Maternal dietary allergen restriction while breast-feeding: Pediatric resident knowledge and practices

An adequate understanding of the relationship between breast-feeding practices and infant food allergy is essential for clinicians. Although there is evidence of an education gap in general breast-feeding concepts, little is known about the pediatric trainee knowledge and practice with regard to breast-feeding, maternal diet, and potential allergy outcomes.

To assess pediatric residents' knowledge, describe practices, and evaluate a module designed to provide evidence-based education about breast-feeding, food allergy, and food avoidance to inform future resources on the topic of breast-feeding and allergic outcomes.

Pediatric residents completed a survey to assess the knowledge and comfort with regard to maternal dietary restriction, breast-feeding, and infant food allergy. Residents then viewed an online educational module about evidence-based breast-feeding and infant food allergy guidelines, and, after 1 month, completed the online questionnaire again.

Among respondents (N = 68), only 8% and 5%, felt knowledgeable and comfortable with current maternal diet during breast-feeding and infant food allergy recommendations, respectively. Eighty-seven percent had not received formal training on the topic, and a large percentage relied on mentor teaching (49%) or anecdotal evidence (19%) as opposed to available guidelines (32%) for guidance. Most respondents (61-93%) correctly answered questions with regard to guidelines on primary and secondary food allergy prevention in relation to maternal diet. The upper-level residents answered more questions correctly about allergic proctocolitis compared with the interns (p < 0.05); no differences were noted for other topics. The majority (63%) did not believe that a mother's nutritional status could be adversely affected by dietary allergen restriction. A review of the pre- and posttest scores showed the educational module had little impact on knowledge.

Pediatric residents reported low comfort and perceived that they had little knowledge about maternal diet and infant food allergy, yet their actual performance suggested the opposite. Those who completed the educational module did not demonstrate knowledge improvement, which highlighted the need for the development of robust educational resources.