“Tremendous Trust” in Pediatricians Facilitates Early Introduction of Peanut

A good relationship with a child’s pediatrician or clinician was the biggest factor associated with caregivers introducing peanut early to prevent allergy.

“Our center had done previous research looking at how allergists and pediatricians approached the 2017 Addendum Guidelines for the Prevention of Peanut Allergy in the United States that recommend incorporating peanut protein into infants’ diets to prevent peanut allergy,” Waheeda Samady, MD, explains. “But parents and caregivers were the missing piece—a very important piece. As pediatricians or allergists, we can educate parents as much as possible, but it’s ultimately up to the caregivers to follow the guidelines.”

For a study published in Pediatrics, Dr. Samady and colleagues examined awareness, beliefs, practices, and outcomes around peanut introduction among US parents and caregivers of children aged 7 months to 3.5 years. The researchers distributed a national survey and focused on parents and caregivers of children born after the 2017 guidelines were introduced.

Multiple Factors Impact Compliance With 2017 Guidelines

The analysis included results from 3,062 parents/caregivers. More than half (59.6%) were aged 30-44 and nearly half (49.4%) identified as White non-Hispanic, followed by more than a quarter (27.9%) who identified as Hispanic.

In total, 13.3% of parents/caregivers reported knowing about the 2017 guidelines. Factors associated with greater awareness (P<0.001) included White race, being 30-44 years old, education, high income, and caring for a child with food allergy or eczema.

“In regard to disparities, what we found is not surprising,” Dr. Samady says. “Imbalances in access to care and systemic racism make it more challenging for all groups to access the same types of information and recommendations. We also know that most primary care clinicians are not adequately educated to identify eczema in people of color, which contributes to our inability to identify risk in specific racial groups. Further, social determinants of health may make it more challenging for a caregiver or parent to comply with the guidelines, even if they were provided the right information.”

Approximately half of parents (47.7%) believed that early introduction of peanut prevented peanut allergy; 17.2% first gave their child foods containing peanut before the age of 7 months and 41.8% did so between 7 and 12 months. Parents and caregivers who were aware of the guidelines offered peanut-containing foods sooner.

“There are multifactorial influences on who is aware and complies with early peanut introduction recommendations,” Dr. Samady says (Figure). “This stresses the importance of the pediatric clinician and shows that parents with a child who has eczema are getting the message that their child is at high risk, which is good. Further, the findings emphasize that adherence to the recommendations for early introduction can be moderated by the type of information caregivers or parents have access to.”

More than half of the parents/caregivers (57.8%) reported that they had discussed peanut introduction with their child’s clinician. Counseling by a clinician was the most common facilitator for the introduction of peanut before the age of 7 months (OR, 16.26). Fear of an allergic reaction was the most frequent reason for waiting until after 7 months (32.5%). However, allergic reactions during peanut introduction were only reported by 1.4% of respondents.

Standardizing Information About Early Peanut Introduction

“It’s important to stress just how significant your voice and your recommendations are as a pediatrician,” Dr. Samady says. “We found that the single most important factor in a parent or caregiver complying with early peanut introduction was that the clinician recommended it. There is a tremendous amount of trust in that relationship.”

She encourages clinicians to become familiar with the guidelines to serve as a source of information for patients and to develop workflows that enable follow-up, which could also “reduce bias in how  we provide information to families.”

Finally, Dr. Samady advocates for a standardized approach for providing information about early introduction of peanut at the 4-month and 6-month well visits, in addition to prepared literature—such as a handout or an after-visit summary—that provides information for families after they’ve left the pediatrician’s office. “Using the survey data and additional research using qualitative methods, such as interviews, we can develop interventions to help address some of the informational gaps and fears around early peanut introduction.”