infant

Major modifiable risk factors for childhood food allergies include delayed introduction of solid foods and early treatment with antibiotics. James W. Mold, MD, MPH

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Importance: The incidence and risk (predictive) factors for early life food allergy development remain uncertain.

Objective: To estimate the incidence and quantify risk factors for food allergy development.

Data sources: MEDLINE and Embase were systematically searched to January 1, 2025. Data were analyzed from June 1, 2025, to November 25, 2025.

Study selection: Incidence estimates included studies confirming food allergy via food challenge. Risk factor analyses included cohort, case-control, and cross-sectional studies in any language assessing children younger than 6 years using multivariable analyses.

Data extraction and synthesis: Paired reviewers independently extracted data. Random-effects meta-analyses pooled incidence and adjusted odds ratios (ORs). Risk of bias was assessed using the QUIPS tool, and certainty of evidence assessed using GRADE.

Main outcome and measure: The primary outcome was food allergy to age 6 years.

Results: A total of 190 studies involving 2.8 million participants across 40 countries were analyzed. Among studies using food challenge, overall food allergy incidence was likely 4.7% (moderate certainty). Among 176 studies identifying 342 risk factors with varying certainty, the strongest and most certain factors included prior allergic conditions (eg, atopic dermatitis [eczema] within the first year of life [OR, 3.88; risk difference [RD], 12.0%; 95% CI, 8.8%-15.7%], allergic rhinitis [OR, 3.39; RD, 10.1%; 95% CI, 6.7%-14.4%], and wheeze [OR, 2.11; RD, 5.0%; 95% CI, 2.1%-8.8%]), severity of atopic dermatitis (OR, 1.22; RD, 1.0%; 95% CI, 0.6%-1.6%), increased skin transepidermal water loss (OR, 3.36; RD, 10.0%; 95% CI, 6.3%-14.8%), filaggrin gene sequence variations (OR, 1.93; RD, 4.2%; 95% CI, 2.4%-6.4%), delayed solid food introduction (eg, peanut after age 12 months [OR, 2.55; RD, 6.8%; 95% CI, 1.9%-14.6%]), infant antibiotic use (first month [OR, 4.11; RD, 12.8%; 95% CI, 0.4%-40%], first year [OR, 1.39; RD, 1.8%; 95% CI, 0.8%-3.1%], during pregnancy [OR, 1.32; RD, 1.5%; 95% CI, 0.6%-2.5%]), male sex (OR, 1.24; RD, 1.1%; 95% CI, 0.7%-1.6%), firstborn child (OR, 1.13; RD, 0.6%; 95% CI, 0.3%-1.0%), family history of food allergy (eg, mother [OR, 1.98; RD, 4.4%; 95% CI, 2.5%-6.8%], father [OR, 1.69; RD, 3.2%; 95% CI, 1.3%-5.5%], both parents [OR, 2.07; RD, 4.8%; 95% CI, 1.3%-5.5%], siblings [OR, 2.36; RD, 6.0%; 95% CI, 4.4%-8.0%]), parental migration (OR, 3.28; RD, 9.7%; 95% CI, 4.9%-16.3%), self-identification as Black (vs White [OR, 3.93; RD, 12.1%; 95% CI, 5.2%-22.5%], vs non-Hispanic White [OR, 2.23; RD, 5.5%; 95% CI, 3.0%-8.7%]), and cesarean delivery (OR, 1.16; RD, 1.0%; 95% CI, 0.3%-1.2%). Factors like low birth weight, postterm birth, maternal diet, and stress during pregnancy showed no significant risk difference.

Conclusions and relevance: In this meta-analysis, the most credible risk factors associated with development of childhood food allergy are a combination of major and minor risk factors, including early allergic conditions (atopic march/diathesis), delayed allergen introduction, genetics, antibiotic exposure, demographic factors, and birth-related variables.

Author/s:

Nazmul Islam, Alexandro W L Chu, Falana Sheriff, Farid Foroutan, Gordon H Guyatt, Romina Brignardello-Petersen, Paul Oykhman, Alfonso Iorio, Ariel Izcovich, Katherine M Morrison, Yetiani Roldan Benitez

2024 edition of the Rourke Baby Record

Hope Smashey — Sat, 13 Sep 2025 19:21:41 +0000

Date Added:

September 13, 2025

Journal/Publication:

Canadian Family Physician

Publication Date:

September 13, 2025

Issue:

Volume:

Pages:

553-561

URL:

2024 edition of the Rourke Baby Record

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.7109553

Keywords

child

infant

Baby

PMID (1):

40940145

MeSH

Culturally Competent Care

primary health care

Vegetarians

Eating

This is an article explaining and updating a tool used in many Canadian practices that care for babies and their mothers. The actual Baby Record can b downloaded free at https://www.rourkebabyrecord.ca

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Objective: To assist busy primary care providers caring for infants and young children and their families by providing them with the most recent recommendations and supportive evidence included in the 2024 edition of the Rourke Baby Record (RBR).

Quality of evidence: Articles from pediatric preventive care literature (January 2019 to March 2023) were reviewed for relevance and quality of evidence. When available, evidence from systematic reviews, relevant clinical guidelines, and clinical trials were incorporated. In the absence of high-level evidence, observational studies and expert opinion on the topic were included. Primary research studies were reviewed and critically appraised using a modified protocol.

Main message: Notable updates in the 2024 edition of the RBR include the promotion of early relational health for families; identification of targeted support and resources as opposed to labelling of high-risk groups; guidance on culturally safe care; clarification and evidence-based adjustments of the age of achievement of some developmental surveillance milestones; recommendations on plant-based beverages, vegetarian, and vegan diets; screening considerations for iron deficiency; dangers of ingestion of button batteries and cannabis edibles; literacy and socioemotional benefits of reading, singing, and storytelling; the importance of unstructured outdoor play; the environment's effect on children's health; the significance of sentinel injuries; acholic stools; and the normal presence and abnormal persistence of developmental (primitive) reflexes.

Conclusion: Building on its 40-year history, the 2024 RBR provides freely available, evidence-informed recommendations to guide clinicians in providing effective, up-to-date, and comprehensive preventive pediatric care. Despite the challenging and evolving landscape of primary health care delivery, the RBR will continue to support primary care providers.

Author/s:

Anne Rowan-Legg, Patricia Li, Bruce Kwok, Leslie Rourke, Denis Leduc, James Rourke, Imaan Bayoumi

2024 edition of the Rourke Baby Record

Hope Smashey — Sat, 13 Sep 2025 19:21:20 +0000

Date Added:

September 13, 2025

Journal/Publication:

Canadian Family Physician

Publication Date:

September 13, 2025

Issue:

Volume:

Pages:

553-561

URL:

2024 edition of the Rourke Baby Record

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.7109553

Keywords

child

infant

Baby

PMID (1):

40940145

MeSH

Culturally Competent Care

primary health care

Vegetarians

Eating

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Author/s:

Anne Rowan-Legg, Patricia Li, Bruce Kwok, Leslie Rourke, Denis Leduc, James Rourke, Imaan Bayoumi

Breastfeeding and Health Outcomes for Infants and Children

Alex Haga — Fri, 04 Apr 2025 20:30:02 +0000

Date Added:

April 4, 2025

Journal/Publication:

Agency for Healthcare Research and Quality

Publication Date:

March 31, 2025

URL:

Breastfeeding and Health Outcomes for Infants and Children

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

MeSH

An evidence-based review of the impacts of breast feeding on health outcomes in infants and children. James W. Mold, MD, MPHJ

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Objectives. To review the evidence on the association between breastfeeding and infant and child health outcomes, including the extent to which these associations vary by the intensity, duration, mode, and source of breastmilk consumption. In this review, breastfeeding refers to feeding breastmilk whether directly from the breast or other means and includes breastmilk from pasteurized donor milk.

Data sources. Systematic literature searches in MEDLINE, Embase and CINAHL for English-language articles published from 2006 to August 14, 2024. We identified additional studies from reference lists and technical experts.

Review methods. We worked with our sponsor and a panel of technical experts to identify the outcomes of interest for this review. The evidence for more than 20 outcomes was synthesized, including outcomes related to infectious diseases, asthma and allergic conditions, oral health, autoimmune gastrointestinal conditions, endocrine conditions, cardiovascular disease (CVD), childhood cancer, cognitive development, and infant mortality. We relied on existing systematic reviews (ESRs) for all outcomes and conducted bridge searches for newer primary studies since the search date of the most recent and relevant ESR. Studies were evaluated for eligibility and quality, and data were abstracted on study design, demographics, breastfeeding exposures and referents, and outcomes. We synthesized the evidence by outcome, summarizing the results of ESRs alongside those of newer primary studies. No meta-analyses were conducted given the combination of ESR and primary study evidence and heterogeneity in exposures and outcomes; but figures were created to visually display point estimates across studies.

Results. A total of 29 ESRs and 145 primary studies were included. The cumulative number of studies included for each outcome varied from only 4 studies examining the relationship between breastfeeding and type 2 diabetes to more than 180 studies reporting on the relationship between breastfeeding and obesity-related outcomes. We rated the strength of evidence as “Low” or “Moderate” for most outcomes, given limitations of the underlying evidence base, along with concerns related to heterogeneity of the study designs, and the consistency and precision of results. An association indicating a reduced risk from “more” versus “less” breastfeeding was most apparent for otitis media, asthma, obesity in childhood, and childhood leukemia. A protective association of breastfeeding was also found for severe respiratory and gastrointestinal infections in younger children, allergic rhinitis, malocclusion, inflammatory bowel disease, type 1 diabetes, rapid weight gain and growth, systolic blood pressure, and infant mortality, including sudden unexpected infant death, although our confidence in these findings was lower. There was no apparent association for the outcomes of atopic dermatitis, celiac disease, and cognitive ability. An association indicating an increased risk of dental caries was noted for breastfeeding 12 months or longer. There was insufficient evidence to draw conclusions about the relationship with food allergies and type 2 diabetes and no data on coronavirus disease 2019 (COVID-19) or CVD endpoint outcomes (i.e., events or mortality). While nearly all outcomes had evidence on ever (versus never) breastfeeding, exclusive (versus nonexclusive or no) breastfeeding, and longer durations (versus shorter or no) of any or exclusive breastfeeding, the exposure comparisons and categorizations reported in the ESRs and primary evidence made it extremely difficult to examine the nuances of these relationships. There was no clear “threshold” of breastfeeding that appeared to be most beneficial for any outcome. Furthermore, there were little data on how the relationships varied by mode of breastfeeding or source of breastmilk.

Conclusions. Breastfeeding is associated with beneficial effects for several infant and child outcomes, although there are limitations to the data that preclude high certainty in the findings. Further research that addresses the limitations of existing studies is needed to continue to inform national guidelines and initiatives.

Positional Plagiocephaly and Craniosynostosis

Aubrey Delammermore — Thu, 12 Jan 2023 06:00:00 +0000

Date Added:

January 12, 2023

Journal/Publication:

Pediatric Annals

Publisher:

SLACK

Publication Date:

January 1, 2023

Issue:

Volume:

Pages:

e10-e17

URL:

Positional Plagiocephaly and Craniosynostosis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.3928/19382359-20221114-03

Keywords

PMID (1):

36625797

MeSH

Plagiocephaly, Nonsynostotic* / diagnosis

Craniosynostoses* / epidemiology

Plagiocephaly, Nonsynostotic* / epidemiology

Craniosynostoses* / therapy

A review of head shape abnormalities in infants, their causes, consequences, and management. James W. Mold, MD, MPH

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Along with the decrease in sudden infant death syndrome due to the successful "Back to Sleep" Campaign, there was a reciprocal increase in cases of positional plagiocephaly (PP). The prevalence of PP significantly rose from approximately 5% to upward of 46% at age 7 months. Consequently, clinicians have seen a surge in the number of patients presenting with head shape abnormalities. Not only does this increase in patient volume pose a logistical problem to clinics, but it also poses a potential risk to patients with craniosynostosis, whose head shape anomalies are similar to a "needle in a haystack" of patients with more common PP. This review explores the causes, risk factors, and treatment options of PP and craniosynostosis, along with the differential of head shape anomalies based on phenotypic presentation. In doing so, we hope to provide pediatric care clinicians with the tools necessary to effectively evaluate and manage patients with head shape abnormalities. [Pediatr Ann. 2023;52(1):e10-e17.].

Author/s:

Santiago, G. S., Santiage, C. N., Chwa, E. S., Purnell, C. A.

Infant pacifier sanitization and risk of challenge-proven food allergy: A cohort study

Devin Evans — Thu, 29 Apr 2021 05:00:00 +0000

Date Added:

April 29, 2021

Journal/Publication:

Journal of Allergy and Clinical Immunology

Publication Date:

March 19, 2021

Issue:

Volume:

S0091-6749

Pages:

00221-9

URL:

Infant pacifier sanitization and risk of challenge-proven food allergy: A cohort study

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.jaci.2021.01.032

Keywords

PMID (1):

33810856

MeSH

infant

pregnancy

Anti-Infective Agents, Local

Food Hypersensitivity

Immune System

Sterilization of infant pacifiers appears to increase the risk of subsequent food allergies. James W. Mold, MD, MPH.

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Background: Environmental microbial exposure plays a role in immune system development and susceptibility to food allergy.

Objective: We sought to investigate whether infant pacifier use during the first postnatal year, with further consideration of sanitization, alters the risk of food allergy by age 1 year.

Methods: The birth cohort recruited pregnant mothers at under 28 weeks' gestation in southeast Australia, with 894 families followed up when infants turned 1 year. Infants were excluded if born under 32 weeks, with a serious illness, major congenital malformation, or genetic disease. Questionnaire data, collected at recruitment and infant ages 1, 6, and 12 months, included pacifier use and pacifier sanitization (defined as the joint exposure of a pacifier and cleaning methods). Challenge-proven food allergy was assessed at 12 months.

Results: Any pacifier use at 6 months was associated with food allergy (adjusted odds ratio, 1.94; 95% CI, 1.04-3.61), but not pacifier use at other ages. This overall association was driven by the joint exposure of pacifier-antiseptic use (adjusted odds ratio, 4.83; 95% CI, 1.10-21.18) compared with no pacifier use. Using pacifiers without antiseptic at 6 months was not associated with food allergy. Among pacifier users, antiseptic cleaning was still associated with food allergy (adjusted odds ratio, 3.56; 95% CI, 1.18-10.77) compared with no antiseptic use. Furthermore, persistent and repeated antiseptic use over the first 6 months was associated with higher food allergy risk (P = .029).

Conclusions: This is the first report of a pacifier-antiseptic combination being associated with a higher risk of subsequent food allergy. Future work should investigate underlying biological pathways.

Keywords: Pacifier; antiseptic; birth cohort; dummy; food allergy; microbial exposure; sanitization.

Author/s:

Soriano, V.X., Koplin, J.J., Forrester, M., Peters, R.L., O'Hely, M., Dharmage, S.C., Wright, R., Ranaganathan, S., Burgner, D., Thompson, K., Dwyer, T., Vuilerman, P., Ponsonby, A.

What Parents Know Matters: Parental Knowledge at Birth Predicts Caregiving Behaviors at 9 Months

Brian Desmarais — Sat, 25 Jan 2020 22:22:10 +0000

Date Added:

January 25, 2020

Journal/Publication:

The Journal of Pediatrics

Publication Date:

January 1, 2020

URL:

What Parents Know Matters: Parental Knowledge at Birth Predicts Caregiving Behaviors at 9 Months

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1016/j.jpeds.2019.12.021 showArticle

Keywords

cognitive development

MeSH

A reminder to assess parental knowledge of infant growth and development at the first well child check and to provide education as needed. The first year of life is arguably the most critical period of human psychological and cognitive development. James W. Mold, MD, MPH

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Objective

To examine the mediating role of socioeconomically disadvantaged parents' knowledge of early cognitive and language development at the first postpartum visit in the relation between education and caregiving behaviors at 9 months.

Study design

Parental knowledge was assessed at the 1-week newborn visit (n = 468); anticipatory guidance received and desired at 1-month (n = 212) and 6-month (n = 191) visits were reported; and caregiving behaviors toward infants during a teaching task were observed at 9-month visit (n = 173).

Results

We found substantial variation in knowledge and caregiving behaviors. Parents who had more knowledge of infant development at 1 week were more likely to respond to cues (r = 0.18; P < .05) and foster social-emotional (r = 0.17; P < .05) and cognitive growth (r = 0.20; P < .05) at 9 months. Importantly, the indirect effect of education on cognitive growth fostering at 9 months through knowledge at 1 week was significant, controlling for primary language and number of other children in the home (infancy: β = 0.06; B = 0.07; SE = 0.04; 95% CI, 0.007-0.165; early childhood: β = 0.04; B = 0.06; SE = 0.03; 95% CI, 0.008-0.152). Open-ended responses indicated that anticipatory guidance in the first 6 months focused on infant physical growth; however, parents did not request additional anticipatory guidance from their pediatricians.

Conclusions

This study sheds light on the importance of promoting parental knowledge about cognitive and language development to foster parental cognitive stimulations and language inputs during the first year of life. This study highlights the important role of anticipatory guidance on cognitive and language development during the earliest well-child visits and the need to better understand parental baseline knowledge to tailor anticipatory guidance to the family strengths and needs.

Author/s:

Leung, C.Y., Suskind, D.L.