Perhaps you have seen the recent news (via Health Journo) that the USA have updated their infant weaning guidelines in light of the best recent research on introduction of peanuts? The LEAP study, and others, give strong evidence that exposing babies at high risk of allergy (due to other existing allergies, eczema or asthma) to peanuts from 4 months seems to have a preventative effect against peanut allergy. This is a really exciting development, as it has the potential to stem the apparent growing tide of allergies among children. To my knowledge, the same evidence hasn’t yet been found for other allergies, but more research is underway; and these results would seem to imply that early allergen exposure is important to the developing immune system.
I’m not down on this news in the slightest – the problem this presents is in the complicated process of changing and communicating this guidance to parents and carers. Anyone who has cared for a very young child will be familiar with the moan from their family members and others:
“oh they (the government, health providers) can’t agree on what you should do”
“they change their mind all the time on what we should be doing”
“we didn’t do it like that in my day”
It becomes a reason to ignore the health professionals and find your own way. “Just trust your instinct” parents are advised by the well-meaning. It breeds mistrust in health visitors and GPs. (And when you’re a new parent, your instinct is sleep-deprived and haywire anyway – I don’t KNOW! I haven’t showered in 3 days! Just tell me how to keep this small screaming thing alive!)
The fact that the message changes is not a failing of the health system – it is a fact of the scientific process. Medical professionals do what the best evidence shows we should do, until better evidence comes along (assuming they are made aware of the better evidence). The fact that the message on allergen introduction may be about to change shows we now understand more, and are willing to change what was wrong – and should breed more trust in the system. Sadly it seems a fact of the human condition that we trust people who are certain and immovable in their opinions rather than willing to reevaluate them in light of new, more reliable information.
I digress. What I wanted to highlight was what a disaster this kind of situation is in terms of health communication. The UK is set to release new guidance on infant nutrition and introduction of allergens in the summer. So between now and then, the interim approach I have gleaned from news reports and expert commentary seems to be:
“If your child is at risk of allergies, introduce peanuts and continue exposure (but not whole nuts for goodness’ sake, they’ll choke!) from 4-6 months, but only once you have persuaded your doctor based on the new US guidelines and emerging research they and your health visitor probably haven’t seen (and could well ignore as you are a neurotic new parent armed with Dr. Google); we’re not sure about other allergens but it seems a fair bet to follow the same approach, and meanwhile breastfeed exclusively until 6 months and then alongside weaning; oh yes also formula exists but we couldn’t mention that before because of the World Health Organisation who might think we are promoting feeding your baby to keep it alive if you can’t do the boob thing.”
At a recent conference I attended, in a session on health communication, the shocking statistic was shown that 42% of adults in the UK are unable to understand basic written health information in a leaflet such as the kind you might pick up in the GP waiting room. If statistics or numbers are included this rose to over 60%. (source). So what hope do people have with the above mish mash of information?
Of course I recognise that science takes time, as do guideline changes; but health communication around infant nutrition is particularly challenging. As well as this 6 month hinterland whilst we wait for new guidelines (during which I assume the parents of children who miss the new information and go on to develop peanut allergy are acceptable collateral damage in health economic terms?!) communicating the new messages in the summer will be a hard and messy task.
Whilst introducing solid food to my now 3-year-old (with eczema and a cow’s milk allergy diagnosed at 12 weeks old) I was fastidious in my research on the best thing to do with respect to introducing other allergens, as well as gluten due to my own coeliac disease. The information I got from health professionals varied enormously – from the faded poster in the hospital warning to delay introduction of nuts for as long as possible, to the pragmatic advice from my GP (herself with a CMPA child), to the new studies coming out of Scandinavia on introduction of gluten, to the health visitor’s baffled reliance on her manual, and a 4 month wait to see a dietitian (um, you kind of missed the weaning bit). Not to mention the NCT’s dumbed down weaning workshop. And that was just for her allergies.
Consider everything else you are worried about getting right when weaning and you are confused by vague or conflicting guidance on everything from portion sizes (be guided by the baby, but don’t make them fat!); inclusion of protein; whether you should go ‘baby led’ or use purées; use of formula; what cup they are supposed to use in which month so their mouths form properly (seriously – do you know any healthy adults who can’t drink from a glass?); when it’s ok to drop milk feeds; what snacks are needed; whether you should have organic food or fortified cereals… Most of us seem to end up muddling our way through somewhere in the middle and borrowing ideas from everywhere. We usually forget to eat ourselves.
As you can see the sources of information for new parents are many and muddled; and that’s before you even consider the wealth of information and misinformation on non-NHS parent portals, alternative health sites, community sites and message boards.
With health literacy as poor as it is, public health bodies have a need to send very simple clear messages. Unfortunately science is not static, babies are not simple or all the same, and it is not always clear what to do. Combine that with the recent crazy proliferation of information online; the challenge to communicate new guidelines effectively even through the ‘official’ sources of health advice is probably even bigger than the science and guideline updates were in the first place.