Early Peanut Introduction Awareness, Beliefs, and Practices Among Parents and Caregivers

Prevention of Peanut Allergy (PPA) guidelines were published in 2017 and recommended early introduction of peanut for prevention of peanut allergy. Despite this, there are still mixed practices on peanut introduction among caregivers. Caregiver beliefs, awareness of guidelines, and practices were explored in this survey study.Surveys were administered to a US general population-based sample of parents and caregivers of children between the ages of 7 months and 3.5 years (infants born after the 2017 PPA Guidelines were published). There were 3062 responses recorded.The survey included questions regarding peanut consumption practices and awareness of the PPA Guidelines, primary care physician (PCP) interactions, knowledge and belief assessments on early introduction of peanut, and outcomes of peanut introduction. Child and caregiver demographics, as well as comorbid atopic conditions and family history of allergy, were also noted.Overall, 47.7% of caregivers believed that early introduction prevented peanut allergy and 76.5% believed peanut consumption prevented peanut allergy. However, varying levels of adherence with PPA recommendations were reported. Overall, 17.2% offered peanut containing foods to their infant before 7 months, compared with 31% in guideline aware caregivers. Primary reasons for introduction of peanut after 7 months included fear of reaction (32.5%) and lack of importance (31.7%). PCP counseling was the most important facilitator for those that introduced peanut before 7 months. Awareness of PPA guidelines overall was 13.3%. Guideline aware individuals were more likely to be those who self-identified as white with higher income or education level and those with atopic conditions themselves or an index child with an atopic condition.Addressing concerns about potential reactions, outreach campaigns to make caregivers aware of guidelines, and greater support for PCPs to allow for conversations regarding early peanut introduction may increase adherence to PPA guidelines.Healthcare providers should address early introduction of peanut with patients at their visits to increase adherence and caregiver comfort and knowledge of PPA guidelines for prevention of peanut allergy. Disparities between guideline aware and unaware caregivers exist; providers should be proactive about having these conversations and discussing recommendations with all patients.