P2.O292: Introducing peanuts: it's nut so scary!

Purpose/Objectives: The addendum guidelines for early peanut introduction were established in 2017 and studies have demonstrated low rates of new peanut allergy after introduction in a high-risk infants. Despite this, some parents have not introduced peanuts to their child which may be for many different reasons. Our quality improvement project aims to increase resident physician awareness for early peanut introduction and how to discuss this topic with families from a baseline of 45% to 60% by November 2023 and sustain for one year.

Design/Methods: Parents with children within the age range of 6-15 months at a single continuity clinic in Phoenix, Arizona were surveyed regarding whether they had introduced peanuts or peanut product to their child and if their physician discussed this with them. Similarly, all residents assigned to this clinic for a large pediatric residency program were invited to participate. The pre-intervention survey assessed baseline knowledge and practice habits on a Likert scale. A detailed lecture regarding the addendum guidelines and practical ways for peanut introduction was presented to resident physicians. One month later, a summarized handout highlighting high yield tips was emailed to residents twice in a 2 week span. Four months later, knowledge retainment and practice habits were reassessed with a post-intervention survey.

Results: Of 49 parents surveyed, 18% reported that they have introduced peanuts to their child and 32% reported that a physician discussed this topic with them. On pre-intervention survey with 40 respondents, 45% of residents were familiar or very familiar with the current addendum guidelines. Similarly, 45% of residents were often or always discussing peanut introduction at the 6 month well child visit. Most reported barriers included time restraints (60%), being unaware of the guidelines (38%), and/or not comfortable discussing this topic (15%). On post-intervention survey with 33 respondents, 84% of residents felt comfortable or very comfortable discussing early peanut introduction with families. Additionally, 84% of residents were familiar or very familiar with the current addendum guidelines and 75% of residents were often or always discussing peanut introduction at the 6 month well child visit.

Conclusion/Discussion: This project highlights the resident physician knowledge gap of the current guidelines for early introduction. Educating physicians increased awareness of current guidelines and improved practice habit to discuss early introduction. The next phase is ongoing by educating families and to reassess the parental perspective and implementation of early introduction. A peanut allergy can have detrimental impact on many aspects of life. However, we as resident physicians have the unique opportunity to educate families to prevent development of a peanut allergy and to share this knowledge at primary care clinics across the country.