The Food Allergy Challenge
Anna J Richards
NZRD
Role of the Allergy Dietitian
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Diagnosis
Myth buster
Crisis manager
Counselor
Educator
Nutrition –
adequacy,
optimal growth
Issues for Children with Allergy
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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……
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Reflux
Eczema
Abdominal discomfort
Wind
Diarrhoea
Constipation
Issues for Children with Allergy
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Early feeding experiences
Orally defensive
Tactile defensiveness
Textural hypersensitivity
Parental anxiety around food
Strong food boundaries
Delayed progression
Diagnosis
Diagnosis in perspective
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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
Nutrition
Complete exclusion -nutrition consequences
Nutrition
- 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
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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
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Early feeding experiences
Orally defensive
Tactile defensiveness
Textural hypersensitivity
Parental anxiety around food
Strong food boundaries
Delayed progression
Ongoing allergy issues
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Feeding aversion
Anxiety
Food jags
Carbo kids
The protein challenge
Feeding Aversions
Reflux
Failure to progress with solids
Delayed solids
Oral 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 eat
not what they can’t