Tips for Achieving Complete Nutrition for Children with Food Allergies

It can be difficult for children with food allergies to meet their nutrition needs, especially for those avoiding cow’s milk or multiple food allergens.  The most commons food allergens are milk, egg, wheat, soy, peanut, tree nut, fish and shellfish which are responsible for supplying important nutrients that provide good nutrition and promote adequate growth in children.  Since food allergies can often occur  during periods of crucial growth and development, removing these foods from a child’s diet can have a great impact on a child’s overall wellbeing.  Avoiding food allergens is an essential step in managing a food allergy, but removing foods from a child’s diet may leave parents concerned about their child’s overall health and wondering what they can do to make sure their child is meeting his or her goals for nutrition and growth.  Here we offer tips on how to make sure your child receives adequate nutrition while successfully avoiding his or her food allergens.

Know the Risks of Elimination Diets

The risks of not meeting nutrition needs with elimination diets and the impact this has on the growth and development of children with food allergies is well documented in research studies. These risks affect children with all types of food allergies including IgE-mediated food allergies as well as food protein-induced enterocolitis syndrome (FPIES) and eosinophilic esophagitis (EoE). Common risks include poor growth, affecting both height and weight, and nutritional deficiencies.  Nutrients that are commonly lacking in elimination diets include protein, carbohydrates, fat, vitamin D and calcium, but may also include other vitamins and minerals¹.

IgE-Mediated Food Allergy

IgE-mediated food allergies are the leading cause of anaphylaxis, a potentially fatal allergic reaction. Food allergic reactions often involve a wide range of symptoms of the body including the skin, GI and respiratory systems.  Strict elimination of the trigger food(s) is necessary to prevent an allergic reaction, therefore elimination diets are common among children with IgE-mediated allergies.  Due to these necessary diet restrictions, these children are at greater risk for nutritional deficiencies and growth issues.

Food Protein-Induced Enterocolitis Syndrome (FPIES)

Similar to management of IgE-mediated food allergies, management of FPIES requires the removal of the trigger food(s). FPIES typically presents in young children and reactions can be triggered by foods such as rice, oats, meats, fruits and vegetables which are commonly considered to be low allergenic foods².  Patients with FPIES sometimes react to multiple foods and expansion of the diet can be slow, further contributing to nutrition risks. Providing a variety of tastes and textures while expanding the diet can be particularly challenging in FPIES patients and lack of variety in the diet can sometimes lead to flavor fatigue.   

Eosinophilic Esophagitis (EoE)

Dietary Therapy using an elimination diet is a common treatment choice for patients with EoE. The most common types of dietary therapy for EoE are empiric elimination diet, test-directed elimination diet and elemental diet.  These elimination diets typically exclude multiple foods with the elemental diet removing all foods and replacing them with amino acid-based formula.  Due to the need for long-term dietary therapy to manage symptoms and a high prevalence of feeding disorders³, children with EoE are at increased nutrition risk and require close monitoring of growth and nutrition status.

Seek the Advice of a Registered Dietitian

Meeting with a registered dietitian to seek advice on how to meet a child’s nutrition needs is arguably the most important step that a parent can take when it comes to food restricted diets. Not only can a dietitian teach families with food allergies how to avoid their allergens, he/she can also assess nutrition status and monitor growth. A registered dietitian will likely take a diet history to better understand the average nutrient intake from the diet. After assessing the current diet, the dietitian will be able to identify what nutrients are missing and make suggestions for safe foods that can replace the lacking nutrients.  In some cases, vitamin and mineral supplements may be needed to meet specific nutrient needs. After gathering this information, the dietitian can provide a personalized plan that works for a specific child and family to optimize the child’s nutrition intake and growth.

Use Strategies to Improve the Overall Diet

Once the gaps in a child’s diet have been identified and advice on replacement foods has been received, practical steps can be taken to improve the overall diet.

• Make a list of safe foods. Organize these foods into food groups.  Choose a food from each food group to create a balanced meal.
• Provide variety by offering foods with different textures, colors, and flavors. This promotes overall healthy nutrition and better acceptance of new foods.
• Get your child involved. Getting children excited about choosing safe foods and preparing meals can increase their intake of different foods.
• Model good eating behaviors by providing structured mealtimes and eating a variety of foods. Avoid negative comments or reactions to your own foods when eating.

Understand the Role of Supplemental Formulas

While there are a wide variety of milk alternatives available in grocery stores, many of them are not successful in replacing the missing nutrition in elimination diets. For children who are unable to meet their nutrition needs and/or growth goals with their diet alone, a hypoallergenic formula may be recommended.  When used to supplement elimination diets, hypoallergenic formulas have been found to improve the intake of calories and protein as well as have a positive effect on growth⁴. Hypoallergenic formulas include extensively hydrolyzed and amino acid-based formulas.  To learn more about the characteristics of hypoallergenic formulas read our recent blog and always discuss with your healthcare provider to determine which formula is right for your child.

Hypoallergenic Formula Options from Cambrooke

Cambrooke offers two hypoallergenic amino acid-based formula options for children over the age of 1 to support the nutrition needs of children following elimination diets.  Both offer complete nutrition and are appropriate for all types of food allergic disorders.  EquaCare Jr. provides comparable nutrition at a more affordable price than the competition.  Essential Care Jr. offers natural, value-added ingredients at a similar price to the competition. Learn more about these formulas by visiting us online today or calling 1-833-377-2773.

References:

1. https://pubmed.ncbi.nlm.nih.gov/23510952/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011627/
3. https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/March-2017-EoE-dietary-management.pdf
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944436/
5. https://www.kidswithfoodallergies.org/replacing-lost-nutrients.aspx