We have a 10-month old, healthy daughter, thank God. I am still breastfeeding her, but she eats everything else except for honey and regular milk. We were wondering several things after hearing conflicting advice from nurses and friends.
We have heard that giving peanuts in the form of peanut butter or snacks like peanut-flavored corn puffs is desirable from this age so the baby does not develop a peanut allergy. Is this correct? If so, how much should we give her?
Also, is it harmful to give her pieces of whole-wheat or other whole-grained bread? Some say it is hard on the stomach. My husband and I eat only whole-wheat bread. Should we give her only white bread for the time being?
And can we give her ordinary tap water to drink or does it have to be boiled and cooled at this age? M.I., Tel Aviv
Prof. Arthur Eidelman, emeritus professor and former head of pediatrics at Shaare Zedek Medical Center, who is currently editor of the journal Breastfeeding Medicine, comments:
As for giving children of this age soft snacks with peanut butter (such as Bamba, corn puffs with peanut butter, which are extremely popular among Israeli children), I strongly endorse this. It is a mistake that many schools, after-school programs and children’s camps have declared themselves peanut-free. Instead, parents should give such snacks to children at a young age, after they start eating solid foods, as early exposure can get the body used to peanuts before an allergy develops.
In Western countries, the prevalence of peanut allergy has unfortunately doubled over the past decade, and it is the leading cause of food allergy-related deaths in the U.S.
Don’t give them actual peanuts, as these pose a serious choking hazard, Instead, give food made from peanut butter. In the year 2000, the American Academy of Pediatrics (AAP) recommended that any child at high risk of peanut allergy (if they belong to a family with a history of peanut allergy or other food allergies or eczema) should not eat peanut products before the age of three. They the not eat any before they turned 3. But eight years later, the AAP stopped recommending this because they found their advice didn’t help.
Around this time, British researchers noted that peanut allergy in Jewish children living in the UK was about 10 times higher than in Jewish children in Israel. Since they shared a similar ancestry, the difference, reasoned the British scientists, had to be something that they were doing.
They learned that UK children rarely ate peanut products before their first birthday, while their Israeli counterparts of this age regularly ate Bamba. They studied 600 babies who were allergic to eggs or suffered from eczema – two conditions that are known to go along with peanut allergies. They divided them up into two groups – one batch of young children were given Bamba (or smooth peanut butter) regularly, while the other group’s parents were told not to give them any peanut products until their fifth birthdays. The study included children who tested positive for a peanut allergy as infants (those with strong positive tests, however, were not included in the study).
At five years, only 3% of the children who ate peanut products were allergic to them, compared with 17% of those who didn’t eat peanuts.
As a result, the U.S. National Institute of Allergy and Infectious Diseases released guidelines to help pediatricians and parents understand and safely apply this. The guidelines were published simultaneously in six journals including the Journal of Allergy and Clinical Immunology.
All infants who don’t already test positive for a peanut allergy are encouraged to eat peanut-enriched foods soon after they’ve tried a few other solid foods. The guidelines are the first to offer specific Children who suffered from severe eczema or egg allergy should first be tested (via a skin-prick or blood test) for peanut allergy, and their parents should consult with doctors about whether and when to expose them to peanut products. Those found to have an allergy should get their first taste of peanut products in the doctor’s office.
There is no testing needed for babies with mild to moderate eczema, although they should still talk with their doctors about their child’s situation and needs. These babies should try peanut products at around 6 months of age.
The babies who don’t have any eczema or food allergy can have peanut products along with other foods based on their family’s preferences and cultural practices. Peanut products can be given as early as four to six months.
It’s very important that parents not give babies whole peanuts or chunks of them (or chunky peanut butter) because babies could choke. Smooth peanut butter mixed into a puree is better, as are snacks or foods made with peanut butter.
As for whole-grained products, these pose no problem to babies of this age. In fact, they are healthful, and it is a good idea to get young children used to whole-grain foods so they become a lifelong habit. White bread and refined grains provide empty calories and result in a lot of sugar.
Finally, potable water of high quality does not need to be boiled and cooled for babies at this age.
I am a 35-year-old woman who likes fruits and vegetables. I try to buy organic produce to avoid pesticides, but it is expensive and not always available. I am confused whether I should peel regular fruits and vegetables, as I may be missing out on vitamins and minerals. How should I handle them, and what kinds of produce needs to be peeled? What kinds should be eaten without removing the peel? V.A., Nahariya, ISRAEL
Dr. Olga Raz, a veteran clinical dietitian at the nutrition department of Ariel University in Samaria, Israel, replies:
You ask a question that has no definite answer. It depends on whom you ask – a naturopath, a vegan or a conventional or organic farmer or a conventional nutritionist (even among them are differences of opinion). This is because the subject has not been studied satisfactorily.
First of all, not all “organic food” is truly organic, as there is not proper supervision to make sure no pesticides are used. There are also disagreements about whether all pesticides are harmful. Therefore, I cannot take a side on this issue.
However, about peeling vegetables and fruits, I can tell you what I do. I wash all fruits and vegetables with dish-washing soap and water, in which I left them soak for a few minutes and then rinse them. I then try to eat those that have edible peels, trusting my body to handle them. In principle, even the air we breathe is not perfect, but we still have to breathe.
I am a 62-year-old woman with no history of breast cancer in the family. I undergo a mammogram every two years, but my doctor said I should also do a breast ultrasound as well while’s I’m at the clinic. It costs more money. Are the ultrasounds more accurate than a mammogram. If so, why do a mammogram? If not, are both together more accurate? M.R., Teaneck, New Jersey, US
Miri Ziv, director-general of the Israel Cancer Association, replies:
Women aged 50 to 75 who are at low risk for breast cancer – that they are not symptomatic and have no first-degree relative in the family that has had breast or ovarian cancer in the past and that they are not carriers of a defective BRCA gene – should go for a mammogram every two years. Women who are at high risk – because they have such a relative or are carriers – should start going for a breast scan at 40 and do so every year.
Such women do not need anything more, as mammograms are the gold standard for detecting breast cancer early. Breast ultrasound can complement mammograms, but they offer only 40% accuracy, which is much less than mammograms.
If the breast tissue is dense or if there is another problem that makes it difficult for the doctor to interpret the mammogram, an ultrasound may be helpful. But it also depends on the skill of the doctor in reading them. There are always things that can be seen on a mammogram and not seen on an ultrasound, and vice versa, but an ultrasound – compared to a mammogram – usually doesn’t reduce mortality.
If you want an Israeli expert to answer your medical questions, write to Breaking Israel News health and science senior reporter Judy Siegel-Itzkovich at judy[at]israel365.com with your initials, age, gender and place of residence and details of the medical condition, if any.