The dangers of whole nuts for under-fives

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Parents fearful of their children developing a nut allergy are mistakenly letting their little ones eat whole nuts.

The Epworth Centre for Paediatric Allergies in Victoria has issued a warning after a worrying jump in the number of young children choking on peanuts or tree nuts.

Researchers found almonds, pistachios, walnuts, cashews and peanuts were among the most common nuts involved.

Larger pieces within crunchy peanut butter also lodged in some young children’s airways.

Epworth HealthCare consultant allergist and immunologist Dr John Ainsworth said there had been a spike in “foreign body aspiration” – meaning children had nuts, food or other objects stuck in their airways.

“Our study found between 2015 and 2018, the number of children admitted to the Royal Children’s Hospital trebled because of peanut and tree nut aspiration,” he said.

“The number of incidents involving other foods, like carrot and apple, also doubled during the same timeframe.

“Toddlers aged between one and three are most at risk and that’s because toddlers often don’t get their molar teeth until age two, and don’t have a mature chewing action until age three.”

Since 2015, parents have been strongly encouraged to safely introduce their children to peanut and other potentially allergenic foods, such as egg, dairy and wheat, in the first year to hopefully prevent the development of food allergies.

However, that advice comes with a warning from doctors.

“While it is important to introduce peanut and other tree nuts to young babies to prevent food allergies, it is vital to continue offering these and other hard foods in a soft or paste form until they’re at least five, to keep them safe from a potentially deadly outcome,” Dr Ainsworth said.

It is a nightmare scenario for any parent, which Geelong mother Rose Kabylakis knows only too well.

In 2019 her then two-year-old daughter, Jordyn, reached for some cashew nuts that other family members were eating at their home in Armstrong Creek.

“I was making a cup of coffee when I turned and noticed Jordyn had a mouth full of nuts,” she said.

“As I told her to take some out, she was startled and gasped, inhaling some nuts into her airway instead of swallowing them.”

A life-threatening emergency quickly developed, with Jordyn unable to breathe properly and becoming unconscious.

Paramedics called to the scene kept Jordyn alive until she reached hospital.

The toddler was later flown to the Royal Children’s Hospital in Melbourne for treatment, where she was put into an induced coma for almost a week. She has since made a full recovery.

“I had no idea it wasn’t recommended that children under five eat whole nuts,” Mrs Kabylakis said.

Over a 10-year period, the Epworth study looked at 200 admissions to the Royal Children’s Hospital where children were diagnosed with foreign body aspiration.

Of those children, 28 were admitted to intensive care.

Dr James Leung, a researcher and Royal Children’s Hospital surgeon, said young children could easily inhale nuts, food and other objects into their airway and this could quickly become life-threatening.

“A child having a foreign body like a peanut in their airway is a surgical emergency,” Dr Leung said.

“Nuts caught in the airway can cause inflammation and are hard to spot on an x-ray. They can lead to other complications including pneumonia or permanent damage to the respiratory tract.”

The study found there was no increase in nut aspiration in children aged over five.

“I am still traumatised by what happened,” Mrs Kabylakis said.

“And I wouldn’t want any family to go through what we went through, and I hope parents take note.”

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