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This explains how to introduce a new nut safely and offers advice on allergic reactions to look out for.
Even if your child has other nut allergies, it does not mean they will be allergic to every single type of nut.
Introduce the new nut as soon as possible once your allergy team or health professional advises you to do so.
If you delay the ‘safe’ nut introduction for too long (beyond 4 to 6 months), there is a risk that your child may no longer tolerate it due to lack of exposure. In this situation, avoid this nut completely and seek further advice from your allergy team or health professional.
Different types of nut
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Peanut
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Hazel
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Almond
|
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Macadamia
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Cashew
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Pecan
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Pistachio
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Brazil
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Walnut
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Introducing a new nut at home
Follow this guidance to minimise the risk of any allergic reaction when you introduce a new nut.
- Introduce the nut at home, preferably with other responsible adults present.
- Ensure that your child’s allergy medication is up to date and easily accessible.
- Choose a day when your child is feeling well and is not doing any unusual activities (such as sports day).
- Ensure your child’s eczema, asthma, hayfever are controlled.
- Introduce one new nut type at a time. Do not introduce other new foods on the same day you introduce a new nut.
- Introduce the nut at a time when you can monitor your child for up to 2 hours after they eat it. For example, introduce it during the day (not just before bedtime).
- Offer the tolerated nut in its purest form. For example, buy nuts that you crack from the shell or use whole nuts from a single nut bag.
- Avoid ground nut bags or crushed nut bags because there is a risk of cross contamination.
- Pure, single nut butters are suitable, provided you check the label first.
- Nut milks or nut oils are not suitable for home nut challenges.
- Do not introduce whole nuts for infants or young children aged under 5 years, due to the risk of choking. You can crush or ground the nuts yourself to reduce the risk of cross contamination, or use pure single nut butters instead.
- If you are introducing peanut into a baby or toddler’s diet, you can use Bamba snacks (you can mix them with water to dissolve into a porridge). You can also use peanut butter (check the label to ensure there is no risk of cross contamination).
- If your child refuses to eat the new nut, do not force them. Try to mix the nut in another food that your child likes (for example fruit puree, yoghurt, breakfast cereal, porridge, tomato sauce etc).
How much of the new nut to give at first
| Day 1 |
For an infant or young child For a child 5 years or older |
| Day 2 | Give ¼ teaspoon (or a full nut to older children). |
| Day 3 | Give ½ teaspoon (or a couple of nuts to older children). |
| Day 4 | Give a whole teaspoon (or 4 to 5 nuts to older children). |
Always do the following
Observe your child closely for symptoms when you introduce a new nut.
Stop giving this nut if you think your child is having an allergic reaction.
Follow your child’s allergy plan (if they have one).
Call 999 for immediate medical support if you are concerned.
Try to write down the details of the reaction or take a picture on your phone, and note how long it lasts.
Contact your allergy team or health professional afterwards so they are aware of your child’s reaction.
Allergic reactions to look out for
Immediate reactions may include the following:
- widespread rash
- itchy or swollen eyes, lips or tongue
- throat tingling or tightness
- hoarse voice
- cough
- wheezing
- difficulty breathing
- tummy pain
- vomiting
- becoming floppy or unresponsive.
Follow your Allergy Action Plan if you have one.
Other reactions may be delayed for up to 72 hours after eating the new nut. These reactions may be less obvious to identify and may include the following:
- eczema flare
- blood in stools
- bloating, constipation, diarrhoea.
Contact your allergy team or health professional for advice.
What happens when you have introduced a new nut
Follow this guidance once you have introduced a safe nut.
- Make sure your child eats at least 2 to 3 servings of each ‘safe’ nut every week. This is so that your child continues to tolerate that nut.
| Age of child | Size of one serving |
| Infant or young child under 5 years | A rounded teaspoon. |
| Child 5 years or older | Your child’s handful (minimum 4 to 6 nuts). |
If you struggle to give the amounts recommended above, give as much as you can.
- Only offer the ‘safe’ nut(s) that your child tolerates when you are in your own home.
- Avoid the ‘safe’ nut if it is in a processed food such as bread, cakes, biscuits, cereal, cereal bars or chocolate. Processed foods increase the risk of cross contamination with other nuts which your child may be allergic to. (See our information section on “May contain nuts” labelling).
- Avoid all nuts when you are away from home (for example at nursery, school, visiting grandparents, in a restaurant or at a party). When you are away from home, there is a risk of cross contamination and possible confusion about identifying different nuts.
Cross-contamination
Cross contamination happens when a food that is nut free or contains a tolerated nut accidentally comes into contact with a nut that your child may not tolerate. This can happen with the manufacturer during storage or processing. It can also happen at home or in a kitchen from contaminated cooking utensils, kitchen worktops or cutlery that has touched an unsafe nut.
If your child eats the contaminated food, it may cause a serious reaction (even if it only involves traces of a nut your child is allergic to).
Examples of nut cross contamination include:
- Using a knife for peanut butter (if your child has a peanut allergy) and then reusing it to spread jam on toast without washing the knife first.
- Eating a tolerated nut from a packet of mixed nuts.
- Taking the nuts off an ice cream or chocolate bar, or marzipan off a fruit cake and eating the rest of the food.
- Eating deep fried foods, such as fish and chips cooked in peanut oil.
Shelled single nut packs
There is still a risk of cross contamination with bags of shelled single nuts, but the risk is small.
Takeaway and ready meals
Asian and Middle Eastern food (for example Indian, Chinese, Thai, Indonesian or Moroccan) are high risk foods that may contain nuts or nut traces. Do not assume that a particular takeaway meal is safe just because your child has eaten it before.
Food labels
By law, the main 14 food allergens (including nuts) must be declared on the ingredient list on food labels. They will be in bold or italic.
Remember that processes or recipes can change. Check labels every time you buy a product, even if you have bought it before. For example, a pesto sauce recipe may change and contain cashew or peanut instead of pine nut.
'May contain' warnings
Food items often include warning labels such as: “May contain traces of nuts” or “Made in a factory that handles nuts” or “Not suitable for nut allergy sufferers”. Manufacturers decide whether or not to use these warning labels and they are not required to do so by law.
Discuss your approach to managing “may contain nuts” products with your allergy team or healthcare professional.
More information
Information on allergies from Allergy UK
Information on peanut and tree nut allergies from Anaphylaxis UK
Contact information
Kingston Hospital Paediatric Dietetics department, Monday to Friday 9am to 5pm