Research Article: What are the beliefs of pediatricians and dietitians regarding complementary food introduction to prevent allergy?

Date Published: March 21, 2012

Publisher: BioMed Central

Author(s): Sara Leo, John Dean, Edmond S Chan.


The timing of complementary food introduction is controversial. Providing information on the timing of dietary introduction is crucial to the primary prevention of food allergy. The American Academy of Pediatrics offers dietary recommendations that were updated in 2008.

Identify the recommendations that general pediatricians and registered dietitians provide to parents and delineate any differences in counselling.

A 9-item survey was distributed to pediatricians and dietitians online and by mail. Information on practitioner type, gender, length of practice and specific recommendations regarding complementary food introduction and exposure was collected.

181 surveys were returned with a 54% response rate from pediatricians. It was not possible to calculate a meaningful dietitian response rate due to overlapping email databases. 52.5% of all respondents were pediatricians and 45.9% were dietitians. The majority of pediatricians and dietitians advise mothers that peanut abstinence during pregnancy and lactation is unnecessary. Dietitians were more likely to counsel mothers to breastfeed their infants to prevent development of atopic dermatitis than pediatricians. Hydrolyzed formulas for infants at risk of developing allergy were the top choice of formula amongst both practitioners. For food allergy prevention, pediatricians were more likely to recommend delayed introduction of peanut and egg, while most dietitians recommended no delay in allergenic food introduction.

In the prophylaxis of food allergy, pediatricians are less aware than dietitians of the current recommendation that there is no benefit in delaying allergenic food introduction beyond 4 to 6 months. More dietitians than pediatricians believe that breastfeeding decreases the risk of atopic dermatitis. Practitioners may benefit from increased awareness of current guidelines.

Partial Text

Food allergy is a hypersensitivity reaction to food allergens initiated by the immune system [1,2]. IgE-mediated food allergy (type I), forms the bulk of food-induced allergic responses and results in elevated allergen-specific serum IgE antibodies. It is not clear how the gut mucosal immune system is oriented toward sensitization versus immune tolerance when exposed to dietary antigens [3]. Food allergy is prevalent, affecting 1 – 10 % of children worldwide [4,5].

This was a cross-sectional study of general pediatricians and registered dietitians in British Columbia (BC). The study was approved by the BC Children’s and Women’s Behavioural Research Ethics Board.

With the exception of breastfeeding advice and delay of allergenic foods, pediatricians and dietitians of BC generally agree in their advice and adhere to the 2008 AAP guidelines.

Our study has provided us with data suggesting practitioners may benefit from increased awareness of current guidelines. With new thoughts on the possible benefits of oral tolerance for infants introduced to regular ingestion of specific food proteins without delay, we feel it is most important for the awareness to focus on the lack of benefit of delay. We speculate this need is not unique to British Columbia. An extension of our study is currently underway in eastern Canada.

AAP: American Academy of Pediatrics; BC: British Columbia; CM: Cow’s milk; EH: Extensively hydrolyzed; LR: Lactose reduced; LEAP: Learning Early About Peanut Allergy; PH: Partially hydrolyzed; RD: Registered Dietitian; UBC: University of British Columbia.

The authors declare that they have no competing interests.

All authors made substantial contributions to the study conception and design, acquisition of data, analysis and interpretation of data. SL drafted the manuscript. All authors were involved in revising the manuscript critically and have given final approval of the published version. All authors read and approved the final manuscript.