This is a 3-topic series focused on nutrition for toddlers, in particular dealing with picky eaters or children who cannot eat certain foods. I’m glad to know a friend, Natalia Stasenko, a registered dietitian, whose passion is pediatric nutrition and shares nutrition tips on her website, online classes and of course, with all of us here in this series!
More on Natalia, RD – Natalia has a Master of Science in Nutrition Education from Columbia University. She founded her private practice Tribeca Nutrition and online nutrition class for parents of babies and young children at Feeding Bytes.
For further information on her latest online course on feeding toddlers, do check out this link. Natalia is also offering 30% to readers of Eczema Blues with the code EcBlues30.
My Child Can’t Eat That!
This final part of the Toddler Nutrition series with Natalia is going to be fun. If you missed the first two parts on How Much to Eat and What to Eat, do click on the links and catch up!
Today we will explore two scenarios:
i. What a Child Cannot Eat due to Allergy, Food Sensitivity or Intolerance, and
ii. What a Child Cannot Eat because he/she just shouldn’t!
MarcieMom: Hi Natalia, so good to have you back! Let’s go straight into the situation when a child cannot eat certain foods. Instead of focusing on each condition, could you offer quick insights into
i. When a parent should suspect there’s a problem with the child after eating the food?
ii. When should a parent bring a child in for test/ examination?
Natalia:In case with allergic reactions, the typical symptoms to look out for are hives, swelling of the face and mucous membranes found in the nose, ears, lungs and throat, nasal congestion and sneezing, intestinal cramps, vomiting and diarrhea. With smaller kids who cannot talk yet, general discomfort and crying after eating a specific food may also indicate an allergic reaction to food. If your child has any of these symptoms after trying a certain food for the first time, food allergy may be suspected. It is a good idea to call your doctor who will probably refer you to an allergist for a testing.
Food allergy is often diagnosed by one of the widely available tests: skin prick test and blood test for antibodies, neither of which gives a 100% guarantee of true clinical reactivity. These tests may be helpful to assist in diagnosing food allergy when the patient history indicates that a specific food may be a problem. A double blind placebo controlled food challenge is considered by this and other reports as a diagnostic “gold standard”. This basically means that a person is given the suspected food once and a placebo another time, without knowing what is what.
The challenges are provided in gradually increasing doses and neither the patient nor the practitioner knows in which order they follow, thus patient and clinician biases are removed.
Once the offering food is identified, the doctor will likely recommend to remove it from a diet.Children with food allergies may be at a high risk for nutritional deficiencies if important foods like dairy, eggs, or wheat are not replaced by nutritionally optimal alternatives. For example: calorie, protein and fat contents of cow’s milk are much higher than those in most milk substitutes, including almond and rice milk. A child who drinks rice milk instead of cow’s milk may not be growing properly because he or she will not be getting enough nutrients in the diet. Soy milk, on the other hand, is closer in calories, fat and protein to cow’s milk and could be considered a good alternative. The US Food Allergy guidelines recommend nutrition counseling and close growth monitoring for all children with food allergies in order to ensure proper growth and development.
MarcieMom: We know that there are certain foods that are the more common food allergens of children, while others are likely to cause intolerance. Given that a food (say fish) has more than one nutrients, how should a parent know what is a suitable replacement food i.e. as long as replacing the main nutrition, say is a protein or replacing the more beneficial nutrients, the omega-3 or finding a food that is as close to fish as possible (but that may trigger the same allergy?).
Natalia: It is a great question and I would like to provide some background information. Food allergy is an adverse reaction to protein in food. So every time the allergen is eaten, the immune system starts fighting it using the whole arsenal of chemicals causing the potentially life-threatening symptoms. Food allergy is often confused with food intolerance, which is caused by lack of digestive enzymes, such as lactase in case with milk intolerance. However, food intolerance does not involve immune system.
Food allergy can be IgE-mediated and/or non-IgE mediated. IgE-mediated basically means that when the allergen is ingested, the body produces Immunoglobulin E antibodies, which attack the allergen causing the release of histamine and other potent mediators that cause the symptoms of a food allergic reaction. Non-IgE mediated reactions primarily affects the gastrointestinal tract lining and causes allergic disorders such as protocolitis and
entrocolitis. To complicate matters further, a bunch of adverse food reactions can be both IgE and non-IgE mediated.
As you see, there are many different ways we can react to certain foods. To answer your questions, in the case with fish allergy it is more likely to the protein the child is reacting to so the health care provider will probably recommend stay away from all fish and seafood and take a DHA supplement instead.
In case of milk intolerance, switching to lactose-free milk will help to avoid the symptoms but if your child. has food allergy to milk i.e. reacting to milk protein, all dairy products lactose free or not, should be avoided. In my private practice I worked with many kids with food allergies who needed a safe and balanced diet to meet their nutrient needs after removing the allergens. In most cases I needed to collaborate with their allergists and pediatricians to create a plan that works for a specific family.
Thanks so much Natalia, we are taking a pause till next week where I’d publish Natalia’s reply to part (ii) of this post on what foods kids simply should not be eating. This is to give some time for parents to digest the tips from Natalia – as you can see, she is thorough in her explanation, so imagine how much more you’d learn from her online class. Do sign up and don’t forget to use EcBlues30 for that 30% off.