

The study, published in the New England Journal of Medicine, came up with a very important finding for an at-risk population, notes Scott Sicherer, MD, the immediate past chair of the American Academy of Pediatrics (AAP) Section on Allergy and Immunology.

“The conclusion is that there’s enough evidence to seriously consider earlier feeding of peanut protein in infants who fulfill the (high-risk) criteria,” Sicherer says.

The study, conducted in London by Gideon Lack, MB, BCh, observed participants aged 4 to 11 months old and already deemed high risk for developing a peanut allergy, based on an existing egg allergy, severe eczema or both. At the start of the study, 530 infants tested negative for peanut allergy, while 98 participants had a small allergy to peanuts. The participants were randomly assigned to either regularly consume a food containing peanut protein or to avoid peanuts entirely. These feeding patterns continued until the children turned 5 years old.

The half of the study consuming peanut products were fed at least six grams of peanut protein per week, the equivalent of about 24 peanuts, distributed over three or more meals. The recommended food for participants was Bamba, an Israeli puffed corn and peanut butter snack.

The participants who consumed peanut protein were far less likely to be allergic to peanuts at the age of 5. Of the children in the nonallergic group, only 1.9 percent of those fed peanuts had developed an allergy by the end of the study, compared with 13.7 percent of the children in the group avoiding peanuts. The numbers represent an 86 percent relative reduction in the prevalence of peanut allergy.

And among the participants who began the study with a small allergy, only 10.6 percent of those fed peanuts developed a full-fledged allergy by age 5, whereas 35.3 percent of those avoiding peanuts developed the allergy, representing a 70 percent relative reduction in the prevalence of peanut allergy.

Sicherer believes that this study can help change practice. He notes that prior to this study, the prevailing “knee-jerk reflex for infants who already ate egg and got hives was to avoid peanuts, but this is the complete opposite advice. It’s saying, if you have an egg allergy, I want you to eat peanuts to try [to] protect yourself from developing a peanut allergy, if you’re not already allergic.”

Sicherer warns that children in this study had undergone allergy testing to be sure starting peanut protein was done safely and explains that they ate mushy forms of it—similar to baby food—because whole peanuts and peanut butter are choking hazards to infants.

In 2000, the AAP released guidelines recommending that peanuts be withheld until the age of 3 from children at risk of developing the allergy. In 2008, those guidelines were rescinded, citing a lack of evidence that such delays prevent the development of allergies, but no official recommendation on when to introduce peanuts was put forward by the AAP.

Ruchi Gupta, MD, MPH, associate professor of pediatrics at Northwestern University Feinberg School of Medicine and author of The Food Allergy Experience, appreciates having “evidence that shows it could be beneficial if you introduce (peanuts) early. Pediatricians are already counseling families to introduce foods when they are comfortable. This data supports the potential benefit.

Gupta recommends that any parent who is nervous about introducing peanuts into their high-risk infant’s diet should visit an allergist and get proper testing before starting peanuts.

For parents weary of flip-flopping advice on such important health issues, Gupta considers the results “groundbreaking” and goes on to state, “It’s a very strong study and very well done. What it shows is something that most experts around the country will back. There is additional work to be done, but I don’t think these results will be revoked or changed anytime soon.”

Medical Must-Haves for Travel with Kids (Article)


Well Community was an online news magazine and discussion forum specifically focused on health and wellness in several North side of Chicago neighborhoods. It ceased publication in 2014.

Medical must-haves for travel with kids

A local pediatrician’s tips and basic first-aid supplies may be the most important items you pack for your family trips this summer.

By Heidi Lading
Well Community Contributor

Summer is officially here, along with the busy season for family vacations.

Unfortunately not every vacation will go as planned. Illnesses or injuries can come up, especially when traveling with babies and small children. But taking certain precautions can put your mind at ease and help ensure the most enjoyable vacation possible.

Dr. Nisha Vijay, a pediatrician at Swedish Covenant Hospital, knows first-hand what it’s like to watch a child suffer with illness while away from home. She traveled to India with her twins when they were just 18-months-old. During the trip both children developed diarrhea and started vomiting.

“It was very bad. The diarrhea was five or six times a day,” said Dr. Vijay.

She immediately replaced regular milk with soy milk, ceased any sugary drinks and gave them thickening foods like rice, bananas and toast. She also made sure they were drinking enough water to stay hydrated.

Soon the twins were back to normal.

Although Dr. Vijay’s training as a physician helped her know what to do, she explained that any parent can defuse a stressful health situation with just a few first-aid essentials and health-related travel tips.

First-aid essentials for every destination
No matter what kind of trip you have planned this summer, Dr. Vijay advises you bring the following:

  • Contact information for your pediatrician or family medicine physician
  • Immunization records and insurance information
  • Oral liquids: acetaminophen (it doesn’t have to be Tylenol), ibuprofen and Benadryl
  • Topical ointments: Benadryl cream and a one percent hydrocortisone cream
  • Antibiotics: any over the counter antibiotic, such as neomycin
  • Anti-fungal cream
  • Bug spray and sunscreen
  • Probiotics to regenerate good bacteria
  • Tweezers (for removing splinters or bee stingers), nail cutters and band-aids
  • If your child has severe allergies, make sure you have two EpiPens on hand
  • If your child has asthma, make sure you carry a nebulizer or an inhaler
  • If your child is currently on medication for seasonal allergies or anything else, make sure you have enough of it on hand, and bring along a refill too.
  • Lots of snacks and bottled water (you never know when you’ll be stranded)

Enjoyable air travel
Older kids know to swallow during take-off and landing to prevent ear pain, but for babies and toddlers Dr. Vijay recommends breast feeding, a bottle or sippy cup, or a pacifier during these moments.

“Something for them to chew or suck on will help with the ear pressure,” she said.

If you are worried the child will have difficulty being constrained to the seat during a long flight, she suggests giving them a dose of Benadryl before the trip. However, you should test this at home well in advance of the trip to see how the child reacts.

“Some kids have a paradoxical reaction to Benadryl and it makes them hyper,” Dr. Vijay said, adding that you should keep ibuprofen or Tylenol in your purse or carry-on in case the child develops a fever in flight.

All the medical precautions aside, her number one must-have for plane travel is lots and lots of kid-friendly snacks.

Open water adventures
If your vacation involves a cruise ship, Dr. Vijay said the most common ailment will likely be motion sickness.

“There’s not a whole lot of stuff you can do for the younger children, but make sure you have enough bags on hand or something to distract them.”

For kids old enough to have hard candy, sucking on a peppermint can help settle the stomach and mitigate nausea.

Memorable road-trips
The same motion sickness advice applies to car trips, but since the children don’t have the luxury of moving around the car, Dr. Vijay suggests taking frequent breaks so the kids can run around.

A reasonable amount of amusement
When it comes to amusement parks, bug spray and sunscreen are essential, along with taking appropriate naps and getting enough to eat. Dr. Vijay also warns about overdoing it.

“A toddler might not be ready for an eight-hour day at an amusement park,” she said. So try not to pack too much in to any one day.

A day at the beach
Parents should always keep an extra close eye on their children when water is involved. Dr. Vijay advises all children wear a personal flotation device and also ear plugs, to prevent ear infections.

She recommends that kids always rinse after coming out of the pool or beach because salt water and chlorine can irritate delicate skin.

Sunscreen and lots of liquids are critical when staying outdoors for extended periods.

The hills are alive
If camping or outdoor activities are planned in a wooded area, make sure your kids are well covered in clothes to reduce the amount of skin exposed to poison ivy, poison oak and insect bites.

Bug spray and sunscreen may be the most important items you bring on a camping or hiking trip.

International waters
“The most common thing you see with travel outside our country is gastroenteritis,” Dr. Vijay said, recommending that you always know exactly where food and water for your family is coming from.

When in doubt, drink bottled water.

Also, prior to leaving, check with your pediatrician or a travel clinic on vaccinations required for your international destination.

What to do when something goes wrong

Do find the nearest emergency room or urgent care facility and get there right away if something serious happens.

Do call your pediatrician or physician if you have a question or need a medication refilled.

Do stay calm and do your best to keep your child calm too.

When are kids old enough to travel?

  • The most difficult period for traveling is age nine months to four years. They get bored and are used to running around so it’s very difficult to restrain them in one place.
  • Kids start forming memories at age two and memories are prominent by age three. So if you are debating between a trip at age 2 or 3, it might be better to wait.
  • To prevent an outburst, make sure you have some kind of activity — like a coloring book or their favorite stuffed animal — at the ready. Anything they are used to and comforted by is best. And make sure you have enough breast milk or formula for infants.
  • To help children retain a favorite vacation memory, look over photos and souvenirs often when you get home and talk about what you liked best about your summer adventures.

Heidi Lading is a freelance writer in Chicago. She once experienced a horrible nosebleed during a family road trip to drop her brother off at Space Camp 400 miles from home. This was just a few weeks after having her tonsils and adenoids removed. It is not her favorite summer memory.

Tell me…what medical precautions do you take when traveling?

Preparing Kid #1 for Baby #2 (Article)

Learning how to be a big sibling

Well Community was an online news magazine and discussion forum specifically focused on health and wellness in several North side of Chicago neighborhoods. It ceased publication in 2014.

They asked me to observe a class, helping prepare young children to become big brothers and sisters, and then write an article about how to make this an easy transition for the children.

Here’s what I learned…

Preparing kid #1 for baby #2

Local experts provide tips on helping older children prepare for a new arrival


by Heidi Lading
Well Community Contributor

Nicoleta Molnar shows her 6-year old daughter Emma how to hold a baby at a recent event at Swedish Covenant Hospital. 

When Nicoleta Molnar and her husband told their only child Emma that she was going to be a big sister, they weren’t quite ready to take the exciting news public. The three-year-old had other plans.

Emma was so excited, she began announcing to the world, “Mama has a baby in her belly!”

“Our mistake was to tell her before we told anybody else,” said Molnar, laughing as she recalled her daughter’s enthusiasm.

Emma’s reaction reminded the Molnars that, although they have been through pregnancy, childbirth and new parenthood before, they now face a new challenge: preparing a child for a new baby brother or sister.

Parents often have questions about the right way to introduce older kids to a new baby and siblinghood.  Because every family and child is different, to tackle these questions Well Community called on the experts: local childbirth educator Kim Wilschek, RN, CCE, and family medicine physician Dr. Marina Claudio, both of Swedish Covenant Hospital.

When do I have the big sister talk?
There is a lot to do in the months and weeks before your new baby is due, but talking to your older kid (or kids) about the new baby and their role as a big brother or sister should be a priority during this time.

“It’s really important to make [the child] realize from the beginning that this is their baby too,” Wilschek said, noting that there is no “best” time for this.

Cameron and Linnea Johnson made the moment special for their daughters Gwen and Sonja, ages 5 and 3, by wrapping up some baby things and letting the two girls open the gifts to reveal they were going to be big sisters.

“It’s really less about the child’s age and more about their emotional maturity,” Wilschek said. “Certainly when they start seeing changes in their mom you need to have a discussion with them about what’s going on.”

What should I teach my child?
Involving your kids in the care for a new baby is the best way for them to feel important and useful as a big sibling.

Wilschek recently taught a “Big Brother / Big Sister” class at Swedish Covenant Hospital for expectant parents and their 3-8 year-olds, where kids could learn some of the basics of helping out with a new baby.

Nicoleta Molnar and Emma were in attendance. During the event Emma practiced holding a baby doll, learned to change a diaper and decorated a onesie for the new baby.

These activities, as well as learning to feed the baby, and play during tummy time, mimic healthy adult behaviors and can give an older sibling a sense of responsibility for the new baby.

What activities should I do with my child?
Keeping your child involved doesn’t require doing anything out of the ordinary.

“In fact, focus on the ordinary,” Dr. Claudio said, using regular doctor’s appointments as her favorite example. “The newborn’s doctor appointments should happen as a global family visit.”

She explained that during check-ups, the medical focus is on the baby, but the whole family can learn about each other. This is also an opportunity for the doctor to observe the family dynamic and better understand how to help if concerns arise.

Additionally, Wilschek and Dr. Claudio both recommend parents talk to the older sibling frequently about how the child is feeling.

“It’s surprising how much [children] open up when you ask them what they think,” said Wilschek.

What if my child isn’t excited about being a big sibling?
“We know that kids change their minds—a lot,” Wilschek said. She advises parents to back off the issue if the child isn’t excited about the new baby and reintroduce the topic a little later.

Gwen and Sonja’s reaction to baby sister Naomi, 10 months, was “one of true love and acceptance into the family,” Johnson said, “But the novelty of having her around quickly wore off.”

Originally Gwen, had an interest in holding and trying to nurture the baby, while Sonja showed no interest. Today, their levels of interest and involvement have flipped.

If a child seems upset by the idea of a sibling, Dr. Claudio recommends addressing any negative feelings immediately so they do not escalate. She recommends reassuring the older child and keeping them involved so they understand that this change is a good thing.

If more serious concerns come up (like hitting or biting from the older child), Dr. Claudio urges families to discuss this with their family doctor immediately, as they will likely have ideas and resources that may help.

A few ideas and activities to smooth the transition for kids:
• Gifts 
— Let your child pick a special present for the baby that’s just from him/her.
• Read — Pick one or two of the many “I’m-going-to-be-a-big-brother/sister” books, and read them with your child
• Record — If your child is old enough, help him or her record themselves reading a favorite book to the new baby
• Help — Allow your child to help set up the nursery and offer suggestions for the baby’s name
• Bring — Siblings-to-be should tag along on your prenatal doctor’s appointments so they can learn what’s happening with the baby

Heidi Lading is a freelance writer in Chicago and the youngest of three children. Her older brother once dressed her up in football pads and used her as a tackling dummy. Occasionally she was allowed into her older sister’s room to play with her sister’s Barbie dolls.

Photo credit to Heidi Lading.