The Food Allergy Challenge Anna J Richards NZRD
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 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 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 eat not what they can’t