Introducing peanut-containing foods to infants can dramatically reduce the risk of peanut allergies later in childhood.
But many parents - particularly those who are Black, Hispanic, lower-income or have less formal education - aren't receiving this potentially lifesaving guidance from their pediatrician and are introducing peanuts at much lower rates, reports a large new Northwestern Medicine study.
The study surveyed in 2021 a nationally representative sample of over 3,000 U.S. parents of children aged seven to 42 months. By the time their child turned one, 51% of white respondents had introduced peanut-containing foods, compared to 42% of Black, 36% of Hispanic and 35% of Asian American parents. Early introduction was also significantly more common among high-income and college-educated parents.
When it came to advice on when and how to introduce peanuts, only about half of Black and Hispanic parents said their pediatrician brought it up, compared to nearly two-thirds of white parents. Just as concerning, only 29% of Black parents believed peanut introduction before 12 months would help prevent peanut allergies, compared to 53% of white parents.
These disparities are especially troubling because children from low-income and minority families already experience higher rates of food allergies and more severe outcomes.
"Our findings suggest that families from racial and ethnic minority groups and those with lower incomes are less likely to receive accurate, timely guidance from their primary care provider on how to introduce peanut during infancy," said first author Dr. Christopher Warren, assistant professor of preventive medicine (epidemiology) at Northwestern University Feinberg School of Medicine.
"It's surprising how inequitable implementation of guidelines remains, especially given how safe and effective early peanut feeding appears to be," Warren added.
According to Warren, this is the first study to closely examine how the food allergy prevention guidance parents reportedly receive from their child's doctor varies based on race, income and other background factors.
The findings were published July 8 in the journal Academic Pediatrics.
What parents need to know
Since 2017, national guidelines have recommended introducing peanut-containing foods around 4 to 6 months of age - a major shift prompted by a landmark clinical trial that showed early introduction cuts peanut allergy risk by more than 80%. Before that, parents were often told to delay peanut feeding out of concern it might trigger allergies.
Peanut allergy, which can be life-threatening, is on the rise and now affects an estimated 2% of U.S. children. Strong evidence from randomized trials shows that early and frequent exposure to peanut products, alongside other complementary foods, helps prevent peanut allergy later in childhood, especially in babies with risk factors like eczema or egg allergy.
The guidelines recommend offering peanut-containing products - such as smooth peanut butter thinned with water or infant-safe peanut puffs - after other developmentally appropriate foods have been successfully introduced.
Closing the gap
To make early peanut introduction more equitable, Warren said primary care providers, especially those serving underserved communities, need better tools and resources.
"We know that parents and primary care providers have limited time together during well-child visits, and many other topics compete for attention," Warren said. "That's why it's essential that both groups are equipped with high-quality information and simple, effective guidance."
Linguistically and culturally tailored handouts can also help parents feel more confident introducing peanut safely at home, Warren added. And larger policy efforts, such as adding peanut-containing products to WIC food packages, could improve access for low-income families.
With about 40% of U.S. infants insured through Medicaid, Warren said Medicaid state programs could also be key in scaling education and outreach.
Other Northwestern University authors that supported the study are Dr. Alanna Stinson, Dr. Waheeda Samady, Dr. Lucy Bilaver, Dr. Sai Nimmagadda and Dr. Ruchi Gupta.
This study titled, "Disparities in Caregiver-reported Knowledge, Attitudes, Behaviors and Guidance regarding Primary Prevention of Peanut Allergy," was funded by Food Allergy Research and Education (FARE) AWD001529.
