Knowledge and practice of pediatricians and nutritionists regarding treatment of cow’s milk protein allergy in infants

FARIA, Dayane Pêdra Batista de; CORTEZ, Ana Paula Bidutte; SPERIDIÃO, Patrícia da Graça Leite; MORAIS, Mauro Batista de

doi:10.1590/1678-98652018000600003

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ORIGINAL ARTICLES • Rev Nutr 31 (6) • Nov-Dec 2018 • https://doi.org/10.1590/1678-98652018000600003 copy

Knowledge and practice of pediatricians and nutritionists regarding treatment of cow’s milk protein allergy in infants

Conhecimento e prática de pediatras e nutricionistas sobre o tratamento da alergia às proteínas do leite de vaca em lactentes

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

This study evaluated the knowledge and practices of pediatricians and nutritionists about cow’s milk protein allergy in infants, with an emphasis on issues related to the exclusion diet and nutritional status.

Methods

A cross-sectional, descriptive study was performed with a convenience sample of 204 pediatricians and 202 nutritionists randomly invited in scientific events in the city of São Paulo, from November 2014 to March 2016.

Results

Between 1.5% and 21.0% of respondents indicated inadequate products for the treatment of cow’s milk protein allergy, including goat’s milk, beverages or juices based on soy extract, lactose-free milk formula and partially hydrolyzed formula. The daily calcium recommendation for children between zero and 36 months of age was correctly indicated by 27.0% of pediatricians and 46.0% of nutritionists (p=0.001). Additionally, 96.1% of pediatricians and 82.7% of dietitians (p<0.001) provided guidance on about labels of industrialized products.

Conclusion

Pediatricians and nutritionists present gaps in knowledge about cow’s milk protein allergy treatment in infants and educational strategies that increase the knowledge of the professionals are important for the management of cow’s milk protein allergy.

Keywords
Cow’s milk allergy; Infant; Knowledge attitude and practice; Pediatricians; Nutritionists

Statements	Correct answer	Number (%) of hits				p ¹ 1 Standard of Chi-square.
		Pediatricians (n=204)		Nutritionists (n=202)
		n	%	n	%
Early introduction of cow’s milk increases the risk of developing a cow’s milk protein allergy	Agree	193	94.6	181	89.6	<0.091

Casein is the only milk protein that is involved in the triggering of a cow’s milk protein allergy	Disagree	187	91.6	149	73.7	<0.001

Exclusively breastfed infants can develop cow’s milk protein allergy	Agree	183	89.7	130	64.4	<0.001

A child allergic to cow’s milk protein may cross-react with soy proteins	Disagree	6	2.9	30	14.8	<0.001

Goat’s milk or any other animal milk (i.e., sheep, mare, or donkey) can be used as a cow’s milk substitute for children with a cow’s milk protein allergy	Disagree	180	88.2	112	55.4	<0.001

Patients with lactose intolerance should exclude all foods containing cow’s milk protein from their diet	Disagree	170	83.3	148	73.3	<0.192

For children with cow’s milk allergy, other allergenic foods, such as soy, eggs, fish, and peanuts, should also be eliminated from the diet as a preventive measure to avoid other reactions	Disagree	131	64.2	104	51.5	<0.125

Terms/ingredients	Pediatricians (n=204)		Nutritionists (n=202)		p ¹ 1 Chi-square test;
Terms/ingredients	n	%	n	%	p ¹ 1 Chi-square test;
Correct exclusion recommendation
Lactalbumin	151	74.0	94	46.5	<0.001
Casein	166	81.4	127	62.9	<0.001
Caseinate	127	62.3	101	50.0	0.169
Milk compound	163	79.9	99	49.0	<0.001
Whey protein	145	71.1	127	62.9	0.098
Lactic yeast	120	58.8	71	35.1	<0.001
Unnecessary exclusion recommendation
Maltodextrin	18	08.8	5	02.5	0.01
Calcium	3	01.5	3	01.5	1.000² 2 Fischer’s exact test.
Hydrogenated vegetable fat	7	03.4	8	04.0	0.984
Calcium stearoyl lactyl lactate	31	15.2	26	12.9	0.595
Lactic acid	29	14.2	31	15.4	0.856
Cocoa butter	29	14.2	18	08.9	0.129

Variables	Pediatricians (n=204)		Nutritionists (n=202)		p ¹ 1 Chi-square test.
Variables	n	%	n	%	p ¹ 1 Chi-square test.
0-6 months
200^* * Values considered correct according to the AI;	31	15.2	35	17.3	0.670
260	4	02.0	9	04.5
400	31	15.2	31	15.3
Another dose	5	02.4	4	02.0
Do not know	83	40.7	60	29.7
Did not answer	50	24.5	63	31.2

7-12 months
260^* * Values considered correct according to the AI;	11	05.4	30	14.9	0.002
400	41	20.1	32	15.8
600	17	08.3	24	11.9
Another dose	4	02.0	5	02.5
Do not know	80	39.2	51	25.2
Did not answer	51	25.0	60	29.7

13-36 months
400	48	23.5	24	11.9
700^ Value considered correct according to the RDA;	13	06.4	28	13.9	0.020
900	19	09.3	32	15.8
Another dose	6	03.0	11	05.4
Do not know	89	43.6	72	35.7
Did not answer	29	14.2	35	17.3

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[1] Correspondência para/Correspondence to: DPB FARIA. E-mail: <dayanefaria19@hotmail.com>.