Are parents adapting to new allergy prevention advice for infants?

By Dr. Liji Thomas, MDReviewed by Lauren HardakerJun 1 2025

Despite strong evidence that early allergen exposure can prevent food allergies, new research shows most parents still wait.

Study: Parental Motivation for Introducing Babies’ First Foods and Common Food Allergens. Image credit: shine.graphics/Shutterstock.com

A study published in the journal Nutrients aimed to understand when and why parents introduce their infants to solid foods.

Introduction

Food allergy prevention in children is an important healthcare need. Current guidelines support the early introduction of allergenic foods to infants to reduce the risk. Yet parental attitudes and practices in this field are unclear.

For more than 40 years, beginning in the late 1970s, parents were advised to delay introducing non-milk foods to their babies to prevent the development of food allergies. As such, the standard of care for healthcare providers was to instruct parents to avoid giving allergenic foods to their babies until they were at least one year old.

Despite this, food allergy prevalence increased significantly over the next four decades.

This prompted the Learning Early About Peanuts (LEAP) trial by du Toit et al., which aimed to determine whether introducing peanuts early or avoiding them in infancy was more effective in preventing peanut allergy. This randomized controlled trial demonstrated the superiority of early introduction.

As a result, the guidelines were modified to reflect this evidence, recommending that parents begin feeding peanut-based products to babies by 4-6 months of age, or if that was not possible, at least as early as possible.  

The question is whether parents are aware of this change in recommendation, and at what age they introduce solid foods to their babies. The current study explored parental decisions in giving first foods and the underlying reasons for their choice.

The study sample included only parents of children with at least one diagnosed food allergy, with an average child age of 6.9 years (54.8% boys, 45.2% girls).

Study details

The study included 42 parents who filled out an online survey. Almost all were mothers, and their children were, on average, seven years old. 61.9% of the children had peanut allergy and 52.4% had tree nut allergy.

Approximately 40% of children were born before 2016; the rest were later. About half of the children encountered their first foods between 4 and 5 months, and the rest later. The first food introduced was cereal, followed by vegetables, in ~55% and ~29%, respectively.

Compared to Canadian parents, American parents were significantly more likely to introduce vegetables rather than cereals as the first food, with an adjusted odds ratio of 9.62.

Guidelines in both countries include cereals and vegetables as appropriate first foods.

So few parents introduced eggs or fruits as the first food that their responses were not analyzed in statistical models due to insufficient sample size.

Healthcare provider advice was cited as the leading factor in parental decisions about when to start first foods in 72% of cases. This was followed by peer advice in 13% of cases.

There was no statistically significant difference in the age at which allergens, such as eggs or peanuts, were first introduced between children born before or after 2016. The data suggested a possible trend, although the number of early introductions in the pre-2016 group was small, limiting statistical power.

Implications  

The study shows that most parents give cereals as the first food to their infants, primarily because of recommendations from healthcare providers. Despite the presence of evidence from the LEAP report, there has not been a statistically significant shift towards earlier introduction.

Parents older than 34 were more likely to introduce first foods earlier in infancy, with an unadjusted odds ratio of 2.08, but this trend did not reach statistical significance.

The study highlighted many reasons why parents delay introducing the first foods in infancy. These include a fear of provoking an allergic reaction, insufficient parental education regarding the benefits of early food introduction, a lack of access to health services, and children's non-acceptance of new foods.

While many healthcare providers across multiple regions are aware of the change in guidelines regarding first foods in infancy, this information has not been fully translated to the general population.

Healthcare providers should, therefore, take opportunities to educate parents on the advantages of beginning first foods for their infants by 4-6 months or whenever the infant can tolerate it. They should present evidence that this practice decreases the risk of food allergies, disproving earlier recommendations that supported avoidance.

The study also evaluated factors such as caregiver education level and household income, but found no statistically significant association between these factors and the timing or type of the first food introduced.

Conclusions

Despite its limitations, the current study suggests that healthcare providers should guide parents in introducing foods to their babies early, based on evidence of its benefits in reducing the risk of food allergy.

However, the study’s small sample size, reliance on caregiver memory, and predominance of mothers limit the applicability of the findings to a broader audience.

A larger sample size and more objective data would increase the value of future studies and validate these findings.

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