Introducing Nuts at Home – A Guide for Parents

Introducing Nuts at Home – A Guide for Parents

This information sheet is intended only for use by the Allergy Multidisciplinary
Team at Worcestershire Acute Hospitals for children and families seen within the
Allergy Service.

Given to: By:

You have been given this information sheet because we think it is safe for you to
introduce nuts to your child at home. Whilst we consider that there is a low risk of your
child reacting to the nuts, we advise following the steps below to keep this risk to a
minimum.

Tree nuts are in a different food family to peanuts. Peanuts grow in the ground and are
in the legume family, whereas tree nuts grow above ground.

Examples of tree nuts are: almonds, brazil nuts, cashew nuts, hazelnuts, pistachios,
pecans and walnuts.

*Please only introduce the nuts that have been recommended to you*

Type of nut to offer to your child

Ground nuts – shop brought or ground at home using a blender or pestle and mortar.
Ground nut powder can then be mixed with chocolate mouse, yoghurts or fruit purees.

Nut butters – nut butters are available in large supermarkets with cashew, almond,
hazelnut, pecan and peanut readily available. These can then be spread on toast,
crackers or added to a small amount of porridge or used plain.

For younger infants, nut butters can be thinned and mixed with a few teaspoons of water
to make it easier to eat.

Please note – whole nuts should not be given to children aged less than 5 years of age
as this is a choking risk.

Procedure
 Each nut must be given individually, on separate days. Ideally 5-7 days apart.
 Your child must be well when introducing nuts. If they have a cold, a fever, are
vomiting or have any other illness then wait until they are fully recovered.
 If your child needs to use their blue inhaler more often than usual then please wait
until they have recovered.
 Introduce the nuts for the first time at home, not at a restaurant or nursery.
 Ideally this should be carried out in a morning when there is another adult present.
 Make sure you focus your attention on your child and are able to stay at home for
at least 2 hours after the meal to watch for signs of allergic reaction.
 Make sure you have some antihistamine (we recommend cetirizine) with you.
 Offer your child a small amount of nut (ground and mixed with your food of choice,
or nut butter) on the tip of a teaspoon. They might lick the spoon or you can rub
some inside their lip.
 Wait 20 minutes. If there is no allergic reaction then slowly give the remainder of
the food at your child’s normal eating speed.
 Your child should eat approximately 2 teaspoons of each nut.
 Keep activities after ingesting the new nut simple and indoors.

Symptoms of an allergic reaction
Mild symptoms: A new rash, vomiting, hives (urticaria) or lip, eye, ear swelling; tingling
lips, tongue or throat.

Severe symptoms: Sudden onset of breathing difficulties such as constant coughing,
hoarse voice or wheezing. A change in skin colour or conscious level.

What should I do if my child has an allergic reaction?
 Stop giving them the food
 For ‘mild’ reactions, administer antihistamine
 Stay with your child
 For severe allergic reactions administer your adrenaline auto injectior if you have
been prescribed one and call 999 and say ‘anaphylaxis’
 If you have not been prescribed an adrenaline auto injector and you feel the
reaction is severe, administer antihistamine and call 999 and say ‘anaphylaxis`.
 Later, you can leave a message for the allergy nurse on the contact details on the
bottom of this information sheet.

What do I do if my child does not have an allergic reaction?
Please carry on giving your child that nut at least twice a week.

For further questions, please contact the allergy team on:
Tel: 07564 848463
Email: wah-tr.paediatricallergy@nhs.net

If your symptoms or condition worsens, or if you are concerned about anything,
please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you
and your loved ones. If you have any questions or concerns, please do speak with a
member of staff on the ward or in the relevant department who will do their best to
answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well
and where improvements can be made. There are lots of ways you can share your
experience with us including completing our Friends and Family Test – cards are
available and can be posted on all wards, departments and clinics at our hospitals. We
value your comments and feedback and thank you for taking the time to share this with
us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the
nurse in charge or the department manager in the first instance as they are best placed
to answer any questions or resolve concerns quickly. If the relevant member of staff is
unable to help resolve your concern, you can contact the PALS Team. We offer informal
help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf,
if you feel unable to do so, to resolve your problems and where appropriate refer to
outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate
your concerns. You can make a complaint orally, electronically or in writing and we can
advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PET@nhs.net

Opening times:
The PALS telephone lines are open Monday to Thursday from 8.30am to 4.30pm and
Friday: 8.30am to 4.00pm. Please be aware that a voicemail service is in use at busy
times, but messages will be returned as quickly as possible.

If you are unable to understand this leaflet, please communicate with a member of staff.

Version 2