Addressing Reference (b) the delivery of child development services in both
metropolitan and regional Western Australia, including paediatric and allied
health services.
Submission by Hayley Cullen and Lily Pridham.
We advocate for the funding of dietitians within the Child and Adolescent
Health Service, to support parents/carers in introducing first solids and
allergenic foods to infants. This will immediately reduce the current loading
on child health nurses, paediatricians, immunology specialists, as well as
providing longer term benefits to the health system as well.
Dietitians are well positioned to take on a larger role within the Child
Development Services, in particular by supporting early childhood nutrition, as
well as the introduction of allergenic foods to infants. This will alleviate a
portion of the wait times across the Western Australian Department of Health,
by supporting child health nurses, and providing preventative care and earlier
identification of nutritionally-related health issues. There are a large number
of questions and concerns about introduction of allergenic foods that are
currently being directed to immunologists and paediatricians, and these can be
more appropriately addressed by a community dietitian at an earlier time point.
Child health nurses currently have to take on the informal role of
dietitian/nutritionist in addition to their many other responsibilities,
despite being significantly under-resourced and under-staffed. Child health
nurses facilitate a 2 hour seminar “A solid start” for parents and carers,
which educates on how to introduce first solids to an infant. This seminar is
run approximately 180-200 times per year across a selection of locations, but
is extremely popular and over-subscribed, meaning that many parents miss out.
Anecdotally, most parents and carers find they have many more questions and
require more information than is provided in a single session, although this is
not generally available. The learning journey for introducing an infant to
solids is complex, for both the infant and its parents/carers. As a result,
parents and carers often turn to other sources of information that may or may
not be accurate, including family, friends and social media.
Additionally, many child health nurses and other health care professionals can
confirm that there is a widespread fear of introducing potentially allergenic
foods such as peanuts. Many parents and carers are delaying introduction
unnecessarily for months, waiting until they are in a hospital car park or
café, or requesting a consultation with a paediatrician or immunologist first.
The longer the delay to introduce allergenic foods, the higher the risk of
developing a food allergy. There are simple steps that can be taken to ensure
safe and relatively easy introduction of allergenic foods, without the need for
delays or medical involvement in the majority of infants. By working closely
with the National Allergy Strategy and other related organisations, dietitians
funded by CAHS will be able to develop programs that are guided by the latest
research and guidelines. And by preventing any unnecessary delay in allergenic
food introduction, we will be able to help reduce the prevalence of allergies.
This outcome alone will have a lifetime of significant benefits for those
individuals and society.
Allergic Disease in Australia; a background:
Australia has become known as the “allergy capital of the world”, with more
than 5 million Australians living with allergic disease (1). The still-ongoing
Australian HealthNuts study has reported preliminary data showing approximately
10% of 12 month olds are clinically diagnosed with food allergies (2). Food
allergy hospitalisations in Australia have increased by fourfold over the
decade, with our health system unable to keep pace (1).
Allergic disease prevention and management has recently been prioritised by the
Federal Government, with a $26.9 million investment package announced on the
30th March 2022 (3). This will hopefully lead to better research, treatments
and outcomes for patients in the long term. We know that development of
allergic diseases are multi-factorial, with some factors that are not
modifiable such as genetic susceptibility, and other factors that are
modifiable, including diet quality (4), and early exposure to allergenic foods
(5,6).
A portion of the federal funding will allow continuation of public health
guidelines and prevention programs such as “Nip allergies in the Bub” (3).
However, there is a need to bridge the gap between ideal recommendations, and
what parents/carers are actually achieving at present. We don’t have time to
wait for our understanding of allergies to be complete, it is necessary to pick
the lowest hanging “fruits” and act as quickly as possible.
References:
-
House of Representatives Standing Committee on Health, Aged Care
and Sport. Walking the allergy tightrope: Addressing the rise of allergies and
anaphylaxis in Australia. (2020).
-
Peters, R. L., Koplin, J. J., Gurrin, L. C., Dharmage, S. C., Wake,
M., Ponsonby, A.-L., . . . Allen, K. J. (2017). The prevalence of food allergy
and other allergic diseases in early childhood in a population-based study:
HealthNuts age 4-year follow-up. Journal of Allergy and Clinical Immunology,
140(1), 145-153.e148. doi:https://doi.org/10.1016/j.jaci.2017.02.019
-
Centre for Food and Allergy Research. Australia Leading the World:
Federal funding secured for allergy prevention and management. Retrieved from
https://www.foodallergyresearch.org.au/australia-leading-the-world-federal-fundi
ng-secured-for-allergy-prevention-and-management/
-
Rey-Mariño, A., & Francino, M. P. (2022). Nutrition, Gut
Microbiota, and Allergy Development in Infants. Nutrients, 14(20).
https://www.mdpi.com/2072-6643/14/20/4316 doi:10.3390/nu14204316
-
Azad, M. B., Dharma, C., Simons, E., Tran, M., Reyna, M. E., Dai,
R., . . . Sears, M. R. (2021). Reduced peanut sensitization with maternal
peanut consumption and early peanut introduction while breastfeeding. Journal
of Developmental Origins of Health and Disease, 12(5), 811-818.
doi:10.1017/S2040174420001129
- Du Toit, G., Roberts, G., Sayre, P. H., Bahnson, H. T., Radulovic, S., Santos, A. F., . . . Lack, G. (2015). Randomized Trial of Peanut
Consumption in Infants at Risk for Peanut Allergy. New England Journal of
Medicine, 372(9), 803-813. doi:10.1056/NEJMoa1414850