Based on the LEAP study, recent landmark guidelines recommend introducing babies to peanuts early. But only around 13% of parents are aware of the guidelines, based on a 2021 survey.
Dr. Erika Nolte, our Science Director, talks about how vital it is for parents to know these guidelines and put them into practice.
The prevalence of food allergies among children, specifically peanut allergies, poses a significant burden on families in the United States. In response to the rising incidence of pediatric food allergies, the American Academy of Pediatrics (AAP) issued guidelines in 2000 recommending a delay in introducing peanuts until the age of three. However, the 2000 guidance was not backed by science. And subsequent research, such as the Learning Early About Peanut Allergy (LEAP) trial in 2015, challenged this approach.
The LEAP trial's results showed an 81% reduction in peanut allergies when infants were fed peanut products between 4 and 11 months of age.
As a result, the National Institute of Allergy and Infectious Diseases (NIAID) revised their guidelines in 2017, and started recommending early introduction of peanuts as a preventive measure for high-risk infants. The AAP has since adopted the same stance as the NIAID 2017 guidelines.
With a commitment to transforming the landscape of peanut allergies, the 2017 Prevention of Peanut Allergy Guidelines introduced a new way of thinking. Gone were the days of delay and avoidance. Instead, the guidelines advocated for the early introduction of peanut-containing foods into infants' diets, aiming to curb the rising tide of peanut allergies.
However, the integration of these guidelines into caregivers' practices has been marked by both progress and challenges.
Research on following the guidelines – how many parents are aware of the guidelines?
Between January and February 2021, researchers at the Center for Food Allergy and Asthma Research conducted a national survey involving parents and caregivers of children aged 7 months to 3.5 years.
The survey included a wide range of questions related to peanut consumption, including:
- Awareness of the recent peanut introduction guidelines
- Understanding of the guidelines' recommendations
- Parents' beliefs about peanut feeding
- Parents' practices in introducing peanut (age and frequency they introduced peanut)
- Parents' demographic information
The study revealed that a mere 13.3% of parents and caregivers were aware of the 2017 peanut allergy prevention guidelines.
This limited awareness was associated with several factors, including ethnicity, age, education level, income, and a personal or family history of allergies. Parents who identified as white, were 30-44 years old, earned at least a bachelor’s degree, and reported at least $60,000 per year in income were more likely to be aware of these guidelines.
Additionally, parents who had a history of allergic diseases like food allergy or eczema were more likely to be aware of the 2017 guidelines.
What percentage of parents know it’s safe to introduce peanut early?
Beliefs and practices varied significantly among respondents. Roughly half of the participants believed that introducing peanuts early in an infant's diet could reduce the risk of peanut allergies.
However, only 7.9% correctly believed that it was safe to feed peanuts before 7 months of age. And nearly a quarter of parents incorrectly believed it was only safe to introduce peanuts after their baby was 10 months old. Among those who were aware of the 2017 guidelines, a higher percentage introduced peanuts before the infant's seventh month.
What percentage of parents are introducing peanut before 6 months of age?
Parents' actual practices in introducing peanuts to their infants varied widely, with only 17.2% of parents introducing peanuts before 6 months of age.
Guideline-aware parents were more likely to introduce peanuts at an earlier age and more frequently.
|
Timing of Peanut Introduction |
|
|
Before age 6 months |
17.2% |
|
Age 7-8 months |
11.8% |
|
Age 9-12 months |
29.9% |
|
After Age 13 months |
31.4% |
|
Never Introduced |
9.7% |
Challenges in early peanut introduction
Challenges to early peanut introduction were evident, with the fear of allergic reactions being a major obstacle. Roughly one-third of parents delayed introducing peanuts due to concerns about potential reactions.
Another third of parents did not understand the importance of feeding peanuts early while approximately one-fourth received advice from their doctor to introduce them at a different age. One-fifth did not know that they should have introduced peanut.
|
Reason for Introduction After 7 Months |
|
|
Wait until after age 7 months due to fear of allergic reaction |
32.5% |
|
Not important to feed before age 8 months |
31.7% |
|
Doctor recommended a certain age |
24.4% |
|
Unaware or able to feed before age 8 months |
18.8% |
The study also delved into instances of actual allergic reactions among infants. The data showed that such reactions were relatively rare, occurring in only 1.4% of cases. Most of these reactions were mild, involving skin and gastrointestinal (GI) symptoms. This finding is particularly important, given the number of parents who delayed peanut introduction out of fear of a reaction.
What are the important takeaways from this study?
Overall, the study highlights the inadequate awareness of the 2017 peanut allergy prevention guidelines among parents and caregivers in the US. Disparities in awareness, based on factors such as ethnicity, income, and education, underscore the need for targeted efforts to ensure widespread knowledge of these guidelines.
In other words:
- More parents need to be educated on recent medical guidelines that recommend introducing peanut to babies early and often.
- More parents also need to be reassured that it’s safe – and best – to introduce peanuts when baby is 4-6 months old. After all, allergic reactions are rare in infants, and tend to be mild.
- Pediatricians and primary care doctors can play an important role in raising awareness of the guidelines, and in encouraging early peanut introduction – especially among families with lower incomes and among parents of color.
A note on introducing peanut safely: Parents need to introduce peanut to their baby in a safe way, as whole peanuts, peanut pieces, and unmodified peanut butter are all choking hazards. The American Academy of Allergy, Asthma, and Immunology (AAAAI) recommends introducing peanut powder (peanut flour) as a safe option, and states in their guidelines, "Peanut-containing products, such as powders/flours… have...been used as safe forms of peanut for infants.”
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All health-related content on this website is for informational purposes only and does not create a doctor-patient relationship. Always seek the advice of your own pediatrician in connection with any questions regarding your baby’s health.
These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure or prevent any disease.
See the FDA Peanut Allergy Qualified Health Claim at the bottom of our homepage.
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All health-related content on this website is for informational purposes only and does not create a doctor-patient relationship. Always seek the advice of your own pediatrician in connection with any questions regarding your baby’s health.
These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure or prevent any disease. If your infant has severe eczema, check with your infant’s healthcare provider before feeding foods containing ground peanuts.