Are practitioners giving the best advice for food introduction?

The introduction of foods is a major milestone for every infant. It opens up a whole new world of tastes and textures, but it can also make parents worry about whether the food will elicit a food allergic reaction. A survey study reported in JAMA Network Open examined the advice that pediatric practitioners give to parents when the time comes to introduce foods.¹

The investigators used a 23-item electronic survey that covered complementary food introduction among infants. Invitations to complete the survey were sent to 2215 member of the Illinois chapter of the American Academy of the Pediatrics and the national American Academy of Pediatrics’ Council on Early Childhood between February 1, 2019, and April 30, 2019. The participants had to be primary medical practitioners, such as physicians, resident physicians, or nurse practitioners who provided care to infants aged 12 months or younger.

The survey was completed by 604 respondents, but 41 were excluded because they didn’t provide care for infants aged 12 months or younger. The remaining respondents comprised 454 pediatricians, 85 resident physicians, and 20 nurse practitioners. Slightly more than 1/3 of the respondents said they recommended waiting 3 days or longer between the introductions of new foods, but 66.3% of them did recommend waiting that amount of time if the infant was at risk for developing a food allergy. Two hundred sixty-eight pediatric practitioners recommended beginning food introduction at 6 months of age for exclusively breastfed infants and 193 recommended the same for infants who had not been exclusively breastfed. Food introduction at 4 months was recommended by 179 practitioners for infants who had been exclusively breastfed and 239 recommended it for non-exclusively breastfed infants. When ask if there was a recommendation about which food to introduce first, 264 practitioners said they recommended using infant cereal, but 226 said that they recommended no specific order for food introduction. A need for training on complementary food introduction was recommended by 310 respondents.

The researchers concluded that many pediatric practitioners are not counseling parents to wait at least 3 days between food introductions during infancy, except in the case of infants who are at risk of developing a food allergy. They said that the findings indicate that current recommendations could limit infants’ food diversity and additionally could delay early peanut introduction. As food allergy prevention methods have changed, a reexamination of the current feeding guidelines could be needed.

Reference

1. Samady W, Campbell E, Aktas O et al. Recommendations on complementary food introduction among pediatric practitioners. JAMA Netw Open. 2020;3(8):e2013070. doi:10.1001/jamanetworkopen.2020.13070