La diversification alimentaire du nourrisson a connu une succession rapide de recommandations dont le respect par les pédiatres n’a pas été évalué.

Évaluer les pratiques des pédiatres au regard des recommandations récentes de la Société française de pédiatrie (SFP).

Il s’est agi d’une étude observationnelle se déroulant du 1^er novembre 2014 au 31 mars 2015 ayant inclus 97 pédiatres varois et 84 internes en pédiatrie affectés à la faculté Aix-Marseille. Le questionnaire comportait des questions sur les caractéristiques des médecins interrogés, les modalités de diversification alimentaire chez l’enfant sain ou à risque atopique et le déroulement de la consultation pédiatrique. Les réponses attendues reposaient sur les recommandations 2008 de la SFP actualisant celles de 2003.

Quatre-vingt-quatre réponses ont été obtenues (51 %) de la part de 50 pédiatres (51 %) et 34 internes (40 %). Seize items ont été classés en fonction de l’existence d’une actualisation postérieure à 2003 ou non. Plus de 80 % des médecins introduisaient conformément aux recommandations les aliments solides et le gluten chez l’enfant sain et les hydrolysats de protéines de lait de vache et le lait de vache chez l’enfant atopique. Au mieux, 65 % des médecins ont répondu conformément aux recommandations pour les items sans actualisation récente : âge d’introduction du lait de vache, des desserts lactés, des protéines carnées, du miel, des corps gras, et des légumineuses, utilisation d’un lait hypoallergénique (HA), et prolongation de l’allaitement maternel chez l’enfant atopique. Soixante-douze pour cent des médecins ne tenaient pas compte du statut allergénique de l’enfant pour introduire les aliments les plus allergéniques. Les internes, pédiatres en formation, ont eu des réponses similaires à celles des pédiatres installés.

Les pédiatres, y compris les internes en formation, ne suivent que partiellement les recommandations.

Infant food diversification has undergone a rapid succession of good practice recommendations in France, but there has been no assessment of pediatrician practices on food diversification.

To assess the practices of pediatricians in relation to current recommendations of the French Society of Pediatrics on infant food diversification.

This was an observational study conducted from 1 November 2014 to 31 March 2015. The study population consisted of 97 pediatricians in the Var department and 84 pediatric residents assigned to the University of Aix-Marseille in France. A questionnaire was sent by email or post to determine physician characteristics, food diversification methods in healthy children and those at atopic risk, and how the pediatric consultation was conducted. The expected answers were based on the most recent recommendations of the French Society of Pediatrics published in 2008, updated from 2003. In summary, breastfeeding is recommended up to 6 months. Food diversification can be started between 4 and 6 months in children with no allergy risk. Gluten, honey, legumes and cow's milk are introduced between 4 and 7 months, after 12 months and after 36 months, respectively. In atopic children, food diversification is delayed until after 6 months and the most allergenic foods (nuts, exotic fruits, peanuts, and shellfish) are introduced after the age of 12 months.

Eighty-four responses were obtained (51%): 50 pediatricians and 34 pediatric residents. Sixteen items were classified depending on whether or not an update after 2003 existed. Over 80% of the physicians responded as recommended for the recently updated items for the age of introduction of “solid food in healthy children”, “gluten”, “cow's milk protein hydrolysates”, and “the time until introduction of cow's milk in the atopic child”. At best, 65% of physicians responded in accordance with recommendations for items without a recent update, age of introduction of “cow's milk”, “milk desserts”, “animal proteins”, “fats”, “vegetables”, “use of a hypoallergenic infant formula”, and “breastfeeding extension with atopic child”. Pediatric residents had the same responses as pediatricians. Seventy-two physicians did not consider the allergenic status of the children to delay the introduction of the most allergenic foods. The lack of complete updating the introduction of solid foods schedule could explain the differences between pediatrician practices and recommendations. Moreover, old recommendations on allergenic food eviction are still available.

Pediatricians and pediatric residents partially applied the current recommendations on the introduction of solid food.