Target: ~6 g of peanut protein per week, divided across 3+ feedings, sustained until age 5 (LEAP-Trio: protection persists even with intermittent later intake).

How to deliver (~2g protein per serving × 3+/week):
• 2 tsp smooth peanut butter (Skippy Natural / Trader Joe's / Smucker's Natural — no added sugar) thinned in warm water/breast milk + spoon-fed (~5 g protein per 2 tsp)
• OR Bamba puffs — the original LEAP study food. ~½ oz pack = ~2 g peanut protein → aim for ~3 packs/week or equivalent across feedings.
• OR peanut powder (PB2) mixed into yogurt/oatmeal

NEVER: whole peanuts (choke risk <4) · spoonful of dry nut butter (choke risk all ages) · introduce when sick/feverish (false reaction signal).

1. Choose a morning when baby is well, fed, and happy. NOT before nap, NOT when sick.

2. Start small: tip of a teaspoon. Wait 10 min. No reaction? Give a full teaspoon.

3. Observe for 2 hours. Stay home. Do NOT introduce another new food same day.

4. No reaction? Re-feed within 2–7 days, then 3+ times per week ongoing. KEEP IT IN — once introduced, dropping it can re-sensitize.

5. Track intros in a notebook or app (Solid Starts app). One new food at a time = traceable reactions.

SKIN: hives · flushing · swelling (lips/tongue/eyelids).
RESPIRATORY: wheeze · hoarse cry · cough · stridor · drooling · refusal to swallow.
GI: repeated vomiting · severe diarrhea · sudden refusal to feed.
CIRCULATORY: pallor · floppy/limp · collapse · blue lips.

ANY 2 systems = anaphylaxis. Give EPINEPHRINE → call 911. Don't wait. Don't dose Benadryl first — antihistamines can't reverse anaphylaxis. After Epi: 911 transport REQUIRED. Biphasic reactions occur in ~5% (Pourmand 2018) — typically 4–8 hr later but can be up to 72 hr; hospital observation 4–6 hr standard, 8–12 hr for severe initial reactions (Joint Task Force 2020).

EpiPen / EpiPen Jr (standard) — auto-injector, 0.3 mg adult / 0.15 mg child <30 kg. Hold 3 sec, outer thigh, through clothes OK.

Auvi-Q — voice-prompted auto-injector (incl. 0.1 mg for 7.5–<15 kg infants/toddlers — only auto-injector for that weight range). Often free for income-eligible families (AffordAbility program).

neffy (epinephrine nasal spray) — needle-free. 2 mg approved Aug 2024 for ≥30 kg; 1 mg approved March 2025 for ages 4+, 15–<30 kg. One spray per nostril. Lowers needle-phobia barrier — many families will use neffy when they wouldn't use auto-injector.

Why epi works: α₁ vasoconstriction reverses hypotension/edema; β₂ bronchodilates + stabilizes mast cells. Antihistamines don't reverse anaphylaxis — never substitute Benadryl for epi.

Peanut: Asian sauces, "natural flavor," mole, satay, baked goods cross-contamination.
Tree nuts: pesto (pine nuts), marzipan, nougat, "may contain" warnings.
Dairy: "casein"/"whey" on labels, deli meats, processed bread, granola bars.
Egg: mayo, baked goods, marshmallows, some pasta, lecithin.
Wheat: soy sauce, salad dressings, soup thickeners, beer.
Soy: "lecithin," "vegetable oil/broth," some chocolate.
Sesame: hummus, tahini, many breads — labeled since Jan 1, 2023 (FASTER Act 2021, sesame = 9th major allergen).
Fish/Shellfish: Worcestershire, Caesar dressing, Asian fish sauce, surimi.

Stage 1 (6 mo): Smooth purees → Stage 2 (7–8 mo): Mashed with soft lumps → Stage 3 (8–9 mo): Soft finger foods, dissolvable solids → Stage 4 (10–12 mo): Chopped family food, self-feeding with spoon.

Skipping textures or staying on purees too long is associated with feeding difficulties later. Move forward when baby shows readiness signs: tongue lateralization + up-down chewing motion.

⚖️ Baby-Led Weaning vs Purees: Both are safe when done correctly. BLW builds self-regulation and fine motor skills earlier; purees give more control over iron-rich intake. Best approach — combination: purees for iron-rich foods (meat, lentils), finger foods for exploration (avocado, banana, steamed veg). No method wins long-term. Evidence grade: B.