Source / Disclosures
Disclosures: Fisher reports no relevant financial disclosures. Providence is an investor in Ready, Set, Food!
In 2020, guidelines changed to encourage parents and caregivers to introduce peanut and egg to infants aged 4 months to 6 months to help prevent food allergies. Yet many parents still refrain from making these early introductions.
Education is key to improving these outcomes, Danelle M. Fisher, MD, specialist in pediatrics at Providence St. John’s Health Center in Los Angeles, told Healio.
“We do have to talk to families about that,” Fisher said. “We want to share our knowledge, and we want families to understand that we actually have good science behind our recommendations.”
How to educate parents
The American Academy of Allergy, Asthma and Immunology supports the introduction of peanut and egg at age 4 months to 6 months, with earlier introduction at 4 months recommended for those at high risk, as do the American College of Allergy, Asthma and Immunology, the American Academy of Pediatrics (AAP) and the FDA.
Ready, Set, Food !, which sells supplements and baby food that include peanut, egg, milk, cashew and other allergens for infants, provides educational resources via electronic medical records about early introduction that Providence will share with families at birth and during well visits at 2, 4, 6 and 9 months.
Danelle M. Fisher
“The first part of the partnership really is all about education so families can understand from an early age that the early introduction of allergens is helpful and important to prevent food allergies, that they’re going to partner with their doctor in this journey of trying new foods, ”Fisher said.
When families have concerns, Fisher continued, providers will address them immediately and appropriately.
“I have had many families who say, ‘I’m allergic to peanuts,’ or ‘My husband is allergic to fish. How are we going to proceed? ‘ And then we talk to them through how we’re going to do a graduated approach, ”Fisher said.
During the first few months, providers work with families on introducing dairy, egg and peanuts into the infant’s diet before trying other allergens. The goal is to introduce solid foods in addition to breast milk or formula between 4 months and 6 months.
During the 2-month well visit, for example, providers will begin discussing specific goals for introducing different foods at 4 months to help families prepare. During the 4-month visit, the goals for the 6-month benchmark will be discussed, and so on.
Iron is also a concern, as iron content declines in breast milk after 6 months.
“Babies who are breastfeeding could potentially get into a situation of anemia,” Fisher said. “We encourage families to introduce oatmeal between 4 and 6 months of age, or any grain cereal really. But I encourage oatmeal because rice cereal is very constipating. ”
In addition to printed handouts, families can access information at preventallergies.org, a nonprofit affiliate of Ready, Set, Food! Also, Providence offers content to families via its Circle app and through CME webinars.
These resources are necessary because many parents are afraid of introducing their children to these foods, Fisher said, because they have been exposed to the idea that these foods are dangerous for many years.
“I can’t tell you how many times I’ve had a family say to me, ‘I would be more comfortable if I took a jar of peanut butter and a spoon and drove to the parking lot of your office and gave it to my kids for the first time there just in case something happens, ‘”she said.
“I have to laugh because I have this visual of parents coming to my office with a jar of Skippy. I always tell them to relax. It’s not going to be that dramatic of a situation, ”she continued, adding that allergies happen after multiple exposures.
“I don’t worry that somebody is going to try peanut butter and become anaphylactic and die,” she said.
Fisher acknowledges that recommendations have changed a lot during her 21-year career. When she was first training in 2001, she advised families to refrain from giving their children nuts until they were aged 2 years or 3 years.
“But what happened was we had so many kids with food allergies,” she said.
The landmark 2015 LEAP study then showed that early introduction to peanut products helped protect against food allergies, she said, adding that keeping track of changes like these can be challenging for many providers.
“We have to ask, ‘Does everybody know the right information?'” She said. “When you’re dealing with a large health care system like Providence that’s delivering care to many, many people, it helps to have that education built into the electronic medical record.”
Clinicians also need to know the science behind these recommendations, she continued. Disseminating the studies that inform these recommendations is a key part of the process.
“We have to take the recommendations that we used to make without thinking, think about them again, read about why they changed, and then make the appropriate recommendations,” she said.
“We’re not just talking about physicians. We’re talking about all the care providers – the nurses, the medical assistants, everybody that intersects with these families. We want to have the same messaging for everybody, ”she said.
That’s why Providence’s partnership with Ready, Set, Food! includes components that help the whole team be on the same page with the most recent science and making the same recommendations.
Beyond Providence, Fisher said that all providers would benefit from additional education not only about these changing guidelines but also in communicating with families. For example, Ready, Set, Food! noted that only approximately 30% of pediatricians teach families about food allergy prevention.
Fisher said she and her colleagues aim to reach providers via lectures about food allergy prevention at pediatric and family medicine conferences. Providers who can’t make it to conferences, however, can take advantage of online resources.
Fisher encourages providers to visit AAP’s websites, which she called the “gold standard” of resources for clinicians and families, with information about early food introduction, links to important studies and educational resources for clinicians and families.
Also, Fisher recommended the websites of AAAAI, ACAAI and NIH.
“NIH is a wonderful resource for clinicians, especially because they really are very top-heavy in the studies,” Fisher said. “They publish the studies that show how we get to these conclusions.”
In addition to the content on preventallergies.org, Ready, Set, Food! offers information and resources on its website, which providers can share with families seeking explanations and information about food allergies.
“It’s good to have more than one website. It’s good to have different sources of information, ”Fisher said. “There are a lot of wonderful resources on the internet that clinicians and families can access.”
With these resources in hand, Fisher said, providers can have discussions about food allergies early and overcome the fears that many families have about introducing solid food into their infants’ diets.
“For some families, it’s just excitement, and for other families, it’s a little nerve-wracking. What I think we need to present to these families is the safety of introducing these foods early and that it can be done, not to induce fear, but to promote tolerance, ”Fisher said.
“I’d love to change that way of thinking so that families approach this in a happy way, because it’s a happy time,” she said.