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Parent-Reported Barriers and Facilitators to Early and Sustained Feeding of Allergenic Foods: A Mixed-Methods
Audrey Y X Su1, Camille X Y Lyu1, Edmond S Chan2
1Food, Nutrition and Health, The University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Parents face significant barriers to introducing allergenic foods like peanut and egg to infants, despite guidelines. Educational and healthcare support can help overcome these challenges for early allergen introduction and tolerance.
Area of Science:
- Pediatric Allergy and Immunology
- Public Health Nutrition
- Infant Feeding Practices
Background:
- National guidelines recommend early introduction (4-6 months) of allergenic foods (e.g., peanut, egg) for primary prevention of food allergies.
- Sustained feeding is crucial for maintaining tolerance, yet parents encounter difficulties with both introduction and ongoing consumption.
- Commonly allergenic foods include peanut, egg, cow's milk, tree nuts, wheat, sesame, fish, shellfish, and soy.
Purpose of the Study:
- To investigate parent-reported barriers and facilitators to the early introduction and sustained feeding of common allergenic foods in infants.
- Understanding these factors is essential for improving adherence to food allergy prevention guidelines.
Main Methods:
- A systematic literature search was conducted across multiple databases (MEDLINE, EMBASE, CENTRAL, CINAHL, PsycInfo) for articles published between January 2008 and July 2024.
- Data from nine selected studies, involving 4,898 parents, were synthesized using the Joanna Briggs Institute convergent integrated approach.
- Reflexive thematic synthesis was employed for data analysis.
Main Results:
- Nine studies involving 4,898 parents revealed more barriers than facilitators to early allergenic food introduction.
- Key barriers included perceived risk/fear of reactions, practical/lifestyle constraints, infant feeding issues, limited healthcare provider guidance, and parental skepticism.
- Educational and healthcare supports emerged as the primary facilitators.
Conclusions:
- Parental, infant, and systemic barriers impede adherence to guidelines for early and sustained allergenic food feeding.
- Enhanced support from healthcare providers and practical, accessible guidance are crucial for addressing these challenges.
- Further research is needed to explore facilitators across diverse sociocultural contexts for allergen feeding.
Background:
For the primary prevention of food allergies, several national professional organizations recommend introducing commonly allergenic foods, particularly peanut and egg, to infants at about age 4 to 6 months (or when developmentally appropriate) and continuing regular feeding to maintain tolerance. However, parents often face challenges with introduction and/or sustained feeding.
Objective:
To examine parent-reported barriers and facilitators to the early introduction and sustained feeding of commonly allergenic foods (peanut, egg, cow's milk, tree nuts, wheat, sesame, fish, shellfish, and soy) in infants.
Methods:
MEDLINE, Embase, CENTRAL, CINAHL, and PsycInfo databases were searched for relevant articles published between January 2008 and July 2024. Extracted data from selected studies were synthesized using the Joanna Briggs Institute convergent integrated approach and analyzed using a reflexive thematic synthesis approach.
Results:
We identified 9 studies reporting on the experiences of 4898 parents. More barriers than facilitators were identified. Five main themes related to barriers in introducing and feeding commonly allergenic foods to infants were identified: (1) perceived risk and fear of adverse reactions, (2) practical and lifestyle constraints, (3) infant-related feeding difficulties, (4) health care provider access and guidance, and (5) parental skepticism. One main theme related to facilitators was identified, namely, educational and health care supports.
Conclusions:
Parental, infant, and system-level barriers continue to limit adherence to guidelines for early and sustained feeding of commonly allergenic foods. Support from health care providers and accessible, practical guidance may help address these challenges. Future research is warranted to better understand facilitators of early and sustained allergen feeding across sociocultural contexts.
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