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Early childhood nut introduction increases the risk of pediatric inhaled foreign bodies

Published online: August 2021

Pediatric airway foreign bodies are a surgical emergency, and peanuts & tree nuts can pose a significant aspiration risk in young children. In 2015, the Learning Early About Peanut allergy (LEAP) trial established that early introduction of peanuts in high-risk infants reduced the risk of developing a peanut allergy. In response, allergy and immunology societies updated their infant feeding guidelines to actively encourage the early introduction of nuts. The impact of this shift in infant feeding advice on the incidence of pediatric foreign body inhalation has not been previously studied.   

In The Journal of Allergy and Clinical Immunology: In Practice, Leung et al. report on the rates of pediatric inhaled foreign bodies, prior to and since the publication of the LEAP trial, spanning 11 years (2008 – 2018) at the Royal Children’s Hospital in Melbourne, Australia. The authors found the incidence of peanut & tree nut and other hard food (e.g. carrot/apple) foreign body inhalation tripled and doubled respectively after the publication of the LEAP trial in 2015. This increase in food foreign body inhalation was found to be exclusively in children younger than 3 years old. There were no cases of peanut or tree nut aspiration in children older than 5 years old.

This study highlights the need to engage the public to promote safe solid food introduction in young children, particularly in this era where early peanut and tree nut introduction is being actively encouraged. The authors suggested that whole or crushed peanuts and tree nuts should never be given to children under 5 years old. They recommended that for children under 5 years old, peanuts or tree nuts should be given only in a smooth paste, powder or butter form and that hard foods, such as apple or carrots, should be finely grated or cooked until soft.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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