Parental Understanding of AAP Peanut Introduction Guidelines

Introduction: The 2015 Learning Early About Peanut Allergy (LEAP) trial demonstrated that the early peanut consumption reduced peanut allergy incidence in high-risk children. As a result, The American Academy of Pediatrics (AAP) revised its guidance in 2017, recommending peanut introduction at 4–6 months rather than at 3 years. Our study evaluates parental understanding of AAP peanut feeding guidelines.

Methods: Parents of children < 18 were recruited via Amazon Mechanical Turk (N=214) for a survey on knowledge of AAP peanut guidelines including timing, food forms and choking hazards. Group comparisons were performed using Chi-square or Fisher’s exact tests, and multivariable logistic regression was used to identify independent predictors of having 1 or 0 correct responses out of 4 questions.

Results:

Results: Mean age of respondents’ youngest child was 2.15 yr, and 210 (98%) had at least a college degree. 62 (29%) participants correctly identified the 4–8 month window for peanut introduction. 151 (71%) participants correctly identified peanut butter/flours as appropriate forms for first introduction to infants. 97 (45.3%) felt that whole peanuts should be introduced at 12 mos of age or younger. 152 (71.0%) respondents had children with food allergies and were significantly more likely to have 1 or 0 correct answers (123/152, 80.9%) compared with parents of children without food allergies (30/62, 48.4%, p<.001). In multivariable analysis, child food allergy status and healthcare worker status independently predicted 1 or 0 correct responses. 203 (94.9%) respondents said they had discussed peanut introduction with their healthcare provider.

Conclusions: Significant knowledge gaps regarding peanut introduction timing persist among parents, particularly among families already affected by food allergies. Findings suggest healthcare provider counseling may be inadequate, potentially increasing nut aspiration risks.