He was about 18 months old. Because of its thick and sticky consistency, peanut butter can be a choking hazard for toddlers, so I held off on introducing it until I felt he was consistently chewing his foods well. I was eager to give it a try. Katie, peanut butter’s #1 fan, was thrilled any time “baby Sam” ate the same foods for lunch that she did. So, the menu was set: a peanut butter and jelly sandwich for Katie; a light smear of peanut butter on a piece of toast for Sam.

He accepted the first bite willingly, then immediately spat it out. This was unusual. Sam typically amused us all when given a new food with a flavor he disliked; he would swallow the first offending bite, then declare “YUCK!” and refuse additional spoonfuls. (“It’s so nice,” I remember telling Michael, “how not liking a food doesn’t turn into a big mess with him!”)

But that wasn’t all. Immediately, Sam’s hands flew to his mouth. He rubbed vigorously at his mouth, and cried out. It was clear to me that he didn’t just dislike peanut butter; it bothered him. I took him from his high chair, dampened a washcloth to wipe his mouth, and nursed him. Then, I called my husband.

“He wasn’t himself,” I said. “It really bothered him. Peanut butter is off limits, until we figure this out.”

Unfortunately, I forgot to tell the baby sitter. About a week later, I left Sam with her while I went to an appointment. When it ran late, she made him lunch. I returned a couple of minutes after she gave him a bite of a peanut butter and jelly sandwich. “He doesn’t like peanut butter?” she asked the moment I walked in the door.

But the vigor of his response to it, and the redness around his mouth suggested Sam’s feelings about peanut butter were stronger than dislike. Although neither Michael nor I have any family history of peanut allergy, the evidence seemed to point in that direction.

Sam, however, was what the pediatrician called pathologically afraid of doctors. “He’ll out grow it,” she promised, “probably in a year or two. But for now, there’s no changing it.” Sam feared doctors so much that even going along to someone else’s appointment was traumatic for him.

We considered the options: traumatize him with a trip to the allergy doctor (and the skin-prick and/or blood tests that would require) or wait and control his environment. We opted for the latter. We explained to Sam, and his siblings, that peanuts and nuts could make him sick. We encouraged him to ask about any food before eating it, and we started reading labels more carefully.

But we knew that was a temporary fix. A few weeks ago, Sam accidentally ingested a small amount of peanuts in a candy. Immediately, he came to me. “My mouth is itching,” he told me unhappily. “What did you eat?” I asked, my heart stopping.

We wiped out his mouth with water and rinsed it thoroughly.  It was then that we noticed the swelling of his upper lip and the redness around his mouth.  I called the doctor right away. At her direction, I gave Sam a dose of over-the-counter antihistamine. He vomited once, but then felt much better. We watched him closely, but luckily, he didn’t have any trouble breathing—this time.

We’d realized that we had almost waited too long. I made a note to call a pediatric allergist in the morning. Peanut allergies can be unpredictable, and next time—if there is a next time—an antihistamine might not be enough.

Sam still doesn’t like doctors, but he was calm about the appointment and a trooper through the series of required skin tests. The results confirmed peanut/tree nut allergy. He submitted—much less calmly—to a blood test that the doctor said may give a clue as to whether Sam might outgrow the allergy.

I have my fingers crossed that he will. I have an Epipen in my purse, and one taped inside the kitchen cabinet. I hope there’s not a next time—I’ll do all I can to ensure there isn’t—but if there is, I plan to be ready.

Parenting four children between the ages of 43 weeks and 8 years keeps Heidi Green busy! Add in husband Michael, paid work and volunteer work, and life becomes a juggling act. Check in with us every week to find out how she manages (or not), and what she learns in the process.

The incidence of allergic disease has increased dramatically in recent years. Although genes play an important role, the reasons for the increase are unclear. If the mother has a strong family history of allergic disease, she might be encouraged to follow certain guidelines in an effort to limit the onset and reduce the severity of allergic symptoms in her baby.

The importance of breastfeeding for all moms and babies cannot be overstated. Admittedly, breastfeeding will not prevent the occurrence of allergic disease in babies with a strong family history of allergy, but exclusive breastfeeding for the first six months and continued breastfeeding for at least the first year may delay the onset of allergic symptoms (gas, diarrhea, vomiting, fussiness, and skin rashes) and reduce their severity.

Research shows that food proteins can appear in human milk in small amounts. In extremely sensitive babies, the amount of protein can be large enough to cause allergic symptoms. Parents of high-risk babies have long been cautioned not to introduce solid foods too soon. However, recent studies suggest that delaying the introduction of foods other than human milk beyond six months may actually increase the risk for allergic disease. It appears that when the immune system is exposed to foreign proteins (antigens) during a specific time period (not too early, not too late), a tolerance to the antigens rather than sensitivity may actually develop.

Because our understanding of allergic disease is constantly changing, mothers of high-risk babies (especially those with a family history of peanut sensitivity) should be advised to talk with their baby’s doctor before introducing any foods other than human milk.

However, eating organic foods can be significantly more expensive than eating conventional ones. So, if you wish to purchase organic foods but need to stick to a budget, start by selecting organic only for those fruits and vegetables with the highest level of pesticides. The Shopper’s Guide to Pesticides, compiled annually by the Environmental Working Group (EWG)—a health and environment watchdog group—provides consumers with the Dirty Dozen and the Clean 15 lists.

Dirty Dozen
These are the fruits and vegetables that consistently test higher in pesticides, and they are typically ones that consumers eat whole—skin and all—without peeling. EWG recommends buying only organic:

1. Celery
2. Peaches
3. Strawberries
4. Apples
5. Blueberries (domestic)
6. Nectarines (imported)
7. Sweet Bell Peppers
8. Spinach
9. Kale/Collard Greens
10. Lettuce
11. Potatoes
12. Grapes (imported)

Clean 15
These fruits and vegetables consistently test as being lowest in pesticides. You don’t need to be as worried about choosing conventional when you buy these fruits and vegetables:

1. Onions
2. Avocado
3. Sweet Corn
4. Pineapple
5. Mangoes
6. Sweet Peas
7. Asparagus
8. Kiwi
9. Cabbage
10. Eggplant
11. Cantaloupe (domestic)
12. Watermelon
13. Grapefruit
14. Sweet Potatoes
15. Mushrooms

Because these agents kill pests by disrupting their nervous systems, Dr. Maryse Bouchard of the University of Montreal explains, “it seems plausible that exposure… could be associated with ADHD-like symptoms.” In fact, with exposure to these pesticides the risk is “100 percent more.”

Organophosphates are persistent or long-lasting, with the U.S. Department of Agriculture finding trace amounts on frozen blueberries, green beans, strawberries, celery, and peaches. In addition, the pesticides are also used by lawn care companies.

Although all of the causes of ADHD are not yet clear, the authors of the Pediatrics study suggest parents avoid using bug sprays in the home and eat organic foods when possible. When that’s not possible, parents should scrub all produce to reduce residue, and consider buying produce from local growers (such as farmer’s markets); even if not organically grown, local produce often has less pesticide residue than industrially farmed produce.

However, eating organic foods can be significantly more expensive than eating conventional ones. The Environmental Working Group provides a list of the most (and least) pesticide-laden fruits and vegetables so you can make the best choices for your family.

In these cases, there are a number of steps parents can take to help their young children remain at the table and enjoy mealtimes:

• Establish a routine. When young children know when to expect their meals or a snack, they may be less likely to fill up on other foods. Also parents or caregivers should make it a rule to not offer juice, milk, or snacks at least one hour before meals. Children who are hungry at mealtime will be more motivated to sit at the table and eat.

• Provide encouragement. So-called picky eaters may need repeated exposure to a wide array of foods before they take their first bite. Remember the rule of thumb for introducing solids? It usually takes repeated offerings (10 or more!) before a child accepts a new food. When it comes to a picky eater, be as persistent with your toddler as you were when he was a baby. Parents can encourage their children to eat during mealtime by talking with their child about how the food looks, feels, tastes, and smells. For toddlers, texture is often as important as taste, so they may have to “play” with it before they actually taste it.

• Pair the old with the new. Parents can serve one of their child’s favorite foods, along with a new food or something that was refused in the past. (It’s important to limit the portion of the favorite food in favor of the new or refused food so she doesn’t fill up after only eating the food she knows she likes.) Or, put a healthy twist on a favorite food. If your child loves French fries, try making homemade sweet potato fries instead.

• Get children involved. The American Academy of Pediatrics (AAP) notes that children who help make their own lunches are more likely to eat them. Take your children to the grocery store so they can help select the foods they will be eating. When mealtime rolls around, have your child help out in the kitchen in any age-appropriate ways, such as setting the table, rinsing veggies, mixing a salad, or stirring a bowl of ingredients. By getting children involved in the cooking process, they may be more eager to sit at the table and participate in the meal.

• Consider presentation. Meals can be much more fun and engaging for young children by serving veggies with dip, and sometimes offering breakfast foods for dinner. The AAP offers these suggestions for ways to inject some excitement into mealtimes: Use cookie cutters to cut sandwiches or other foods into fun, interesting shapes; put a new twist on old favorites (top peanut butter with raisins, bananas, or apple slices); for color and crunch, try cucumber slices, grated carrots, or zucchini.

• Set an example. Some children, especially “picky eaters,” may be more willing to try new foods once they see their parents sit at the table and eat those foods. The AAP points out that regular mealtimes allow children to observe normal eating behavior modeled by their parents. That means parents who want their children to eat a variety of foods, try new foods, and sit at the table should practice what they preach. The AAP adds that by the time children reach grades 3–5 they will begin to exert more independence about food. Establishing healthy eating habits early on could serve as a foundation for their future.

• Sit up with no support
• Eliminate his tongue-thrust reflex (pushing food out of his mouth, a defense against choking)
• Chew (with his gums if he has no teeth) or move food from the front to the back of his mouth and swallow without choking
• “Pincer” grasp (the ability to pick up small, soft foods between his thumb and forefinger)
• Show interest in food you are eating

When your baby shows these signs of readiness, you can begin to introduce solids.

If your baby refuses to open his mouth, turns his head away from the food, or pushes the spoon away from his mouth, it may indicate that he is not hungry or that he isn’t interested (yet) in the food being served. It usually takes repeated offerings (10 or more!) before a child accepts a new food. If your baby refuses to eat, wait a few minutes and try again. If he still resists, try a different food. Refusing to eat at all might be a sign that your baby is full or that he is not developmentally ready for solids.

Click here to learn about first foods to serve as you start your baby’s introduction to solids.

You can expect your baby’s transition to solid foods to be a slow one. Prepare only a tablespoon-sized portion of whatever food you choose to begin with, knowing that your baby will likely eat only half of that at first. At 6 months of age, babies typically eat about two ounces of solids a day. Always breastfeed or bottle-feed your baby first, and then offer her the solid food. Watch for signs of food allergy such as vomiting, diarrhea, or skin rashes as you begin introducing your baby to solid foods. Introduce only one new food every 3–5 days, and always in the morning, so that you have ample time to detect any allergic reactions or intolerance before moving on to the next food.

Experts disagree about the best first foods for babies, but all agree that they should be rich in iron. Some advocate for iron-fortified cereals, while others suggest starting with protein-rich poultry, beef, or tofu. Still other experts recommend beginning with fruit since it is naturally sweet, while others advise starting with vegetables so babies don’t develop a preference for sweet foods only. There is no right or wrong choice, and your baby will ultimately decide which solid foods she prefers. Click here to learn more about first foods, finger foods, and foods to avoid as you begin introducing your baby to solids.

“There is no good reason,” according to Dr. Frank R. Greer, a member of the AAP’s Committee on Nutrition, “not to introduce meats, vegetables, and fruits as the first complementary foods.”

That being said, you may want to consider giving your child small portions of meat as a first complementary food, since it provides iron in a more readily digestible form (compared to the iron found in fortified cereals) and introduces children to a new texture of food they haven’t previously experienced.

When you introduce meat:

• Cook it well. Make sure that any meat you give your baby has been prepared safely and is well-cooked, not raw. There should be no “pink” color visible. If the meat is dry it can be hard to swallow. Adding a small amount of breast milk or formula may help.
• Serve small portions. Remember that babies eat very small servings of complementary foods in the beginning. One or two tablespoon may be all you need to prepare.
• Vary your choices. “Red meat” may be the first iron-rich meat that comes to mind, but poultry,  fish, and tofu are other nutrient-dense options in this food group.
• Cut into small pieces. Chewing is a challenge for babies beginning complementary foods, so be sure to grind up the meat, or cut it into pieces appropriate to your baby’s age and ability.