byNorthwestern University

Handout used in the study with instructions for parents on how to add peanut protein to their baby's diet. Credit: Northwestern University

A few easy-to-implement tools—a trainingvideo, electronic health recordpromptsandhandoutsfor families—greatly increased how often pediatricians recommended early peanut introduction to infants, reports a new clinical study led by Northwestern University and Ann & Robert H. Lurie Children's Hospital of Chicago.

Since 2017, national guidelines have encouraged pediatricians to recommend introducing peanut-containing foods around 4 to 6 months of age to reducepeanut allergies. Yet, surveys show that few pediatricians strictly follow these guidelines. Peanut allergy, the most common pediatric food allergy, is on the rise and affects more than 2% of children in the U.S.

In the study, guideline adherence was 84% for low-risk infants (no eczema and no egg allergy) in practices that used the tools, compared with 35% in clinics that did not. Infants in theintervention groupwere nearly 15 times more likely to receive guidelines-based care.

The study ispublishedin the journalPediatrics.

"We found that supporting pediatricians with training, electronic health record prompts andeducational materialsfor parents significantly improved their ability to counsel families on early peanut introduction," said lead author Dr. Ruchi Gupta, professor of pediatrics and medicine at Northwestern University Feinberg School of Medicine and pediatrician at Lurie Children's.

"Because pediatric visits at four and six months are so busy, this support is critical to ensure families receive clear guidance," 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."

Therandomized trialincluded 30 pediatric practices in the Chicago and Peoria, Illinois, regions, spanning federally qualified health centers, private clinics and academic practices. Intervention practices received a clinician training video, electronic health record prompts, visual aids for parents anda scorecardto identify severe eczema; control practices did not.

Scorecard used in the study to help pediatricians identify severe eczema. Credit: Northwestern University

The primary outcome was clinician adherence to guidelines, documented in the electronic health record (EHR) data at the four- or six-month well-child visit. In total, 18,480 infants were seen by 290 clinicians.

Lucy Bilaver, lead statistician for the study and associate professor of pediatrics at Feinberg 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," she said.

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. In addition, 36% of high-risk infants in the intervention group were referred to an allergist or given an allergy test, compared with 10% in the control group.

"While more work is needed, the success of this intervention supports wider dissemination to preventpeanut allergyin children," Gupta said.

Outcomes in the trial will be tracked until children are 2.5 years old to see if the intervention reduces actual peanut allergy prevalence.

Since 2017,national guidelineshave recommended introducing peanut-containing foods around four to six months of age—a major shift prompted by alandmark clinical trialthat 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.

When a baby is developmentally ready tostart solids, peanut products can be introduced, according to the study authors. Early introduction of egg and other common allergenic foods is also encouraged, based on family preference.

More information: Ruchi S. Gupta et al, Pediatric Clinician Adherence to Peanut Allergy Prevention Guidelines: A Randomized Trial, Pediatrics (2025). DOI: 10.1542/peds.2025-071233 Journal information: Pediatrics

Provided by Northwestern University