Tree nuts: do I have to offer all of them or is one enough?

Katie Ferraro (0s):

Making this a podcast for you is one of the most enjoyable things I do every week. We have over 400 episodes at this point and I know you have a lot of options when it comes to parenting content. And I wanna say thank you for being here to learn about Baby Led Weaning with me. I have a quick request I wanted to ask if you found any information on this show, either useful or educational or even remotely entertaining, would you please leave a written review of this show for me on Apple Podcasts? And since I know you're a podcast person, you might also be an AirPods person. Right now I'm doing a giveaway where you can win one of two sets of Apple AirPods Pros just for leaving a review on Apple Podcasts. So if you leave a review of the Baby Led Weaning with Katie Ferraro podcast, now through Friday, January 26th, you are entered to win one of the two sets of AirPods Pros.

Katie Ferraro (48s):

Just be sure to include your Instagram handle name in your review so I can find you and dm you when you win. This giveaway is not sponsored or endorsed by Apple and the contest is open to U.S. listeners only. The giveaway ends Friday, January 26th and if you've previously left a review you can update it and that counts as an entry. I personally read every single review and honestly some of the best episode topics I've done are suggestions that you leave in the reviews. So please put that in there too. If you have an idea of a future topic you want me to cover, your honest reviews are so important for helping this show get found by other parents and caregivers who want to learn about baby led weaning and how to do it safely. And thank you again for your feedback.

Katie Ferraro (1m 28s):

It's honestly the only tool I have to improve the show based exactly on what listeners want to hear. So happy feeding and I look forward to reading your reviews. Thanks so much for listening. So I have a baby led weaning cabinet in my kitchen. It's where I store all of the feeding gear that we use for work. It's a 100% EZPZ and actually some of the EZPZ suction mats and bowls in there are more than seven years old at this point. Still going strong. I know you guys already have a lot of baby gear in your house, but when it comes to feeding gear, the EZPZ products are beyond compare. Everything EZPZ makes is designed by their infant feeding expert. She also happens to be my good friend and colleague, Don Winkleman. She specializes in baby led weaning and we were just chatting that the tiny cup that she designed for EZPZ , which was the first ever baby led weaning cup, it's now five years old.

Katie Ferraro (2m 14s):

She sent us a prototype to try out with our twins when they were doing their 100 First Foods and now it's won all sorts of awards and their feeding line has expanded so much. I love that when we start babies on the tiny line of EZPZ feeding gear, they're getting developmentally appropriate tools to help them succeed at self feeding. So when your baby turns one you size up to the mini line for toddlers, then it's into their happy line for bigger kids, EZPZ has a new basics line. I mean like their, their website's so big now, like we've been using that one for our own kids right now. Don designed all of those products and it's been so fun to see our family grow kind of in line with the growth of the EZPZ feeding line. They're also going backwards though because they are revolutionizing the pre-feeding space. So even if your baby hasn't started solid foods yet, there are some great pre-feeding tools that EZPZ is now making.

Katie Ferraro (2m 59s):

You can check it all out at ezpzfun.com. My affiliate discount code for EZPZ is KATIE10. I think that code is like seven years old too. At this point. I love using the EZPZ products in my house for my own kids as well as the babies that I work with in my infant feeding practice and that I hope the EZPZ gear is as helpful to your family as it has been to mine. That code, again is KATIE10 for all of the fabulous feeding gear over at ezpzfun.com. So if your baby is diagnosed with a tree nut allergy and you've got a full-blown confirmed tree nut allergy in your baby, yes it is very likely that they're going to be allergenic to more than one tree nut. However, few babies will react to all tree nuts.

Katie Ferraro (3m 44s):

Hey there, I'm Katie Ferraro, Registered dietitian, college nutrition professor and mom 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 confidence and knowledge you need to give your baby a safe start to solid foods using baby led weaning. When it comes to tree nuts, there are a whole category of potentially allergenic foods and we know that early introduction can help reduce the risk of tree nut allergy down the road. But what's the deal? Do we need to do all of the tree nuts or is one enough? In this episode I'm gonna share a bit about tree nuts as a potentially allergenic food category.

Katie Ferraro (4m 26s):

Talk a bit about tree nut allergy prevalence, how we can prevent tree nut allergy by introducing them to your baby early and often. But what does that really mean and how do we do it safely? And whether or not we do them all at once or one at a time. And then if you really have to do all 18 tree nuts separately in order to rule out tree nut allergy, now I like to start these solo mini baby led weaning training episodes with a baby led weaning tip of the day. And when it comes to the first introduction of tree nuts for your baby, my tip is to avoid mixed nut butters. So there's these nut butters that you can buy that are a combination of a variety of different tree nuts and they're wonderful and delicious. My favorite one from Trader Joe's just got discontinued and I'm still very sad about it.

Katie Ferraro (5m 7s):

But when it comes to your baby, we want to do an isolated tree nut introduction for the first time. So the reason why we don't want to do a multitude of tree nuts together is that if your baby were to have an allergenic reaction, and we've done lots of content on the podcast about what you do if your baby has an allergenic reaction to food, but if they did and you had just introduced like six different tree nuts at once, how would you know which tree nut your baby is Allergenic to? Now we'll talk a little bit about how allergies for tree nuts work. And if your baby is allergenic to one tree nut, they're certainly at slightly higher risk for allergies to other tree nuts, but it does not necessarily mean that they would be allergenic to all of them. So once you identify that your child does have what appears to be true food allergy, you need to of course follow up with your primary care provider who will then hopefully refer you to a pediatric allergist so that you can get food allergy testing.

Katie Ferraro (5m 55s):

And we're gonna talk a little bit about food allergy testing as well in this episode. So hang tight 'cause there are benefits to doing a variety of tree nuts. I'm gonna teach you exactly how to thin out tree nut butters, but I also wanna give you a less labor intense option. So you can check tree nut off of your a 100 First Foods list and safely introduce this potentially allergenic food to your baby. So what are tree nuts? In the United States, there are 18 different tree nuts, and in some resources you'll see that only about half of them are responsible for the vast majority of reactions. The Food Allergy Research education group fair@foodallergy.org, they say that the six tree nut allergies that are most commonly reported by children and adults are allergies to walnut, almond, hazelnut, pecan, cashew, and pistachio.

Katie Ferraro (6m 40s):

Now about half of kids who are allergenic to one tree nut are also going to be allergenic to another tree nut. And another interesting thing about tree nuts is that they kind of cluster together. So most patients, again, who have a tree nut allergy are gonna be allergenic to more than one, but few of them will react to all of the tree nuts. Then there's strongest correlations between cross sensitivity and cross reactivity between if we look at like cashew and pistachio and walnut and pecan. So I always think of like the shoe, like pistachio and cashew. Those two are linked. So if you're allergenic to one, you're much more likely to be allergenic to the other. And then walnut and pecan are also linked as well.

Katie Ferraro (7m 20s):

Now in the United States, you know if you're encountering these ingredients because plain language labeling on packaged foods is required, it's now required for 18 different tree nuts. And I want you to also know that tree nuts are separate from peanuts. So we talk about peanut allergy very separately from tree nuts. Peanuts are a legume. So from a botanical standpoint they're different. And from an allergy standpoint they're different. Although it is true that children with peanut allergy are at slightly higher risk of having tree nut allergy and vice versa, although it does not put your baby in the high risk category to have a tree nut allergy if they already have a peanut allergy. And I'll give you an example of a baby, Braden that I worked with a little while back. She had a egg allergy, the baby had a severe eczema.

Katie Ferraro (8m 1s):

So when we went to trial peanut, I was like, Hey mom, who is my friend? Very high risk that your baby's gonna have an allergenic reaction. She's like, yeah, but the doctor said do it at home and if there's allergenic reaction, we'll deal with it. Exactly. So the only way to know if your baby's allergenic to a food is to offer them that food. We did baby peanut butter puffs. Sure enough, the baby had an allergenic reaction. We went through all of the requisite steps, she followed up, got testing, et cetera, but the recommendation was for her to try tree nut at home. And the mom was like, I'm super scared to do this at home. Like, okay, I'll help you, we'll do it together. We did tree nut together for at home introduction a number of times with no signs of tree nut allergy. And I'll tell you, it made that mom feel so much more confident in her ability to try other allergenic foods when she saw, 'cause this is a baby who'd already had egg allergy, already had had peanut allergy and had questionable cow's milk allergy.

Katie Ferraro (8m 45s):

And the mom's like, I don't wanna do any of these allergenic foods. I'm so scared. Once we passed tree nut, she was like, oh, maybe my baby is not gonna be allergenic to all of these other foods. And in fact, the baby was not. We did all of the rest of the Big 9 Allergenic Foods. Yes, she did have some food allergies, she still has them as a toddler, but tree nut was not one of them. Hey, we're gonna take a quick break, but I'll be right back.

Katie Ferraro (10m 27s):

Now, do you need to offer all of the tree nuts? Okay, so a lot of times parents will say, should I trial all of these tree nuts separately? Should I do it early and often and keep like detailed records of which tree nut we've done and whether or not the baby reacted? And my simple answer is no, that is not necessary. Okay, if we're looking at the typical population, the vast majority of you out there who are listening, the risk of your baby having a reaction to any tree nut or frankly any food is very low. And as I've said, I think no less than three times already, the only way to know if your baby is allergenic to a food is to actually offer them that food. Now if for some underlying medical clinical reason, your baby is suspected to be at high risk for tree nut allergy, although that criteria has not been very well established, there are certain instances where you might be advised to do it under the guidance of your own healthcare provider.

Katie Ferraro (11m 15s):

But the vast majority of you will be advised to do home introduction of tree nut, just like with the other allergenic foods. And sometimes parents are like, well, I'm just gonna go get tested for tree nut 'cause that's how I'm gonna figure out if the baby's allergenic or not. Please know that it's thought that about 50% of positive food allergy test results are false positives. So just because you get a positive food allergy test result, it certainly does not mean that your baby is allergenic to that food. If you have a reaction to the tree nut, then you would want to pursue testing. But we don't start out with testing. And if you'd like to learn more about the high rates of false positive food allergy test results, I want you to listen to episode 125. It's called "Why are False Positive Results in Food Allergy Testing So Common?"

Katie Ferraro (11m 56s):

And that's an interview with Dr. David Skuas. He's one of the world's leading pediatric food allergy experts and he explains it in a very straightforward way. Now, what sort of research or data is there on early introduction of tree nuts? Oftentimes you'll see the Health Nuts study cited. This is a long-term ongoing study of food allergy. It involves over 5,000 children in Australia and it's one of the most robust studies about early introduction of tree nut. And so results showed initial results that about 3.6% of infants who did not eat cashew until age one or later. So one year or later they developed cashew allergy by age six, but not one infant in the study who ate cashew before age one had cashew allergy at six years.

Katie Ferraro (12m 40s):

Okay? This is not a randomized control study like the LEAP trial, the one that established the really good data about peanut allergy. Randomized control studies are the gold standard of studies, but the results are quite strong and very promising. And we know and researchers know and practitioners will tell you there are absolutely no reasons to withhold the introduction of foods like tree nuts to your baby. Can you offer all of the tree nuts to your baby? Yes, certainly you can. Do you need to do all of them. If your baby doesn't have food allergies and you've passed one or two or three of the tree nuts without any sign of allergenic reaction, you've tried them a number of times and that's important. 'cause we don't just do, it's not a one and done thing, right? You don't just do cashews once and you're like, oh, they're not allergenic.

Katie Ferraro (13m 20s):

Because if the baby is going to have an allergenic reaction, it will very likely occur on the second or subsequent introduction. So do it a number of times. But let's say I know for the parents that are in my Baby Led Weaning with Katie Ferraro program, we really focus on almond. It's a really easy one to do. We can do it in a number of different ways and I'll share some ideas with you in just a moment. But when they passed almond they've done in a number of times. We'll generally say go and do one or two of the other tree nuts and here's a list of them. But if your baby hasn't had an allergenic reaction to one or a couple of these tree Nuts, they're very unlikely to have allergenic reactions down the road. Now, can food allergies manifest and show up later in life in adulthood? Yes, certainly. So is it a good idea to keep a variety of tree nuts in the diet?

Katie Ferraro (14m 0s):

Heck yeah. If it works with your food culture or the foods that your family likes to eat, go for it. But do you need to be taking detailed, meticulous notes? If your baby is not under treatment for food allergy maintenance or management currently, then no, that's certainly unnecessary. Now, how do you safely prepare tree nuts when it comes to safely feeding babies tree nuts, we use pretty much the same premise that we do for thinning out peanut butter. Okay, so peanut butter is very widely accessible around the world, but thick globs of nut butters like peanut butter or cashew butter or almond butter, those are a choking hazard for your baby. And we also need to avoid any raw, hard, crunchy, sticky foods. So we don't do thick globs of nut butter, but there are definitely safe ways to do nut butters.

Katie Ferraro (14m 41s):

And one of them is to thin out the nut butter. So you can take plain, unsweetened, unsalted almond butter, you can mix it with breast milk formula yogurt if your baby's already passed cow's milk protein without any allergenic allergenic reaction. You could also mix it with unsweetened applesauce. You get it nice and thin. I usually use a whisk, it doesn't work great with a spoon. Get it with a whisk until it's nice and thin and then put your adult stainless steel spoon in there. If it slides off the stainless steel spoon, that means that it's thin enough to not get lodged on the roof or the size of your baby's mouth. Now you can also do flour. Almond flour is another very widely available, albeit fairly expensive source of protein. Okay? We don't do the thick globs of nut butter, we don't wanna do intact almonds, but you could get a tree nut flour like almond flour.

Katie Ferraro (15m 23s):

And almond flour is basically ground up blanched almonds. So almonds are blanched to remove the skin and then they're ground up to a very fine texture that you can use in baking. You could make your own almond flour at home, but I kind of recommend against this 'cause there's a fine line between making a fine ground nut flour and then the next stage where it turns immediately into a paste, which of course is sticky and therefore not safe for your baby. So unless you are a proficient nut flour maker, I just suggest buying almond flour at your store. I get super fine or extra fine, kind of preferred to over the course of flowers, the super fine or extra fine, ultimately the safest, really soft goes well into baked goods. I get my almond flour mostly online from Bob's Red Mill. Not sponsored by any means, it's just widely available. They have a good selection of whole grains and legumes.

Katie Ferraro (16m 5s):

They have a lot of the different allergenic foods as well as the whole grains that are on my 100 First Foods list. So I get their super fine almond flour. You wanna store your almond flour in the refrigerator in order to maintain its optimal freshness and nutrition. It is a high fat flour and anything with fat in it is going to go rancid more quickly than a non-fat product. Almond flour is certainly very popular and like low carb keto communities, that's fine, but we're not using almond flour as a way to like reduce carbohydrates. Rather we're using it as a way to introduce babies to tree nuts. And so if you're baking with it, it's not a direct substitute for all purpose flour. You can generally do up to about a quarter of the flour for almond flour. Okay? And a lot of the baked goods out there are gonna be too high in salt. Contain added sugars, which we don't feed to babies inside of my program.

Katie Ferraro (16m 45s):

I know our parents are usually making almond flour pancakes. We've got a recipe for that in our 100 First Foods daily meal plan. We also have a mini muffin almond flour recipe, which parents love as a way to also introduce almonds to their baby. You can do the nut butters, as I mentioned, thinning them out. Sometimes parents asked about crush nuts. Theoretically, you could crush up tree nuts until they're very fine, but it's still very likely that there will be pieces that could be harder, crunchy and therefore potentially of choking hazards. So we want to stay away from them. Hey, we're gonna take a quick break, but I'll be right back.

Katie Ferraro (18m 46s):

One of my favorite ways to do almonds for babies is with Almond Puffs. So baby Almond Puffs, I like the brand Puff Works, so they make a peanut only product and I use that for the introduction of peanut. And then once your baby has passed peanut no signs of allergenic reaction, then later on I'll do the other allergenic food almond using their almond puffs. So they're called Puff Works Baby Almond Puffs. And the almond product also has peanut in it. So you don't do it first before peanut. You gotta do the peanut first, make sure there's no peanut allergy and then you're reintroducing peanut while at the same time introducing almond. And that's totally fine 'cause you know your baby's not allergenic to peanut 'cause you've already done it in a number of times without reaction. Now it's okay to do the almond and I love this product because it's a very, very safe size for baby led weaning.

Katie Ferraro (19m 29s):

They kind of look like, well they taste like stale almond Cheetos without the amazing Cheeto Crunch, but they're nice and soft and they dissolve so easily on your baby's tongue. So these are safe for your babies to do even before they have teeth. Again, the brand is called Puff Works and if you wanna check them out online, they're at puffworks.com. I have an affiliate discount code BABYLED, and I think that gets you 15% off of the peanut baby puffs and the Almond baby puffs. Just make sure you're getting the ones that are called the baby puffs 'cause those are the ones that have no added sugar in just a small amount of salt. So if you wanna check out some of the tree nut recipes that I talked about, they're all inside of my program. Baby Led Weaning with Katie Ferraro, you can sign up for that at babyledweaning.co/program. If you're in there and you're counting all of your tree nuts more power to you.

Katie Ferraro (20m 12s):

If you just do a couple of 'em and get through 'em with no reaction, that's perfectly fine as well. Don't forget not to start with a combination nut butter, but down the road if you wanna knock out a bunch of 'em and you almost certain your baby's not allergenic to tree nuts. 'cause if you've done it a bunch of times, one of those mixed nut butters, if you can find one without added sugar or salt is perfectly fine. But again, not advisable for your first introduction of tree nut to your baby. I'll put all of the links for today's episode in the Shownotes, which you can find at https://blwpodcast.com/episodes/403. A special thank you to our partners at AirWave Media. If you like podcasts that feature food and science and using your brain, check out some of the podcasts from AirWave Media. We're online at BLWpodcast.com. Thanks so much for listening and I'll see you next time.

Katie Ferraro (21m 2s):

Like a lot of mobs out there, I will totally admit I am quite Type A. I am a total task master and one of my weekly work tasks is to review the feedback forms that are new students in my program, which is called Baby Led Weaning with Katie Ferraro that they leave for us. So basically this form asks a lot of questions about you and your baby and your baby's feeding and medical history and concerns that you might have or fears about starting solid foods. And all of this data helps me when I'm answering parent questions inside of our weekly live office hours so I can then tailor my response to your particular baby and situation, right? Because it's not a one size fits all approach when it comes to what your baby's eating, right? Because maybe your baby has an egg allergy or another mom in the program.

Katie Ferraro (21m 43s):

She might really be struggling with how to make meat safe 'cause she doesn't like to cook. So this week on the form, there's a new mom named Janine and she wrote, and this is her quote, "I researched a lot on the internet and I have a lot of books. I saw a lot of other baby led weaning programs, but in the end, this is the one that I realized is what I'm really looking for as a new mom. I love that Katie's program has a community and that there are videos for everything you need to know and how to make the foods. And what I love the most is that there's already a meal plan ready". And this just like stopped my heart because this is exactly why I created the Baby Led Weaning with Katie Ferraro program. I wanted to literally put everything that you need to know about starting solid foods safely in one place with a super easy to follow 20 full weeks meal plan.

Katie Ferraro (22m 30s):

Okay, there's 20 weeks 'cause it's five foods a week. I want your baby to get to those a 100 new foods before they turn one. 'cause I also know you have lot going on as a new mom and hunting and pecking all over the internet to try to figure out what am I gonna feed this baby that is not the solution. So if you want to check out the Baby Led Weaning with Katie Ferraro program, I would be honored to work with you and your baby. You can head to babyledweaning.co to get started and hopefully I'll be reading your feedback soon too.