Introducing Tree nuts

First serve

One teaspoon of a single smooth nut butter (almond is a common start) thinned with 2–3 teaspoons of warm water, breast milk, or formula to a drizzly consistency and stirred into a familiar puree.

Build up like this:

Day 1: a small taste (about ¼ teaspoon of the thinned nut butter mixture) mixed into a familiar food, early in the day; watch for 2 hours.
If no reaction, repeat over the next several days, working up to the full thinned teaspoon.
Build to a regular serving of that nut, then start the next tree nut (cashew, walnut, ...) as its own new introduction.

Then keep it going: Once a nut is tolerated, keep it in the diet about twice a week as thinned or thinly spread nut butter — and maintain each tolerated nut separately.

What a reaction can look like

• Hives or raised welts, often starting around the mouth or face
• Redness or rash where the nut butter touched the skin
• Vomiting within about 2 hours
• Swelling of the lips, face, or eyes
• Coughing, wheezing, or labored breathing — treat as an emergency

Trouble breathing, tongue or lip swelling, widespread hives with vomiting, or a pale, floppy baby means call 911 now. See the emergency guide.

Good to know

• Each tree nut is a distinct allergen: tolerating almond says nothing about cashew or walnut, so introduce every nut individually with the same one-at-a-time process.
• Whole nuts and nut pieces are choking hazards until at least age 4 — deliver tree nuts only as thinned or paper-thin nut butters, or finely ground into other foods.
• Serve every new allergen early in the day so you can observe for the next 2 hours, and introduce one new allergen at a time with about 3 days before the next one.

Foods that deliver it

Almond butter →Cashew butter →Walnut →