Reevaluation of published guidelines may be warranted
The current recommendations from the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) call for introducing to infants one single-ingredient food at a time and waiting three to five days to observe for food allergy before introducing another new food. However, the long waiting period might be too long, given that food allergy becomes apparent within minutes to a few hours after eating a new food. A recent survey of pediatricians, published in JAMA Network Open, found significant variability in their recommendations to parents about solid food introduction, which calls into question the relevance of the current guidelines. The study authors suggest that these guidelines are out of synch with the latest approaches to food allergy prevention, and that the long waiting period might even be harmful.
“Waiting for days between each new food introduction limits food diversity in the infant diet and may delay peanut introduction,” says lead author Waheeda Samady, MD, from Ann & Robert H. Lurie Children’s Hospital of Chicago, who is an Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “There is now evidence that food diversity helps to decrease the development of allergic diseases in infants, and early peanut introduction is an important peanut allergy prevention strategy. The current guidelines on solid food introduction to infants might interfere with these efforts to prevent food allergies. The advances in food allergy prevention and the variability in pediatric practice found in our study indicate that we should reevaluate the recommendation to wait days between foods.”
In the survey of 563 pediatric practitioners, nearly two-thirds recommended waiting less than three days and only half felt that waiting several days was helpful for families. A need for additional training on solid food introduction was reported by more than half of pediatricians participating in the survey.
“From the perspective of food allergy detection, there is no reason to wait three to five days to introduce another food,” says senior author Ruchi Gupta, MD, MPH, Director of the Center of Food Allergy and Asthma Research (CFAAR) and Professor of Pediatrics and Medicine at Northwestern University Feinberg School of Medicine and Lurie Children’s. “The guidelines need to be revisited and updated to reflect the latest research on food allergy prevention and to provide greater clarity for pediatricians and parents on safe solid food introduction to infants.”
Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through the Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Last year, the hospital served more than 220,000 children from 48 states and 49 countries.