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BackgroundCow's milk allergy (CMA) overdiagnosis in young children appears to be increasing and has not been well characterised. We used a clinical trial population to characterise CMA overdiagnosis and identify individual‐level and primary care practice‐level risk factors.MethodsWe analysed data from 1394 children born in England in 2014–2016 (BEEP trial, ISRCTN21528841). Participants underwent formal CMA diagnosis at ≤2 years. CMA overdiagnosis was defined in three separate ways: parent‐reported milk reaction; primary care record of milk hypersensitivity symptoms; and primary care record of low‐allergy formula prescription.ResultsCMA was formally diagnosed in 19 (1.4%) participants. CMA overdiagnosis was common: 16.1% had parent‐reported cow's milk hypersensitivity, 11.3% primary care recorded milk hypersensitivity and 8.7% had low‐allergy formula prescription. Symptoms attributed to cow's milk hypersensitivity in participants without CMA were commonly gastrointestinal and reported from a median age of 49 days. Low‐allergy formula prescriptions in participants without CMA lasted a median of 10 months (interquartile range 1, 16); the estimated volume consumed was a median of 272 litres (26, 448). Risk factors for CMA overdiagnosis were high practice‐based low‐allergy formula prescribing in the previous year and maternal report of antibiotic prescription during pregnancy. Exclusive formula feeding from birth was associated with increased low‐allergy formula prescription. There was no evidence that practice prescribing of paediatric adrenaline auto‐injectors or anti‐reflux medications, or maternal features such as anxiety, age, parity and socioeconomic status were associated with CMA overdiagnosis.ConclusionCMA overdiagnosis is common in early infancy. Risk factors include high primary care practice‐based low‐allergy formula prescribing and maternal report of antibiotic prescription during pregnancy.
BackgroundCow's milk allergy (CMA) overdiagnosis in young children appears to be increasing and has not been well characterised. We used a clinical trial population to characterise CMA overdiagnosis and identify individual‐level and primary care practice‐level risk factors.MethodsWe analysed data from 1394 children born in England in 2014–2016 (BEEP trial, ISRCTN21528841). Participants underwent formal CMA diagnosis at ≤2 years. CMA overdiagnosis was defined in three separate ways: parent‐reported milk reaction; primary care record of milk hypersensitivity symptoms; and primary care record of low‐allergy formula prescription.ResultsCMA was formally diagnosed in 19 (1.4%) participants. CMA overdiagnosis was common: 16.1% had parent‐reported cow's milk hypersensitivity, 11.3% primary care recorded milk hypersensitivity and 8.7% had low‐allergy formula prescription. Symptoms attributed to cow's milk hypersensitivity in participants without CMA were commonly gastrointestinal and reported from a median age of 49 days. Low‐allergy formula prescriptions in participants without CMA lasted a median of 10 months (interquartile range 1, 16); the estimated volume consumed was a median of 272 litres (26, 448). Risk factors for CMA overdiagnosis were high practice‐based low‐allergy formula prescribing in the previous year and maternal report of antibiotic prescription during pregnancy. Exclusive formula feeding from birth was associated with increased low‐allergy formula prescription. There was no evidence that practice prescribing of paediatric adrenaline auto‐injectors or anti‐reflux medications, or maternal features such as anxiety, age, parity and socioeconomic status were associated with CMA overdiagnosis.ConclusionCMA overdiagnosis is common in early infancy. Risk factors include high primary care practice‐based low‐allergy formula prescribing and maternal report of antibiotic prescription during pregnancy.
AimTo explore parents' perceptions/experiences of help‐seeking for unsettled baby behaviours, including views and experiences of obtaining advice from primary healthcare professionals.DesignSemi‐structured qualitative interviews.MethodsRecruitment occurred via social media, general practice and health visiting teams. Remote semi‐structured interviews were conducted with parents of babies. Babies were under 12 months old at time of interview, and parents had perceived unsettled baby behaviours in their first 4 months of life. Interviews were transcribed and data analysed using reflexive thematic analysis.ResultsBased on interviews with 25 mothers, four main themes were developed. ‘The need for answers’ highlighted parental uncertainty about what constitutes normal baby behaviour, leading to help‐seeking from multiple sources. ‘The importance of health professionals’ and ‘Experiencing health professional support’ identified perceptions about limited access, communication, mixed advice and how these influenced parental perception/management of behaviours. ‘Foundations to help‐seeking’ highlighted important roles of social support and online help for valued shared experiences, emotional and practical support.ConclusionHealth professional access and advice are important to parents, despite the increasing role of online help and importance of social support. More support and improved access to reliable sources of information is needed for parents.Implications for the Profession and/or Patient CareFindings will inform future research and clinical practice to address parental uncertainties. Qualitative research with front‐line health professionals is necessary.ImpactFindings can inform the development of resources to support professionals/families managing unsettled babies.Reporting MethodStandards for Reporting Qualitative Research.Public InvolvementA public contributor was involved throughout all stages of the research. Emerging findings were discussed at a parent group.What does this paper contribute to the wider global clinical community? Addressing parental uncertainties is important; about what is normal, non‐pharmacological approaches and when pharmacological intervention is required. A digital information/self‐management intervention may be useful for parents/clinicians.
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