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Study: More parent education, pediatrician support needed on early peanut introduction guidelines

July 21, 2023

Just 13% of parents are aware of recommendations on early introduction of peanut protein to infants, and pediatricians play a major role in educating them, according to a new study.

Researchers are calling for more communication with parents and support for clinicians to prevent children from developing peanut allergies and reduce disparities.

“As a pediatrician, I’m sensitive to the fact that there is a lot to juggle during a four- or six-month appointment,” senior author Ruchi S. Gupta, M.D., M.P.H., FAAP, director for Northwestern University’s Center for Food Allergy and Asthma Research, said in a press release. “We need to find ways to support pediatricians in their workflows to incorporate the prevention guidelines.”

In 2017, the National Institute of Allergy and Infectious Diseases released guidelines endorsed by the AAP calling for peanut protein introduction as early as 4-6 months for infants at increased risk of developing a peanut allergy.

Researchers from Northwestern and the Ann & Robert H. Lurie Children’s Hospital of Chicago set out to learn more about parents’ knowledge of and adherence to those guidelines. They surveyed a nationally representative sample of about 3,000 parents or caregivers of children ages 7 month to 3.5 years and reported findings in “Early Peanut Introduction Awareness, Beliefs, and Practices among Parents and Caregivers,” (Samady W, et al. Pediatrics. July 21, 2023).

About 13% of parents said they were aware of the guidelines. They were more likely to be aware of them if they were White, 30-44 years of age, educated, had a high income, had a personal history of atopy or had a child with an atopic condition, according to the study.

About 17% of all parents introduced their child to peanut-containing foods before age 7 months compared to 31% of those aware of the guidelines and 21% of those whose child had eczema. About 42% of parents offered peanuts to their child between 7 and 12 months.

Authors acknowledged not all infants were in the high-risk group recommended to receive peanut before 7 months, but said they wanted to know what reasons parents had for waiting. 

One-third of parents said they were afraid their child would have a reaction. However, only 1.4% of children experienced a reaction. The most common reactions were dermatologic (hives, rash, itching, swelling) and gastrointestinal (vomiting, diarrhea, stomach pain).

“Previous studies have found that, on average, infant reactions are much milder than older kids’ reactions,” author Waheeda Samady, M.D., FAAP, director of clinical research at Northwestern’s Center for Food Allergy and Asthma Research, said in a press release. “Based on this, I would say you should be more concerned about your older child, not your five-month-old. Statistically, reactions are much milder younger in life.”

About 58% of parents discussed peanut introduction with their primary care provider. Those who did were more likely to introduce peanuts before 7 months. However, nearly three-quarters of the group that discussed peanut introduction with their primary care provider did so when their child was already 6 months or older. In addition, clinicians gave similar guidance to families of children with and without eczema. 

Authors said primary care providers need handouts and tools to educate parents and that these efforts need to go beyond affluent areas. They also suggested early childhood programs, religious centers and Special Supplemental Nutrition Program for Women, Infants, and Children clinics could help communicate the guidelines.

“Future efforts to increase guideline adherence need to address disparities, provide support for medical providers, and educate about the true incidence of reactions,” they wrote.



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