The Food Allergy Challenge

Anna J RichardsNZRD

Role of the Allergy Dietitian• Diagnosis• Myth buster• Crisis manager• Counselor• Educator• Nutrition –

adequacy, optimal growth

Issues for Children with Allergy

• Early feeding experiences• Orally defensive• Tactile defensiveness• Textural hypersensitivity• Parental anxiety around food• Strong food boundaries• Delayed progression

Children……

……do something when it is fun

…..and stop doing it

……when it is no longer fun

Undiagnosed allergy……

……often takes the fun away

Undiagnosed allergy……

- Reflux- Eczema- Abdominal discomfort- Wind- Diarrhoea- Constipation

Issues for Children with Allergy

• Early feeding experiences• Orally defensive• Tactile defensiveness• Textural hypersensitivity• Parental anxiety around food• Strong food boundaries• Delayed progression

Diagnosis

Diagnosis in perspective

• Accurate diagnosis• Interpretation of results• Clinical picture• Resolution of allergy

Complete exclusion

…. Correlates most strongly with resolution of allergy

…..What does that mean for us????

Risk Assessment• Household ? Structure, food habits of

other family members, use of allergenic food, frequency, lifestyle, social activities, pets

• Other regular carers? • Diet history• What is a

reasonable risk?

Understand the family

Understand what is going on for the family

Understand toddlers

Toddlers are toddlers…..

Minimizing anxiety• Plan for this child/family• Independence• Support

Management Plan

• Age• Co-sensitivites• RAST/ Skin prick results / significance/

parental understanding• Risk management• Breastfed – maternal diet

NutritionComplete exclusion -nutrition consequencesNutrition

- Energy, protein, fat- Calcium- Riboflavin- Iron- Zinc

Additional nutritional demands of eczema? Malabsorption consequent to gastrointestinal

food allergy

Growth

• Historical• Well Child Book

– pattern of growth• Growth faltering

? Catch up growth

Practical Application

• Management vs current eating pattern• Family risk factors• Addressing nutrition deficits, supplements• Clear guidelines• Sample meal plan• Meal and snack alternatives/ brands• Recipe substitutions• Coping socially – family, friends, daycare

Make feeding enjoyable again…

Addressing feeding issues

• Early feeding experiences• Orally defensive• Tactile defensiveness• Textural hypersensitivity• Parental anxiety around food• Strong food boundaries• Delayed progression

Ongoing allergy issues• Feeding aversion• Anxiety• Food jags• Carbo kids• The protein challenge

Feeding Aversions

RefluxFailure to progress with solids

Delayed solidsOral defensiveness

Hypersensitivity to texture

FOOD JAGS

CARBO KIDS

Remember …..allergy is a constantly changing picture

• Accidental exposure• Importance of food challenges

Reassure…..• Most children grow out of

most allergies over their childhood years

• Most children with allergy will never experience anaphlyaxis

• We have not had any infant deaths from allergy in NZ• Although a childs diet might

seem restrictive to us, usually they know no difference

• Emphasize what children can eatnot what they can’t