New intervention improves pediatricians' ability to counsel families on early peanut introduction

Results from a randomized clinical trial published in Pediatrics show that pediatricians who received targeted educational and clinical decision-support tools were significantly more likely to advise parents to introduce peanut-containing foods early – an approach recommended by national prevention guidelines but often underused in practice.

About 8% of U.S. children have food allergies. Peanut allergy, the most common pediatric food allergy, affects more than 2% of children nationwide.

We found that supporting pediatricians with training, electronic health record prompts, and educational materials for parents significantly improved their ability to counsel families on early peanut introduction."

Ruchi Gupta, MD, MPH, lead author, pediatrician and researcher at Ann & Robert H. Lurie Children's Hospital of Chicago, and Professor of Pediatrics and Medicine at Northwestern University Feinberg School of Medicine

"Because pediatric visits at four and six months are so busy, this support is critical to ensure families receive clear guidance," Dr. Gupta added. "Our hope is that these conversations will help parents feel confident introducing peanut products early. We want to reverse the trend of increasing food allergies in the U.S. through prevention."

The randomized trial included 30 pediatric practices in the Chicago and Peoria regions, spanning federally qualified health centers, private clinics, and academic practices. Intervention practices received a clinician training video, an electronic health record (HER)-embedded decision-support tool, and visual aids for parents; control practices did not. The primary outcome was clinician adherence to guidelines, documented in EHR data at the four- or six-month well-child visit. In total, 18,480 infants were seen by 290 clinicians.

Lucy Bilaver, PhD, lead statistician for the study and Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine, noted the importance of leveraging EHR data for this pragmatic trial. "We were able to measure the primary outcome by making use of the clinical notes and structured data that pediatric clinicians generate during these well-child visits."

Among low-risk infants, guideline adherence was 84% in the intervention group versus 35% in controls. For high-risk infants, adherence was 27% in the intervention group versus 10% in controls.

"While more work is needed, the success of this intervention supports wider dissemination to prevent peanut allergy in children," said Dr. Gupta.

Dr. Gupta holds the Mary Ann and J. Milburn Smith Research Professorship for a Sr. Scientist in Child Health Research at Lurie Children's.

The study was funded by the National Institute of Allergy and Infectious Diseases (NIAID U01AI138907).