1. The Food Allergy Challenge Anna J Richards NZRD

2. Role of the Allergy Dietitian Diagnosis Myth buster Crisis manager Counselor Educator Nutrition – adequacy, optimal growth

3. Issues for Children with Allergy Early feeding experiences Orally defensive Tactile defensiveness Textural hypersensitivity Parental anxiety around food Strong food boundaries Delayed progression

4. Children…… ……do something when it is fun

5. …..and stop doing it ……when it is no longer fun

6. Undiagnosed allergy…… ……often takes the fun away

7. Undiagnosed allergy…… -Reflux -Eczema -Abdominal discomfort -Wind -Diarrhoea -Constipation

8. Issues for Children with Allergy Early feeding experiences Orally defensive Tactile defensiveness Textural hypersensitivity Parental anxiety around food Strong food boundaries Delayed progression

9. Diagnosis

10. Diagnosis in perspective Accurate diagnosis Interpretation of results Clinical picture Resolution of allergy

11. Complete exclusion …. Correlates most strongly with resolution of allergy …..What does that mean for us????

12. 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?

13. Understand the family

14. Understand what is going on for the family

15. Understand toddlers

16. Toddlers are toddlers…..

17. Minimizing anxiety Plan for this child/family Independence Support

18. Management Plan Age Co-sensitivites RAST/ Skin prick results / significance/ parental understanding Risk management Breastfed – maternal diet

19. Nutrition Complete exclusion -nutrition consequences Nutrition - Energy, protein, fat - Calcium - Riboflavin - Iron - Zinc Additional nutritional demands of eczema ? Malabsorption consequent to gastrointestinal food allergy

20. Growth Historical Well Child Book – pattern of growth Growth faltering ? Catch up growth

21. 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

22. Make feeding enjoyable again…

23. Addressing feeding issues Early feeding experiences Orally defensive Tactile defensiveness Textural hypersensitivity Parental anxiety around food Strong food boundaries Delayed progression

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

26. Feeding Aversions Reflux Failure to progress with solids Delayed solids Oral defensiveness Hypersensitivity to texture

27. FOOD JAGS

28. CARBO KIDS

29. Remember …..allergy is a constantly changing picture Accidental exposure Importance of food challenges

30. 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