1. Much Ado About Diets: Paige Gustafson, RD, LD
Children and Modified Dietary Needs
Paige Gustafson, RD, LD
Pediatric Clinical Dietitian
University of Minnesota Amplatz Children’s Hospital

2. Disclosures
None

4. Objectives
List major food allergies and strategies for school food services to be safe
Define gluten and foods to avoid to maintain gluten-free diet in the cafeteria
Review renal diet including challenge to provide appropriate lunch options with school lunch reform
Understand dietary modifications as medical nutrition therapy rather than diets in the promotion of disordered eating behaviors

6. Food Allergies An immune response to a foreign protein The Big 8
Peanuts
Wheat
Tree Nuts
Soy
Cow’s Milk
Fish
Eggs
Shellfish
1 in 13 children in US have a food allergy. An allergic response triggers the immune system to “fight off” this protein it thinks is harmful or a germ. The chain reaction sets off reactions that can cause symptoms as simple as stomach ache, hives to the severe swelling of the airway. 8 foods account for 90% of the foods that cause this allergic rxn. The Big 8 are: Peanuts, Tree Nuts, Milk, Eggs, Wheat, Soy, Fish, and Shellfish.
Intolerance? Do not involve the immune system and related to digestion of the food (or the inability to digest). Lactose intolerance is in the ability to break down lactose, the sugar found in milk, due to lack of activity of the digestive enzyme lactase. Symptoms are often gas, bloating, and digestive in nature. Although uncomfortable an intolerance will not cause a fatal end where an allergy could result in death.
Intolerance? Lactose

7. Milk Egg Soy Wheat Shellfish Fish Peanuts Tree Nuts
Milk is number one allergy in young children followed by egg, soy, and wheat. Often all these allergies will be outgrown by age 3. Allergies to egg is to protein in the egg white but egg yolks aren’t recommended due to cross contamination.
The most common allergies are peanuts and tree nuts. In fact peanuts are not nuts but legumes and grow under the ground. Tree nuts include walnuts, almonds, pistachios, brazil nuts, hazelnuts, and cashews. Allergies to tree nuts and peanuts tend to be life long but about 9% of children outgrow tree nut allergy and 20% of peanut allergies are outgrown.
Shellfish and fish (technically finned fish) can sometimes develop in adult hood at a staggering 40% of first reactions happening beyond childhood.

8. Tips for Service Know your students and their allergies
Accessible information to know the ingredients in your foods
Reading food labels

9. 2004 it was mandated the big 8 allergens be clearly labeled.
2004 it was mandated the big 8 allergens be clearly labeled.

10. Gluten-Free Gluten – protein structures found in certain grains
Wheat Oats Rye Barley
Celiac Disease (celiac sprue) – an autoimmune response at the digestive system that attacks the lining of the intestines leading to malabsorption
Prevalence 1 in 133 people, more common in relatives of those with celiac disease

11. Foods Allowed when Gluten-Free
Alternative grains – Corn, Flax, Quinoa, Rice, Soy, Potato Flour
Naturally (unprocessed):
Beans, seeds, nuts
Eggs
Fresh meats, fish, and poultry (not breaded, battered, or marinated)
Fruits and Vegetables
Most dairy products

12. Beyond WORB:
Gluten is often added to processed foods for taste and texture or in non-food items.
Medications, vitamins, play dough, lotions, malt flavoring

13. Tips for Service Cross contamination Menus / Choices Cost

14. Renal Diet Chronic kidney disease / dialysis
Potassium, phosphorus, sodium restriction
1 in develops ESRD

15. Potassium Milk Fruit Vegetables Tomato Potatoes Banana Winter Squash
Oranges
Collard Greens
Cantaloupe
Milk

16. Phosphorus Dairy – milk, yogurt, cheese Whole grains Chocolate
Peanut butter, Nuts, Seeds
Processed foods - cola

17. Sodium Table Salt Processed / Convenience Foods Soup Cheese Fast Food
Seasonings
Sports Drinks

18. Healthy Hunger-Free Kids Act of 2010
More fruit & vegetables, more whole grains, lower sodium, etc.
Good for most, bad for kidney disease

19. Medical Nutrition Therapy
Protein-restricted
Low Fat
Low Sodium
Vegetarian
Vegan
FODMAP
Casein-free

20. Much Ado About Diets? Nutrition - an ever changing science

21. pgustaf3@fairview.org / 612-273-3740 “Brave”
2450 Riverside Ave
Minneapolis, MN 55454 /
“Brave”

22. References
Academy of Nutrition and Dietetics. Pediatric Nutrition Care Manual. Chicago, Ill: American Academy of Nutrition and Dietetics; 2012.
Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of NIAD-Sponsored Expert Panel. The Journal of Allergy and Clinical Immunology; 126 (6), Supplement: S1-S58.
Mahan, L. & Escott-Stump, S. (2008). Krause’s Food and Nutrition Therapy (12 ed.) St. Louis, Missouri: Saunders Elsevier.

23. Thank You