Pistachios

You can offer pistachio once your baby is ready for solids, usually around 6 months, but only finely ground or as butter mixed into other foods. Whole or chopped pistachios and thick butter are choking risks, so learn how to prepare them safely.

Pistachio is native to Central and Southwest Asia. Today it thrives in sunny, dry places from California to China, Iran and Turkey. Much of the world supply comes from these countries. In a ripe orchard you can hear the small popping sound of shells opening.

Pistachio is very good in healthy fats, fiber and zinc, which support brain growth, digestion and immunity. It is also rich in iron, which helps babies on plant-based diets. It holds vitamin K, needed for blood clotting.

First try

On the first try, a pinch of finely ground pistachio is plenty, as is roughly 1/8 teaspoon of creamy butter thinned with formula, breast milk, or water. If there is no reaction, increase the portion over the next meals. It is fine if your baby does not finish it, since the aim is steady allergen exposure. Offer it about twice a week if you can.

If your baby has severe eczema, has had an allergic reaction before, or you suspect nut allergy, talk to your pediatrician or a pediatric allergist before offering it at home.

Shell and whole nuts

Pistachios often come with a shell nobody can eat. Take it off before you prepare the nuts for your baby. The shell clearly poses a choking risk, so a baby or toddler must not suck on it or chew it.

Pistachio is especially risky and hard to eat: it is firm, hard to bite, small and round. Before moving to whole nuts, your child should eat softer nuts such as walnut and pecan easily and be able to shell a partly open pistachio alone after a demonstration. Still, medical bodies count nuts as a choking risk until age 4. In this app whole pistachios are not given before age 4.

Storage and milk

Pistachios may turn rancid. Whether shelled or not, they stay fresh for up to 1 year in the fridge and 2 years in the freezer.

No pistachio milk as a drink before 12 months, but it can go into a cooked dish such as oatmeal. After 12 months it can be an occasional drink, but it falls short in calories, fat and protein.

All whole nuts, nut pieces and lumps of nut butter are choking risks for babies and young children. Pistachio is one of them, and the shell adds a further risk.

To lower the risk, remove the shell and grind the nuts to a powder. Loosen the butter with water, breast milk, formula or yogurt to a smooth, non-sticky texture and spread it very thinly. Stay close while your baby eats and keep them upright.

Pistachio is a common allergen. The World Health Organization counts it as a Global Priority Allergen. Pistachio is treated as a tree nut (even though botanically it is a seed). Its proteins are close to those in cashew, so a child allergic to one is often allergic to the other. More than 95 percent of children with pistachio allergy are also allergic to cashew. Between 0.5 and 1.2 percent of people are allergic to tree nuts, and the allergy usually lasts for life. Only about 9 percent of children with tree nut allergy grow out of it.

Sumac and pink peppercorn come from pistachio's plant family (Anacardiaceae), so people with pistachio allergy may react to these spices too. Mango is in the same family, but most people with pistachio allergy eat mango flesh with no reaction.

Allergy to one nut raises the chance of allergy to another, but it does not mean every nut must be dropped. If pistachio allergy is present, work with an allergist to decide whether other nuts can be eaten safely.

In most cases, babies need no allergy test before nuts are introduced, and that holds when allergies run in the family. Evidence for the protective effect of early allergen introduction is growing, so do not delay more than needed.