Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois.
Center for Food Allergy & Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
JAMA Netw Open. 2020 Aug 3;3(8):e2013070. doi: 10.1001/jamanetworkopen.2020.13070.
The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend waiting 3 to 5 days between the introduction of new complementary foods (solid foods introduced to infants <12 months of age), yet with advances in the understanding of infant food diversity, the guidance that pediatric practitioners are providing to parents is unclear.
To characterize pediatric practitioner recommendations regarding complementary food introduction and waiting periods between introducing new foods.
DESIGN, SETTING, AND PARTICIPANTS: In this survey study, a 23-item electronic survey on complementary food introduction among infants was administered to pediatric health care professionals from February 1 to April 30, 2019. Responses were described among the total sample and compared among subgroups. Survey invitations were emailed to 2215 members of the Illinois Chapter of the American Academy of Pediatrics and the national American Academy of Pediatrics' Council on Early Childhood. Participants were required to be primary medical practitioners, such as physicians, resident physicians, or nurse practitioners, providing pediatric care to infants 12 months or younger.
The main outcome measures were recommendations on age of complementary food introduction and waiting periods between the introduction of new foods. Categorical survey items were reported as numbers (percentages) and 95% CIs. Means (SDs) were used to describe continuous survey items.
The survey was sent to 2215 practitioners and completed by 604 (response rate, 27.3%). Of these respondents, 41 were excluded because they did not provide care for infants or pediatric patients. The final analyses included responses from 563 surveys. Of these, 454 pediatricians (80.6%), 85 resident physicians (15.1%), and 20 nurse practitioners (3.6%) completed the survey. Only 217 practitioners (38.6%; 95% CI, 34.1%-44.6%) recommended waiting 3 days or longer between food introduction; 259 practitioners (66.3%; 95% CI, 61.4%-70.8%) recommended waiting that amount of time for infants at risk for food allergy development (P = .02). A total of 264 practitioners (46.9%; 95% CI, 42.8%-51.0%) recommended infant cereal as the first food, and 226 practitioners (40.1%; 95% CI, 36.1%-44.2%) did not recommend a specific order. A total of 268 practitioners (47.6%; 95% CI, 43.5%-51.7%) recommended food introduction at 6 months for exclusively breastfed (EBF) infants, and 193 (34.3%; 95% CI, 30.5%-38.3%) recommended food introduction at 6 months for non-EBF infants (P < .001); 179 practitioners (31.8%; 95% CI, 28.1%-35.8%) recommended food introduction at 4 months for EBF infants, and 239 practitioners (42.5%; 95% CI, 38.4%-46.6%) recommended food introduction at 4 months for non-EBF infants (P < .001). A need for additional training on complementary food introduction was reported by 310 practitioners (55.1%; 95% CI, 50.9%-59.1%).
In this survey study, most pediatric practitioners did not counsel families to wait 3 days or longer between introducing foods unless infants were at risk for food allergy development. The findings suggest that the current recommendation limits infant food diversity and may delay early peanut introduction. Because the approach to food allergy prevention has changed, a reevaluation of published feeding guidelines may be necessary.
美国儿科学会和疾病控制与预防中心建议在引入新的补充食品（<12 个月大的婴儿食用的固体食品）之间等待 3 到 5 天，但随着对婴儿食物多样性理解的进步，儿科医生向家长提供的指导意见尚不清楚。
描述儿科医生在补充食品引入和引入新食品之间等待期方面的建议。
设计、地点和参与者：在这项调查研究中，于 2019 年 2 月 1 日至 4 月 30 日向伊利诺伊州美国儿科学会分会和美国儿科学会早期儿童理事会的儿科保健专业人员发送了一份关于婴儿补充食品引入的 23 项电子调查。对总样本进行了描述，并对亚组进行了比较。调查邀请通过电子邮件发送给 2215 名伊利诺伊州美国儿科学会分会的成员和美国儿科学会的理事会成员。参与者必须是主要的医疗从业者，如医生、住院医师或执业护士，为 12 个月或更小的婴儿提供儿科护理。
主要结果是关于补充食品引入年龄和引入新食品之间等待期的建议。分类调查项目以数字（百分比）和 95%置信区间报告。连续调查项目的平均值（标准差）用于描述。
该调查发给了 2215 名从业者，其中 604 名（回应率为 27.3%）完成了调查。其中 41 名因不照顾婴儿或儿科患者而被排除在外。最终分析包括 563 份调查的回复。其中，454 名儿科医生（80.6%）、85 名住院医师（15.1%）和 20 名执业护士（3.6%）完成了调查。只有 217 名从业者（38.6%；95%置信区间，34.1%-44.6%）建议在食物引入之间等待 3 天或更长时间；259 名从业者（66.3%；95%置信区间，61.4%-70.8%）建议对有食物过敏发展风险的婴儿等待那么长时间（P = .02）。共有 264 名从业者（46.9%；95%置信区间，42.8%-51.0%）建议婴儿谷物作为第一种食物，226 名从业者（40.1%；95%置信区间，36.1%-44.2%）不建议特定的顺序。共有 268 名从业者（47.6%；95%置信区间，43.5%-51.7%）建议纯母乳喂养的婴儿在 6 个月时引入食物，193 名（34.3%；95%置信区间，30.5%-38.3%）建议非纯母乳喂养的婴儿在 6 个月时引入食物（P < .001）；179 名从业者（31.8%；95%置信区间，28.1%-35.8%）建议纯母乳喂养的婴儿在 4 个月时引入食物，239 名从业者（42.5%；95%置信区间，38.4%-46.6%）建议非纯母乳喂养的婴儿在 4 个月时引入食物（P < .001）。310 名从业者（55.1%；95%置信区间，50.9%-59.1%）报告需要额外的补充食品引入培训。
在这项调查研究中，大多数儿科医生没有建议家庭在引入食物之间等待 3 天或更长时间，除非婴儿有食物过敏发展的风险。研究结果表明，目前的建议限制了婴儿食物的多样性，可能会延迟早期花生的引入。由于食物过敏预防方法已经发生变化，可能有必要重新评估已发表的喂养指南。
