American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Advisory: Do Not Feed Peanuts to Infants and Young Children at Risk for Peanut Allergy

In response to recent news coverage of a scientific article published February 26, 2015, in the New England Journal of Medicine,1 “Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy,” the Advisory Council for Otolaryngology – Head and Neck Surgery, and the Advisory Council for Pediatric Surgery of the American College of Surgeons have released the following infant and child safety comments on feeding infants and young children peanuts.

Pediatric otolaryngologists and surgeons are concerned with parents getting the wrong message regarding the safety/desirability of letting babies and young children eat peanuts to prevent them from developing peanut allergies. Recent news coverage concerning exposing babies to peanuts to avoid a food allergy into adulthood sounds positive, but it could have unintended disastrous outcomes. While the desire to decrease or eliminate an important food allergy is great, peanut, nuts of any kind, seeds and other hard foods can be very dangerous for infants and young children. In fact, peanuts are one of the leading food items that babies and children under the age of three choke on, sometimes with deadly results.2 Infants do not have molar teeth and are not able to chew the nut into a size to swallow safely. In addition, the coordination of the swallowing muscles in babies and infants is immature which also increases the chance that the peanut will enter their lungs and not their stomachs.

When food material enters the lungs, serious blockage may occur to breathing and the material must be removed as soon as possible so that there is no prolonged decrease in the child’s oxygen. Removal of the foreign material requires an emergency trip to the operating room. Delays can be deadly.

The Right Setting for Peanut Exposure

It is important that parents and caregivers are aware of the risks of giving nuts to babies and infants. The scientific paper on a randomized controlled trial of peanut consumption in at-risk infants published in the New England Journal of Medicine responsibly addressed this worry but much of the news coverage of this research has not highlighted the dangers inherent with not proceeding with caution. It is important that parents realize that exposure to peanut antigen in babies at-risk for allergy should take place in a physician’s office where the babies can be carefully monitored. An appropriate trial should include the eating of smooth peanut butter while monitored and NOT the eating of peanuts!

Dangerous Aspiration Risks

Although introducing peanut protein early may be helpful, as physicians and surgeons who deal with foreign body aspirations, we have to make sure that parents are NOT being given the OK to feed their babies peanuts and set them up for aspiration episodes!

Foreign body aspiration is a common cause of morbidity and mortality in young children, and peanuts are the leading food product in that category. There are as many as 3,500 fatal aspiration episodes annually in the U.S.4 with peanuts being the most frequently aspirated food product in children under the age of 3. 3,5,6  Infants and young children have immature swallowing mechanisms that predispose them toward aspiration and they lack molar teeth to adequately chew peanuts.

The responsible message for parents

It is imperative that we make sure that parents do not get the wrong message from recent news coverage on peanut exposure in infants and young children. It is promising that we may be able to decrease peanut allergy in children by introducing peanut butter, in a controlled setting, to at-risk babies, but it is not safe to feed babies and young children peanuts!

Clarification of this message is important to avoid any unintended consequences associated with much of the publicity that has surrounded the scientific findings regarding early exposure to peanut proteins to prevent peanut allergy in children.

We support the Choking Prevention recommendations issued by the American Academy of Pediatrics, and encourage all parents to become familiar with this document.

More Information for Parents on Choking Prevention

  1. Du Toit G, Roberts G. Sayre PH, et al. Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy. N Engl J Med, 2015; 372(9):803-813.
  2. Atkinson R, Chen X, Milkovich S, et al. Fatal and non-fatal food injuries among children (aged 0-14 years). Int J Pediatr Otorhinolaryngol, 2008; 72(7):1041-46.
  3. Tan HK, Brown K, McGill T, et al. Airway foreign bodies (FB): a 10-year review. Int J Pediatr Otorhinolaryngol, 2000; 56:91.
  4. WISQARS Leading causes of death reports, 1999 - 2001. National Center for Injury Prevention and Control. (
  5. Eren S, Balci AE, Dikici B, et al. Foreign body aspiration in children: experience of 1160 cases. Ann Trop Paediatr. 2003, 23:31.
  6. Schmid H, Manegold BC. Foreign body aspiration in children. Surg Endosc. 2000, 14:644.

Updated 3.5.15