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Instructional handout given to parents for incorporating peanut protein into infant diets

Credit: Northwestern University

• Pediatricians were nearly 15 times more likely to follow prevention guidelines when using new clinical tools

• Resources included a training video, electronic prompt system, and family handouts

• Study examined 30 pediatric clinics and 18,480 infant visits

CHICAGO — A new clinical trial led by Northwestern University in cooperation with Ann & Robert H. Lurie Children’s Hospital of Chicago found that simple tools—such as a clinician training video, electronic system cues, and educational materials for parents—substantially increased pediatricians’ recommendations for introducing peanut-based foods early in infant diets.

Since 2017, healthcare guidelines have advised early peanut introduction between 4 to 6 months of age to help prevent peanut allergies. Still, many pediatricians haven’t consistently applied these guidelines. Peanut allergy remains the most common food allergy among children in the U.S., affecting over 2% of young children and continuing to increase in prevalence.

According to the study, pediatricians following the intervention tools recommended early peanut introduction for 84% of low-risk infants (those without eczema or egg allergies), compared to only 35% in practices that did not use these supports. The presence of these tools made it nearly 15 times more likely for families to receive guideline-based advice.

“Providing doctors with thorough training, digital reminders, and take-home materials for families clearly helped improve communication around early peanut exposure,” explained study lead Dr. Ruchi Gupta, a pediatrician and professor at Northwestern University Feinberg School of Medicine and Lurie Children's Hospital.

“Well-baby visits at 4 and 6 months are often packed with information, so these resources ensure families receive focused and practical guidance,” Gupta added. “We want parents to feel more confident beginning peanut foods early, with the goal of preventing more food allergies across the country.”

The study findings will be officially released in the journal Pediatrics on Monday, October 6.

Study design and methodology

The randomized trial included 30 pediatric clinics located in the Chicago and Peoria, Illinois areas. These represented a range of settings, including federally qualified health centers, private practices, and academic institutions. Clinics in the intervention group were provided with a variety of resources: a clinician video tutorial, electronic health record (EHR) alerts, visual aids for families, and a tool to assess severe eczema. Clinics in the control group did not receive these aids.

The central focus of the study was whether doctors followed national guidelines, which researchers verified through the patients’ EHR data during their 4- or 6-month wellness visits. A total of 18,480 infants were seen by 290 healthcare providers.

Lucy Bilaver, the study’s primary statistician and associate pediatrics professor at Northwestern, emphasized how important EHR information was to tracking results. “We were able to assess the main outcome by analyzing structured documentation doctors created during routine visits,” she said.

Key outcomes

Among infants considered low-risk, pediatricians in the intervention group followed the guidelines 84% of the time, versus 35% in the control group. For high-risk infants, guideline adherence was 27% in the intervention group and only 10% in clinics without tools. Notably, more high-risk infants from intervention clinics were referred to specialists or tested for allergies—36% compared to 10% in control practices.

“Although further steps are needed, this intervention shows promise for broader adoption and represents a step forward in preventing peanut allergies,” Gupta commented.

Researchers plan to continue monitoring the children involved in this study until age 2.5 to determine if guideline compliance actually translates into fewer peanut allergies.

What families should understand

Since 2017, federal guidelines recommend that peanut-based foods be introduced to infants as early as 4 to 6 months old. Those recommendations emerged after a major clinical trial demonstrated that early exposure to peanuts can lower the risk of developing peanut allergies by over 80%. Previously, parents were often advised to wait before introducing these foods, due to allergy concerns.

According to the study authors, parents should look for signs their baby is ready for solid foods, then begin offering peanut-containing items appropriately. Early introduction of eggs and other potential allergens is also advisable, depending on the family’s approach.

This research, titled “Pediatric Clinician Adherence to Peanut Allergy Prevention Guidelines: A Randomized Trial,” received funding support from the National Institute of Allergy and Infectious Diseases (NIAID U01AI138907).

Journal

PEDIATRICS

Article Title

Pediatric Clinician Adherence to Peanut Allergy Prevention Guidelines: A Randomized Trial

Article Publication Date

6-Oct-2025