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

Nutrition

Complete 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

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 eatnot what they can’t