Source: The LEAP study

Did you know that nearly 30% of children in the United States have some form of allergy and that the rate of allergic disease in children is on the rise?

I found this fact quite interesting – and troubling – as I read this article about childhood allergies. What is even more interesting is that the progression of allergic disease in children appears to follow a predictable pattern called the Allergic March.

It goes like this – first it starts with dermatitis (eczema), then to chronic gastrointestinal (GI) issues, then to chronic serous otitis media (ear infections), then to chronic rhinitis (stuffy nose) and finally to asthma.

The problem is that allergic disease doesn’t have a cure, and that is why, prevention is the only smart choice. It helps to know that the pattern of allergic disease is predictable, which is why, early signs of allergic symptoms like eczema and food allergy or sensitivity should be considered seriously.

Most babies in their first 1-2 years of life show sings of food sensitivity to certain foods such as egg, dairy, soy, rice and wheat. This is because their young immune systems are yet to mature and sometimes they get confused by different proteins in these foods. Good news is that, most children do grow out of these early issues by the time they reach age 5.

The news is not so good if there is a family history of allergy, which is why getting to know the allergic march is quite important. If either mom or dad – or both – have a history of allergy, the chances of their child developing an allergy can be as high as 50 -80%. If not diagnosed and prevented early, the allergic march is likely inevitable.

We have been interested in food allergy here on Littlestomaks, because it affects so many babies and toddlers. Although there is no reason to hit the panic button over a few episodes of vomiting and reflux, it is prudent to take them seriously when allergy runs in the family. Same goes for ear infections, which again are quite common in children. A link between milk allergy and ear infections, for example, is being reported in many cases. Talk to your doctor about the history of allergy in your family on a routine visit to treat an ear infection. For all you know, it might be the first step on the allergic march, which you can avoid with early intervention.

Here are a few nice links for more information:

The LEAP study
The Allergy March
Food Allergies on About.com
Pediatric food allergies on Today’s Dietitian

Do you have a child with food allergies? Share your story, we would love to hear from you!

©2011 Littlestomaks.com

This is a guest post by registered dietitian Brooke Schantz. She blogs at Bitchin’ Nutrition about nutrition and healthy eating.

photo credit: shawncampbell

With Halloween coming up, many parents may feel stress and pressure with all the allergen-laden treats that are given out during this time of year.  It can be hard around Halloween because part of the celebration revolves around food and treats.   Making a game plan before Halloween during trick-or-treating, parties, and school events can help relieve stress!

Here are a few tips to help your children with food allergies enjoy Halloween:

At Home

Don’t buy your trick-or-treat candy at the last minute.  Shop for your candy early, so you will have enough time to read the ingredient lists on your family’s favorite candies and decide what is okay to buy.

Plan your trick-or-treat route days before Halloween.  Take some of your child’s favorite treats to the neighbors ahead of time.  Your child will still get to enjoy the experience and you will feel relieved knowing that the treats they will receive are safe to eat.

Trick-or-Treat for the United Nation International Children’s Emergency Fund (UNICEF).  This will teach your children about helping others and you can still give them their favorite treats when they get home as a thank you.

At Parties

Host a party at your house!  You will be able to control the environment and still provide delicious treats your child can eat.

Have your child eat before they attend a party.  Talk with the host ahead of time and let them know what food allergies your child has, so they can prepare at least one treat that everyone can enjoy.

Take your own appetizers or treats to a party.  This way the buffet or dessert table won’t spook you, because you know what foods can be safely consumed.

At School

Speak with your child’s teacher before any fall party to remind him or her of your child’s food allergies.

Encourage other parents of children in the class to provide non-candy gifts during the school party.  Handout Halloween gifts like: pencils, stickers, or plastic pumpkin baskets.

See if you can volunteer to help out during the party. You can also let the teacher know that you are willing to be in charge of the snacks.

Always pack an allergen–free snack for your child to enjoy just in case there are no other safe options.

Review with your child what foods are safe for him or her to eat and what foods should be avoided.  Teach your children to ask questions about foods and/or treats at parties prior to consumption.

©2010 Littlestomaks.com

This is a guest article by Dr. Russell A. Faust, PhD, MD, FAAP, who blogs at Boogor Doctor. Recently, I asked him if there was a link between milk allergy and chronic ear infections. His article below offers an excellent understanding of what an ear infection is and why it is commonly seen in young children.

Russell A. Faust, PhD MD FAAP PhD – Molecular and Cellular Biology, University of Washington MD Otolaryngology, University of Minnesota Fellowship training in Otolaryngology at Johns Hopkins University Faculty appointments at Ohio State University and Wayne State University Contributor and instructor for Baby Boot Camp Nutrition Solutions program Expertise: pediatric ENT care, rhinitis and sinusitis, minimally invasive surgery for children Books: Robotics in Surgery Website: Boogor Doctor Twitter: @boogordoctor Contact: via website

Do milk allergies cause ear infections?

Without giving a straight “yes” or “no” answer, the following describes the factors that link food allergies (specifically milk) and otitis media, in a 1-2-3-4 stepwise fashion.

Otitis media is a complex disorder, and I want to simplify this link as much as possible. Please write and let me know whether I have succeeded:

As a pediatric boogor doctor, I see plenty of ear infections – Otitis media is what we call the disorder in medicine. It is affected by both inherited and environmental factors.

(1) The highest incidence of otitis is among infants and toddlers.

This is the first factor to keep in mind: the age group – infants and toddlers.

Some Definitions

Let’s define some basic terms before going further. Otitis media is inflammation of the middle ear space (see Figure).

Eustachian tube (the blue arrow) and middle ear cavity (bright pink)

Acute otitis media (AOM) is acute infection of the middle ear. Signs and symptoms are usually rapid in onset, and include fever, earache, and purulent fluid in the middle ear (pus). No signs and symptoms are universally accepted as definitively proving the diagnosis.

Otitis media with effusion (OME) is inflammation of the middle ear with a collection of fluid in the middle ear space.  This fluid may be thin and watery, thick mucus, or pus – any of these, just fluid, but without acute symptoms.

Chronic otitis with effusion (COME) is the label given to OME when it has been present for more than 3 months.

Hearing

The ear simply does not function when the middle ear space if full of fluid – hearing is reduced in the presence of middle ear fluid. When the fluid clears, hearing (nearly always) returns 100%. More on this in a little bit.

Some Anatomy

The middle ear cavity is normally air-filled. Anything else is considered pathology. Air or any gas within a closed cavity will be absorbed by the body. I don’t remember all of my partial-pressure formulas from physics classes, but if there is no way to get air into the middle ear cavity, this absorption will create a vacuum.

Let’s look at the Figure. The way air normally gets into the middle ear is through the Eustachian tube.

So here is the problem for infants and toddlers: the Eustachian tube is floppy.

Ever notice how a baby’s ears are soft and almost floppy? The cartilage inside is young and soft – just like the cartilage around their Eustachian tubes. So young Eustachian tubes are more floppy than mature Eustachian tubes.

Hence, infants and toddlers don’t get air into their middle ears very well.  The result is:

(2) “Eustachian tube dysfunction” (ETD)

That’s the term for Eustachian tubes that don’t work normally. This is the second factor in the link between milk and otitis.

We can relate to what ETD feels like, at least for s short while – we are all familiar with the sensation in our ears from traveling in a plane, or going rapidly up or down many floors in a fast elevator. It feels like pressure, and our ears feel “stuffy” and our hearing is muffled.

When the Eustachian tubes don’t work normally, a vacuum is formed in their middle ears, this draws fluid in from surrounding tissues – OME.

This fluid can become infected –AOM, potential COME. This is one reason why infants and toddlers have a higher incidence of otitis media.  Another reason is their immature immune systems – their immune systems are just not as wise and experienced as an adult’s, so they may be unable to fight off those infections.

Inflammation

We have seen that the Eustachian tubes in toddlers and infants are floppier than older children and adults. In addition to this given tendency to collapse, ANYthing that adds inflammation will make the collapse worse.

(3) Any inflammation of the lining of the Eustachian tube can worsen ETD.

This is the third factor in the link between milk allergy and otitis:

Inflammation worsens collapse of the Eustachian tubes.  Chronic inflammation can increase the risk of otitis.

What can cause inflammation of the Eustachian tubes?

• Viruses, Bacteria
• Reflux
• Allergies – hayfever
• Allergies – food allergies
• Air Pollution – most commonly tobacco smoke, but any airborne irritant
• Chemical irritants – example: chlorinated pool water

For infants and toddlers, upper respiratory infections (URI) with viruses is the most common cause of inflammation that causes ETD.

Reflux (regurgitation of gastric contents) in babies and infants. Medical studies have shown that reflux can cause otitis media.

Allergic Effects

Studies that have looked for a link between otitis and allergies suggest that there is a link between allergies to milk and COME.

If we think about it, this link should not be surprising:

Remember, any inflammation, like allergies, will worsen Eustachian tube dysfunction in our age group with ear infections – infants and toddlers.

What is the most common allergy found in infants and toddlers? Allergies to the airborne allergens (the things that we react to) don’t really develop until later. In this age range, the most common allergic reactions are to foods.

(4) What is the most common food allergy in infants and toddlers?

Right: Dairy – milk and eggs. This is our fourth and final link between milk allergy and otitis.

So yes, there is a link between milk allergies and ear infections, but no, milk does not cause ear infections. Not any more than an allergy to grass or flowers causes ear infections.

Note that in those people who do respond to milk allergens, it often thickens their mucus secretions. This is not a good effect when we are talking about Eustachian tube function – thicker mucus makes it harder for the Eustachian tubes to work normally.

So, to recap:

1. Otitis is common in infants and toddlers
2. Eustachian tube dysfunction is common in infants and toddlers, and increases risk of otitis
3. Inflammation of the Eustachian tubes, including inflammation from allergies, increases risk of otitis
4. The most common food allergy in infants and toddlers is milk

What Can You Do With This Information?

Well, for starters, if your little boogorhead has recurrent ear infections, consider eliminating dairy from their diet for a few weeks. A good place to start is the recent article Preventing Food Allergies on Littlestomaks. When it is time to visit a doctor, try to visit a pediatric boogor doctor (Ear, Nose, & Throat specialist). Yes, any ENT doctor can place ear tubes to treat recurrent ear infections. You will find that a pediatric ENT doctor’s office will be more “kid-friendly” – their waiting rooms are usually full of books and toys for children of all ages, their nurses are devoted to the care of children, and their medical instruments are kid-sized. Not to mention that the docs themselves have devoted their lives to the care of children, exclusively.

During that visit, they may obtain a hearing test, they may consider allergies, or reflux, among many other potential factors for causing your child’s otitis. Be patient. Otitis media is a complex disorder, influenced by hereditary and environmental factors, and it can take awhile to sort it all out.

Hearing

As an integrative holistic pediatric ENT specialist, my goal is to combine the best of conventional and alternative medicine to get my patients healthy. As a result, I am ultra-conservative with regard to surgery, especially for things like otitis media. The balance between aggressive and conservative can be tricky.

I waited too long to have my first son’s COME treated (he never complained, had no acute infections, just fluid), and his start of speech was delayed due to the reduced hearing while the fluid was in his middle ears.  So – get it evaluated by a specialist, get it treated if necessary.

My son got his set of ear tubes (the only way to eliminate the chronic fluid in the middle ear cavity), hears normally now, and his speech has taken off (can’t shut him up, wouldn’t want to).

©2010 Littlestomaks.com

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

If you have a child with food allergies, naturally you worry if he is getting proper nutrition from his somewhat restricted diet. Perhaps you have considered giving a multivitamin but found yourself worrying about safety of those vitamins. This week, Registered Dietitian Brooke Schantz offers a few tips on what to look for when selecting a multivitamin for your child with food allergies.

Question: What kind of multivitamins are safe for my child with food allergies? What should I be concerned about?

Answer:

First, let me review the difference between a food allergy and food intolerance.  A food intolerance is an abnormal physiological response to food. Symptoms can affect the skin, respiratory tract, gastrointestinal tract (GIT) either individually or in combination. Some examples of symptoms of a food intolerance are gas, bloating, diarrhea, etc.  It can be difficult to determine the food that causes an intolerance because if the immune system is involved, the response takes place slowly. A food allergy is an immunological hypersensitivity which occurs most commonly in response to food proteins that are mistaken as harmful and therefore a defense system is created to fight them off. These allergic reactions have an acute onset (from seconds to one hour) and may include:  soft tissue, severe swelling of the tongue, hives, itching, nausea, vomiting, diarrhea, stomach cramps, nasal congestion, wheezing, shortness of breath, or anaphylactic shock.

Children with various food allergies would not be allergic to vitamins or minerals in supplements themselves; but rather to a possible ingredient used in the making of the multivitamins.  The Food Allergen Labeling Consumer Protection Act (FALCPA) was passed by the Food and Drug Administration (FDA) in 2006 to require manufacturers to identify the use of the top eight allergens.  These allergens are eggs, dairy, soy, tree nuts, peanuts, fish, shellfish, and wheat.  Unfortunately, vitamins fall under the category of “dietary supplements” which are not included in this law.  A dietary supplement is defined as products taken by mouth that contain a “dietary ingredient” intended to supplement the diet.  This is important to note, because vitamins are not meant to be a substitution for a healthy diet or justify consuming a poor diet.

The FDA does not approve dietary supplements prior to being put on the market.  Therefore, if your child is allergic to a specific allergen it is important to familiarize yourself with all the derivative names for that allergen.  For example, if your child has a milk allergy, you would also want to look for words on the ingredient label that include but are not limited to: calcium caseinate, casein, caseinate, rennet, curds, hydrolyzed casein, hydrolyzed milk protein, lactalbumin, lactalbumin phosphate, lactate, lactose, lactoferrin, and lactoglobulin.

What you can do:

1. Check the ingredients label for the specific food allergen and its derivative names.  Some vitamin labels even include information on common allergens, even though the manufacturers are not required to list this information. Below is an example children’s vitamin ingredients list.
   Ingredients: Sucrose, Sodium Ascorbate, Stearic Acid, Maltodextrin, invert sugar, Vitamin E Acetate, Corn Starch, Gelatin, Niacinamide, Magnesium Sterate, Natural Flavors, Yellow #6, Riboflavon, Thiamine, Folic Acid, Vitamin D3, Vitamin B12
   Contains: Soy
2. Look for the USP seal.  The U.S, Pharmacopocia (USP) is a non-profit organization that has established standards of quality for prescritpion and nonprescription drugs.  Using vitamins and other supplements with the USP seal indicates some quality of control.  Vitamins that have the USP seal can be found here.
3. Follow the dosage directions correctly!  Your child doesn’t need more than the recommended daily dose.  Some parents believe that if their child has eaten really poorly for one day giving an extra vitamin is better and this is not the case.   An overdose of certain vitamins could be dangerous and also lead to the preventing other vitamins from being properly absorbed.
4. Discuss the use of all supplements with your doctor and registered dietitian.

©2010 Littlestomaks.com. All Rights Reserved

Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

This is a guest post by Lauren Morgan, a dietetic intern at the University of Maryland and blogger at The Blue Plate Special. Having grown up with food allergies, and because of her training as a dietitian, she has a strong interest and technical knowledge of this topic. In this article, she presents the latest research and recommendations for preventing food allergies in high risk infants.

photo credit: saia.neogaia

The American Academy of Pediatrics (AAP) reviewed older recommendations (from 2000) and the current research to publish their most current recommendations for the prevention of food allergy in high risk infants.  The AAP defines a high risk infant as a child with at least one parent or sibling with documented allergic disease.  Several factors stayed the same from their 2000 recommendations, but there were also newer recommendations thanks to research.  Here are some of the most important factors when it comes to prevention of food allergies:

Breastfeeding

The AAP, World Health Organization (WHO), American Academy of Allergy Asthma and Immunlogy (AAAAI), all recommend breastfeeding as the best source of nutrition for an infant as well as the best approach for preventing food allergy development.  According to AAAAI, breast milk strengthens the infant’s immune system and is the least likely food to trigger an allergic reaction.  The AAP’s recommendation is exclusive breastfeeding for at least four months.  While the evidence for breastfeeding preventing the development of food allergies is lacking, there is evidence for many other benefits that come along with breastfeeding.  Therefore, it is still the most highly recommended feeding method.

Maternal Pregnancy Diet

There is a long-standing thought that moms of high-risk infants should avoid certain foods during pregnancy; however this thought is not backed up by the research.  Researchers have not found conclusive evidence that moms should make any dietary restrictions during pregnancy.  In 2000, the AAP recommended there be no dietary restriction except the possible avoidance of peanuts.  The 2008 recommendations do not state an avoidance of peanuts during pregnancy is necessary.

Maternal Lactation Diet

Should moms avoid certain foods while they are breastfeeding?

The most recent research says no.  In the year 2000, the AAP recommended eliminating peanuts and nuts and consideration of elimination of eggs, cow’s milk, and fish.  However, in the updated 2008 recommendations the AAP states there is no dietary restriction needed.  According to the AAAAI, while research has been done on changes in mom’s diet, it has not proven to be as effective as the careful and timely introduction of foods to infants.

Soy Formulas

Should soy formulas be used for infants at high risk of developing food allergies?

The research again says no.  Previously, it was thought this might be an appropriate intervention; however, there has been no conclusive evidence to support this.  In fact, it is common for infants with cow’s milk allergy to be allergic to soy as well.  If breastfeeding is not an option the best alternative is providing the infant with a special hypoallergenic formula that has hydrolyzed protein.  These formulas need to be carefully considered and only used when necessary as instructed by your pediatrician.  These are very specialized and are much more expensive than standard formulas.

Introduction of Solid Foods

Should I wait to give my child certain foods like milk, eggs, and nuts?

Solid foods can be introduced between four and six months of age.  Cereal grains, vegetables, and fruits are the best to begin introducing.  Make sure you only give your child one ingredient at a time when introducing foods.  If they have apples, oranges, green beans, and grains and have a reaction you will not be able to tell which food they are allergic to.  Start with one food and wait several days before trying another one.  In the AAP’s 2000 recommendations it was recommended to delay introduction of foods with the most common allergens.  The recommendations included cow’s milk at twelve months, eggs at twenty-four months, peanuts, nuts and fish at thirty-six months; however, these recommendations have changed based on more current research.  The AAP now recommends no delay in introduction of any of these foods.  They state “there is no evidence for delaying introduction of any foods beyond this period [4-6 months], including those considered highly allergenic (e.g., fish, eggs, foods containing peanut protein)” (Greer).

The Take Away

While there is still so much unknown about the development of food allergies, it is encouraging to have solid, science-based recommendations for the prevention of food allergies.  I have continued hope that there will be great revelations in research that help find answers to food allergy questions.  Until then I rely on recommendations like these from credible institutions to help guide my practice as a nutrition professional and in my personal life as well.

References

• American Academy of Allergy, Asthma, and Immunology.  Tips to Remember:  Prevention of Allergies and Asthma in Children.
• World Health Organization.  10 Facts on Breastfeeding
• American Academy of Pediatrics, Committee on Nutrition.  Hypoallergenic infant formulas.  Pediatrics.  2000; 106: 346-349.
• Greer FR, Sicherer SH, Burks AW, and the Committee on Nutrition and Section on Allergy and Immunology.  Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.  Pediatrics.  2008; 121(1): 183-191.

Parents: do you have a child with food allergies? What steps do you take to prevent or manage your child’s allergies?

©2010 Littlestomaks.com

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, registered dietitian Kerry Robinson clarifies the difference between milk allergy and lactose intolerance and offers advice on how to deal with both.

Kerry Robinson, RD B.S. Virginia Tech – Human Nutrition, Foods and Exercise with concentration in Dietetics Dietetic internship at Virginia Tech Expertise in food and health communication at IFIC Analyzes trends in food and health issues on traditional and social media Twitter – @IFICmedia Contact via email – robinson@ific.org

Question: How can I be sure if my child has milk allergy or lactose intolerance?

Lactose intolerance is an inability to digest and absorb the sugar in milk (lactose) that results in gastrointestinal symptoms such as nausea, vomiting and diarrhea when milk or milk-containing products are consumed.

Unlike lactose intolerance, a milk allergy is caused by an immune system response in which milk proteins (casein and whey) are mistakenly identified as being dangerous and antibodies are created to fight them off in an effort to protect the body.

For example, a child with a lactose intolerance, can consume  lactaid (lactose –free milk) or yogurt without symptoms but a child with milk allergy can not. The difference between milk allergy and lactose intolerance is not only the cause, but also the severity of the symptoms.  While a child with a milk allergy can display similar gastrointestinal symptoms as one who suffers from lactose intolerance, it is important to understand that the symptoms of an allergic reaction can be much more severe, and even life threatening at times.

The following are the most common signs and symptoms of a reaction to a food allergen, like milk

• Skin rashes, itching, swelling or hives
• Vomiting or other gastrointestinal symptoms
• Respiratory distress, such as wheezing or breathing difficulties
• Anaphylaxis, which is a systemic allergic reaction that can involve multiple symptoms at once and can range from mild to fatal

Once you suspect that your child or loved one has a reaction or intolerance to milk you should consult your health care provider, pediatrician and/or a board-certified allergist.  He or she may ask you detailed questions about signs and symptoms, perform a physical exam, request a detailed food diary, and perform a combination of skin prick or blood sample tests to confirm an allergy or intolerance.

Should a milk allergy be confirmed, you will need to eliminate all milk and milk-containing products from your child’s diet.   While this can seem like a daunting task, a registered dietitian can provide expertise in helping to ensure your child receives adequate nutrition, especially calcium to foster proper growth and development.  Since strict avoidance of the offending food allergen (in this case, milk) is the only way to prevent a food-allergic reaction, a registered dietitian can work as part of the healthcare team to:

• Review how to avoid specific food allergens
• Ensure nutrient adequacy (especially calcium and Vitamin D)and add variety to your child’s diet
• Provide suggestions for meals and snacks and strategies to enjoy dining out
• Assist in label reading
• Monitor growth and development
• Share resources related to food allergies

Whether your child is lactose intolerant or allergic to milk, it is important to engage your healthcare team, especially a registered dietitian to help guide you in making sure your child eats and stays healthy.

For more information on allergies, join IFIC and Food Allergy and Anaphylaxis Network for a Twitter chat on Tuesday May 11, 2010 at 8 p.m EST using hashtags #foodinsight and #FAAW

©2010 Littlestomaks.com. All Rights Reserved

Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

This is part 2 of a series by guest writer Lauren Morgan, a dietetic intern at the University of Maryland and blogger at The Blue Plate Special. Having grown up with food allergies, and because of her training as a dietitian, she has a strong interest and technical knowledge of this topic. Feel free to leave a question or comment for follow up!

In part 1 on milk allergy, we introduced a definition and some common symptoms of milk allergy. In this second part, we offer a few tips if you are trying to manage your child’s nutrition when he or she has a known milk allergy.

Do we know the reasons why a child may develop milk allergy? Is it because of genetic reasons or are there environmental factors?

This is a good and complicated question because the causes of allergies are not well understood.  Children develop allergies when they come into contact with allergens, thus this is an environmental trigger.  Children are at greater risk for developing allergies if one or both parents have allergies, so this is the genetic component.  Researchers do think that there is generally a strong genetic component although it is not well understood.

How to achieve proper nutrition and avoid calcium and vitamin D deficiency if my child has a milk allergy?

Like we mentioned last week, milk is a great source of calcium and vitamin D which are very important to the body.  Calcium is key for healthy bones, especially for children as their bodies are growing and developing, and vitamin D is necessary for our bodies to absorb the calcium.  The good news for parents of kids with milk allergies is that there are other places to get these important nutrients if your child cannot have any milk or milk products.

Many foods are fortified with calcium these days including fortified ready-to-eat cereals, soy milk (although many children with milk allergy are also allergic to soy so be careful with this one), sardines, collards, spinach, kale, okra, and soybeans and tofu (again watch out for the soy allergy).  Many of these foods have much lower amounts of calcium then a dairy source so be aware of this to make sure your child is getting enough calcium.

Our bodies can make vitamin D, and all we need for this is some sunlight to activate the process!  However, many Americans are deficient in vitamin D for several reasons including that we are more careful and precautious in the sun by applying more sunscreen.  While sunscreen is very important (especially on your children!) it is still possible to make some vitamin D.  By exposing your arms and legs in the sun for about 15 minutes and then applying sunscreen you will be safe in the sun and produce enough vitamin D when doing this 2-3 times a week.  If you are uncomfortable with this or do not think you can be out in the sun enough then food sources or a multivitamin with vitamin D are a good way to make sure you are getting enough.  Food sources include egg yolks, saltwater fish, liver, and some vitamin-D fortified cereals.

What precautions should be taken when traveling or eating out?

Eating out when you have a child with a milk allergy can be a scary thing.  Closely evaluate the menu and pick items that are traditionally milk free; however, you cannot completely rely on this because you never know what ingredients a specific recipe will call for.  The safest strategy is to ASK!  Talk to your server and ask to speak with the chef; they can tell you exactly what ingredients are in the dish and if it is safe for your child to eat.

The Food Allergy and Anaphylaxis Network has a wonderful resource for eating out!  Their chef card template is available for download for FREE.  Just fill out the card with the ingredients your child cannot have and then present this to your chef when dining out.

Stay alert, stay safe, and stay nutritious with food allergies!
©2010 Littlestomaks.com

This is part 1 of a series by guest writer Lauren Morgan, a dietetic intern at the University of Maryland and blogger at The Blue Plate Special. Having grown up with food allergies, and because of her training as a dietitian, she has a strong interest and technical knowledge of this topic. Feel free to leave a question or comment for follow up!

While many people go through their lives never giving a second thought to drinking milk, that is not how it goes for kids and parents of kids with milk allergy.  Milk is a fundamental part of the diet, especially for many young children.  There are certainly ways to have a healthy diet and healthy child while avoiding milk, but for parents of young children just developing these allergies it can be a rough road.  Let’s address the basics of the milk allergy.

What is milk allergy?

Milk allergy is one of the most common food allergies seen in children these days! Here are a few basic facts to know about milk allergy:

• It involves an allergic reaction which is a reaction of the immune system to the protein present in cow’s milk.
• The immune system identifies the protein in milk as harmful and begins to fight it by producing immunoglobulin E (IgE) antibodies to attack the protein.
• The IgE antibodies then trigger a cascade of responses in the body to fight off the allergen; this is what leads to the body’s response of vomiting, swelling, etc.
• There are mild to severe reactions involved in a milk allergy.
• One thing to remember about food allergies is that repeated exposure can lead to more severe reactions.  The first exposure, known as sensitization, begins the production of these antibodies. So the next time the body sees the protein the antibodies are there to fight it off.  This can happen more intensely over time.

It is important to note here that many people mistake a milk intolerance for a true milk allergy.  A true milk allergy involves a reaction of the immune system where as a milk intolerance will often involve digestive problems such as bloating, and/or gas after drinking milk or eating milk-containing products.  It is important to know the difference because milk allergy is a very serious issue that can be life-threatening. Also you do not want to deprive your child of milk and milk products if their digestion can be helped with lactase enzymes or other products. Milk, after all, is a good source of calcium and vitamin D.

Check out a good introduction to general allergic reactions on MedlinePlus and milk allergy on Mayo Clinic and  and HERE for more information on the process behind the milk allergy reaction.  If you are interested in how things work in the body then this will fascinate you!

How can you recognize an allergic reaction to milk in your child?

Allergic reactions happen within minutes to several hours after consumption of the food, or drink in this case.
You could see these symptoms if your child is having an allergic reaction:
Immediately

• Wheezing
• Itchy eyes
• Runny nose, sneezing
• Hives
• Vomiting
• A more severe reaction called anaphylaxis, which is a systemic reaction in the body that can be life-threatening and needs emergency medical attention immediately

Symptoms that take more time to develop

• Diarrhea
• Abdominal cramps
• Loose stools which may contain blood
• Itchy skin rash that is often around the mouth
• Colic in babies

Here is a good description of signs and symptoms of food allergy by American Academy of Pediatricians

How many kids are affected? What is the age range of affected kids and how early can I find out if my child has milk allergy?

According to the Food Allergy and Anaphylaxis Network approximately 2.5% of children younger than 3 years of age are allergic to milk. If an allergy to milk is going to develop, it almost always develops in an infant’s first year of life.  The good news with milk allergies is that most children (it’s estimated 80-90%) will outgrow the milk allergy in their first few years of life.

That’s a lot to take in about milk allergies, so digest it, and I will be back to talk about the “so what do we do?” side of it very soon!

Photo Source: Clearly Ambiguous on Flickr

©2010 Littlestomaks.com

This is a guest post by Lauren Morgan to support the National Nutrition Month® along a theme of Nutrition From the Ground Up.

One of my favorite topics is food allergies because it is so personal to me.  My parents discovered I was allergic to peanuts when I found the peanut butter in the cupboard, and then they found a little girl who was swollen as could be.  Soon after, I found that I was allergic to tree nuts (all of them), green peas, salmon, and soy.  Even though my parents had to steer me away from all of these dangers, they were still able to feed me a wholesome, nutritious diet.  For those of you who have children, grandchildren, or loved ones with food allergies you know just how hard this can be!

Based on what I have learned from my own life living with food allergies and now that I am in the field of nutrition, I have developed some building blocks for developing healthy, nutritious lifestyles in children with food allergies:

• Eliminate the allergens.  This one seems like common sense, but it is very important.  Completely eliminate the food allergen(s) from your child’s diet, and if necessary, their home environment.
• Look for balance.  Check out the great resources at MyPyramid.gov (check out the section for preschoolers) to see what a balanced diet looks like and compare what your child can eat.  Try including foods from as many of the food groups as you can.  If your child has multiple allergies this may not be possible, so include as many foods as they can eat from each group.
• Keep it interesting.  Children like foods that look interesting to them, so try to have variety to keep your kid interested and feeling like they get to eat many foods.  One great way to do this is to add different colors.  Try doing red, yellow, and orange peppers sometime- the colors are so bright they just stick out to kids!
• Talk with your kids.  It is so important to talk with your children about their food allergies.  They should know what foods to avoid, why they should avoid them, and how to share this information with teachers, friends, and out at restaurants as they get older.
• Have fun!  Children can feel deprived when their diets are limited and they can’t eat the same foods as their friends.  Try cooking together with them to make some fun dishes.  For example, if your child cannot have pizza, make your own!  Try a fruit pizza and let them pick the fruits that they add.  There is so much room to be creative and kids will have fun with it, too!

Here are a few useful websites for more information on food allergy:

The Food Allergy and Anaphylaxis Network
FoodInsight.org Resources on Food Allergy
American Academy of Asthma Allergy & Immunology

What has worked for you? Share your tips in comments below.

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

Thinking about introducing your little one to fish and other seafood but worried about food allergy? Check out these handy tips from Registered Dietitian Keri Gans!

Question: We want to introduce our 2 year old to fish and other seafood. What should we be worried about? Are there any safe seafood we can try first?

Answer:

The good news is that as of January 2008 the American Academy of Pediatrics declared that there is no convincing evidence that delaying any food beyond 4 to 6 months reduces the risk of developing an allergy to it. So even though fish is one of the top eight allergenic foods, no need to worry, it is definitely time for your 2-year old to start enjoying it.

What is important to remember is that fish and shellfish are an important part of a healthy diet. They contain high quality protein and other essential nutrients that are low in saturated fat. The Omega 3 fatty acids found in fish are considered beneficial for cardiovascular health and preliminary research suggest they can enhance brain development and improve learning, behavior and vision. The American Heart Association currently recommends recommending two servings 2-3 ounces of fish a week for children as an early prevention of cardiovascular disease.

Follow these recommendations for your young child:

1. Do not serve shark, swordfish, king mackerel or tilefish because they contain high levels of mercury.
2. Ok for your child to eat up to 12 ounces a week of a variety of fish and shellfish that are lower in mercury, such as shrimp, canned light tuna, salmon, pollock and catfish.
3. Serve no more than 6 ounces of fresh or canned albacore (white) tuna. They have more mercury than light tuna.
   Make sure your fish is thoroughly cooked to avoid food borne bacteria and viruses.
4. Buy fish from reputable sources.
5. Introduce only one type of fish at a time.

After introducing any new food in your child’s diet wait 3 days until moving on to another food. Watch for signs of a food allergy, swelling of the tongue, lips or face, skin rash, wheezing, abdominal cramping, vomiting or diarrhea. If symptoms appear call your doctor right away.

Also remember that you are a food role model for you child. If they don’t see you eating fish they will not grow up eating fish. There is also no need to try and disguise the fish, by heavily breading and frying it. Serve it to them just as you would yourself, hopefully that is grilled, broiled or baked.  I remember when my niece was around 3 years old….she loved tilapia, but thought she was eating chicken.

Great resources on seafood:
Environmental Protection Agency
Seafood WATCH
Kid Safe Seafood

©2010 Littlestomaks.com. All Rights Reserved

Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

In her recent article Vaccine for ear infections soon to be on the market,  Chicago Family Health Examiner Jasmine Jafferali, MPH, wrote that the underlying cause of chronic ear infections in children could be milk allergy. I was so intrigued by this suggestion that I contacted her to address this idea in a Question-Answer format for my blog. If your child is suffering from chronic ear infections and you are concerned about excessive use of antibiotics, this article is a must read for you! Let me know what you think!

Question: You have said that milk allergy is an underlying cause for chronic ear infections. Can you provide a credible reference to support this?

Jasmine: Dr. Greene, a prominent pediatrician,  has discussed a link to milk allergies and ear infections.  Up to 40 percent of kids who suffer from chronic ear infections has a milk allergy.  In fact a 1997 report on food allergies in the Journal of the American Medical Association found that cow’s milk allergies tend to hit children in their infancies, showing up as colic, acid reflux or eczema.  However many pediatricians are overlooking the possibility of food allergies, especially milk allergies to chronic ear infections.

Question: How can parents recognize the signs of food allergy and dairy allergy in particular?

Jasmine: Although a child can develop an allergy to almost any food, well over 90 percent of food allergies in children are caused by one of only six foods: milk, eggs, peanuts, wheat, soy, and tree nuts. The immediate symptoms of food allergies in babies and toddlers are irritability, colic, wheezing (sometimes asthma), a minor rash, chronic runny nose, or itchy eyes. These more immediate symptoms are less likely to occur than slower onset symptoms, which your baby can experience seven to 10 days after exposure to cow’s milk.  These more common symptoms include diarrhea (possibly with blood), abdominal cramps, vomiting, coughing, gagging, acid reflux, ear infections, runny nose, eczema and colic.

Food allergies is becoming more and more common in our children.  Parents are fearful and the information out there is confusing.  These findings are all consistent with the 2008 American Academy of Pediatrics guidelines that overturned previous recommendations by declaring that there is no evidence that delaying any food beyond 4 to 6 months helps prevent allergies at all — for healthy term children who are not already allergic.  However, many parents get quite excited introducing solids to their infants.  Remember, the main source of nutrition for an infant is breastmilk or formula for the first year of life and solid food is meant to be the supplement.  Look for signs that your baby is ready to eat solids.

Question: What kind of questions should parents ask when an antibiotic is prescribed?

Jasmine: If an antibiotic is prescribed some questions to ask are:

1. Is the infection bacterial or viral?  If viral, then antibiotics will not improve symptoms of the ear infection.  It is like being prescribed antibiotics for a cold.  Ask for possible alternatives.
2. Where is the location of the infection?  If the infection is in the middle ear, ask if waiting it out is an option and what you can do to help minimize their pain.  Eighty percent of ear infections will resolve on its own within 4 to 7 days without antibiotics.  WebMD wrote an article on this study back in 2005.
3. If my child must take antibiotics, can I give them some probiotics after the finished antibiotics to help replenish their good bacteria?  (remember antibiotics kills BOTH good and bacteria and you have replace the good back into the body)  Studies are showing the benefits of taking probiotics after antibiotic treatment and during cold and flu season.

Question: How can parents tell if they are exposing their child to excessive antibiotic use?

Jasmine: If you are in the doctor’s office for the third time in one year getting another round of antibiotics it is time to ask the long term effects of getting the antibiotics and start looking into the underlying cause for the chronic condition.  If your child is an infant, you may want to switch formulas where the formula is more broken down and easier for your baby to digest.  Or if you are breastfeeding looking at your own diet as possible issues.

Question: Can ear infections be treated without the use of antibiotics?

Jasmine: Often, an antibiotics is prescribed to treat the ear infection. According to the June 2009 British Medical Journal article, prescribing antibiotics leads to more ear infections.  In fact, if the children had taken antibiotics, there was a 63 percent chance they’d had at least one subsequent infection. The risk was only 43 percent for children who’d been given an inactive placebo.  Other studies show that it takes children only three days longer to recover from the middle ear infection without antibiotic treatment.  (see the WebMD article)

There are alternate treatments to chronic ear infections.  In fact, my own grandmother used some of these home remedies on us when we suffered from ear infections.

1. Warm compresses with a warm washcloth. Do not put the water in the ear and make sure the washcloth is not too hot.
2. Hyland’s ear drops is used with a confirmed diagnosed ear infection.  This can be purchased at your local drugstore or health food store.
3. Warm olive oil, or warm garlic infused olive oil: In test tube studies garlic has been found to have antibacterial, antiviral, and antifungal activity-garlic is a natural antiseptic!  Chop 2 garlic cloves and allow the small pieces to marinate in a half cup of olive oil for a day (if you can’t wait proceed to warming the oil over the stove).  Warm the oil slowly over the stove, it should be warm to your touch.  Get an ear dropper and put a few drops into the ear.  You may add a few more drops later in the day, the first round should do the trick.  This mix will last for about two weeks.  Many parents are turned off by this home remedy, however, there are plenty that use and swear by this method.
4. Echinacea – this is an herb which can safely and effectively boost the immune system.  Click on Dr. Greene’s guide to using Echinacea properly.
5. Chiropractic care – chiropractic adjustments to the skull and neck can improve middle ear drainage and decrease ear infections.  Many parents are finding relief going this route

Using a combo of the above will be helpful such as warm compresses and whichever remedy you choose.
WARNING – if you see any liquid or pus draining out of the ear, DO NOT PUT ANY OF THE ABOVE DROPS INTO THE EAR.

Question: Can you give suggestions to dairy alternatives if dairy allergy is found to be the cause of ear infections?

Jasmine: If you child has a confirmed milk allergy with an ELISA allergy testing, then eliminating all dairy can be a difficult transition for your child.  Finding the right dairy substitute is tricky.  Often kids allergic to dairy are often or have a hard time digesting soy.  As rice cereal was probably your child’s first food, rice milk is a nice alternative and easy to digest.  If there are no tree nut allergies, almond milk is another great substitute.  If you are concerned about your child getting the fat from the milk, you may add up to 1tsp of flax oil to the milk substitute.   There is now coconut milk yogurt and coconut milk ice cream which is both delicious and provides some great health benefits.  So Delicious is a wonderful brand and your child will not miss out.

©2009 Littlestomaks.com

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, Registered Dietitian Victoria Retelny offers some tips for switching your baby from infant formula to cow’s milk.

Question: Can you give some tips for switching my child to milk from infant formula?

Answer:

Typically, by 12 months old, infants can be completely weaned from infant formula to cow’s milk.  Be sure to choose whole, full-fat milk as your baby needs the fat and calories for healthy brain development until he/she turns two (at that point you can switch to low-fat or fat-free milk).   However, moving from formula to milk does not have to a cold turkey proposition.  Although it seems like a big transition, it can be a gradual change. Weeks before a baby’s first birthday, you can begin mixing milk in with formula, cereals, vegetables, such as creamed corn, spinach, peas, broccoli, and fruit like mashed bananas.

Since cow’s milk is one of the major food allergens for infants and children, a slow introduction is the ideal way to get your child’s delicate system used to cow’s milk as well as give you an opportunity to see if he/she has any reactions, such as gas, bloating, diarrhea, constipation or skin rashes, which may be associated with lactose/dairy intolerance or allergies.   If you suspect a reaction has occurred from milk, contact your pediatrician or a pediatric allergy specialist for further evaluation.   Have no fear, there are other options to cow’s milk – try soy milk or rice milk.  Always look for added calcium and vitamin D as you don’t want your child to miss out on those key nutrients for healthy bone development.

©2009 Littlestomaks.com. All Rights Reserved

Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

Having read about the Food Allergy Awareness Week while researching for last week’s Five for Fridays, I wanted to dig into this topic a little more. This is a problem that an increasing number of parents are worried about these days. If you are one of them, I would love to have you share your personal experience and tips in the comments below. Here is a summary of my research from several good sources on food allergies.

I am also glad to announce that this is my 100^th post!

First the numbers

The Centers for Disease Control and Prevention (CDC) published a report on Food Allergy Among US Children in October 2008. Here are few interesting, and in my opinion a little worrisome, statistics from this report -

1. Almost 4 in 100 children less than 18 years old were reported to have some form of food allergy in 2007. This corresponds to a total of 3 million children. The rate of food allergy in children less than 5 years old is nearly 5 in 100.
2. Compared to 10 years ago, this represents an increase of 18%.
3. Children reporting an allergic response to food were 2 to 4 times more likely to develop asthma or other allergies compared to children without food allergies.
4. Eight types of foods account for over 90% of food allergies - milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat.
5. Hospitalizations with diagnosis of food allergy have increased nearly 4 times compared to 10 years ago.

Why food allergies are on the rise

The exact reason why a child develops allergy to various foods are not well known. However a lot of experts believe that poor quality of early childhood nutrition may be a factor. In his book Disease-Proof Your Child, Dr. Joel Fuhrman writes that apart from non-dietary factors, following nutrition related issues are responsible for increasing the risk for asthma and food allergies -

1. Lack of breastfeeding
2. High ratio of omega-6 acids to omega-3 fatty acids. People on meat rich diets in the Western world typically get ratios around 10 to 1 and some get as high as 30 to 1. This ratio should be around 4 to 1 or lower.
3. High ratio of omega-6 to omega-3 in mother’s diet during pregnancy
4. Low vitamin E intakes
5. Lack of fruits and vegetables

The immune system of young children is not fully developed, which makes them more likely to develop food allergies especially if they do not get good nutrition. But the good news, according to Dr. Fuhrman, is that it is also easier for them to recover from food allergies when a program of good nutrition is adopted.

It is easy to confuse food intolerance with food allergies

Sometimes the first symptoms of a mild food allergy may be similar to food intolerance, so it is easy to get confused. The main difference is that food allergy is a response from the immune system while food intolerance is a problem with digestion. For example, people with lactose intolerance cannot digest milk because their bodies do not have an enzyme called lactase. Lactose intolerance can result in discomfort, gas, bloating or nausea or diarrhea, but is not life threatening. Allergy to cow milk on the other hand is a result of antibodies produced by the immune system as a reaction to milk protein and can cause a very severe reaction. Similarly, intolerance to gluten causes the celiac disease which affects the small intestine, but it is not the same as wheat allergy.

Diagnosing food allergies

It is good to take any reaction to food  seriously and consult with your doctor who can run tests to confirm if your child has food allergies. Physical examination and a comprehensive medical history is usually the first step. Use of blood tests to detect food related antibodies is becoming very common, but without a good interpretation and link to the medical history, these can be very misleading. In fact there is an increase in the number of misdiagnosis of food allergies based on blood tests which I wrote about recently in my Five for Fridays column. This can result in unnecessary over restriction of foods. Skin testing with known food allergens is another option but this is not routinely done. In some extreme cases, your allergy specialist may decide to do food challenges to find out which specific foods cause an allergic response. Do not try it at home! The key is to keep a watchful eye on the reaction of your child, and if you suspect food allergies or intolerance, contact your physician as soon as possible.

Tips for managing nutrition of children with allergy

In his book, Dr. Fuhrman provides examples of how food allergies and asthma can be managed, and in some cases, completely reversed by good nutrition. I like one example of 3 year old twin boys who had severe allergic reactions to almost anything like soy, milk, peanuts, corn, strawberries, cats, dogs, and how within a few years of his nutritional therapy he was able to resolve most of these problems. In general, he recommends a diet rich in vegetables, walnuts and fruits with DHA supplements and multivitamins and no processed foods, dairy fats or trans fats. Not that this can guarantee to result in reversal of food allergies, but it makes good sense to me.

I would love to hear your experiences and tips if your child is suffering from food allergies. I am sure it is very hard for you as a parent, and it is my sincere hope that things get better for you in time. Please leave a comment below if you want to share.

Photo source – laffy4k on Flickr
©2009 Littlestomaks.com