Adherence to Australian Infant Food Allergen Introduction Guidelines: Factors Influencing Infant Feeding Practices.

Abstract

There has been a striking shift toward earlier allergen introduction after updated 2016 Australian infant feeding guidelines. Identifying factors contributing to community uptake is important for ongoing allergy prevention efforts. To determine whether and how families received feeding advice, factors associated with the receipt and accuracy of advice, and the influence of advice on allergen introduction. Parent-completed questionnaires from the EarlyNuts population-based study of 11- to 15-month-old infants (n = 1,699), captured demographic characteristics, timing of allergen introduction, and information about feeding advice. Most families (99%) received feeding advice. Advice accuracy was highest for solids, egg, and peanut (93% to 97%), and lowest for dairy (81%). Families receiving accurate advice had greater odds of timely (4-11 months) introduction of peanut (odds ratio [OR] = 9.2; 95% CI, 5.5-15.6), egg (OR = 6.2; 95% CI, 2.9-13.4), tree nuts (OR = 3.0; 95% CI, 1.9-5.0), and dairy products (OR = 2.9; 95% CI, 1.8-4.7). Maternal child health nurses were the most common source of advice (87%) and were associated with increased odds of timely peanut (OR = 1.5; 95% CI, 1.0-2.2; P = .04), egg (OR = 2.2; 95% CI, 1.4-3.6; P = .001), and dairy (OR = 1.7; 95% CI, 1.0-2.8; P = .04) introduction. Infants with parents born outside Australia were less likely to receive allergen advice (eg, peanut advice: Australia [92%], other country [80%], and East Asia [76%]). Families residing in the North East region of Melbourne (Australia) had the highest rates of any group and accurate advice. The receipt and accuracy of infant feeding advice was widespread and associated with timely allergen introduction; however, rates were lower in culturally and linguistically diverse families. Guideline dissemination and adherence likely benefited from local council and maternal child health nurse programs.