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

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 Jill Castle suggests a few alternatives to cow’s milk for your toddler if you are concerned about introducing dairy products.

Question: I am hesitant to give cow milk to my 15 month old daughter because I have heard that there are many problems with dairy. What other options do I have?

Answer:

Choosing which milk to feed your baby is an important decision, and one that requires thoughtful consideration.  With the plethora of milks available on the commercial market, it is often confusing to know which milk is appropriate for your child.  And many of these milks advertise their health benefits and are largely targeted at the adult.  The younger toddler (aged 1-2 years) continues to have unique nutritional requirements that are different from those of older children and adults, such as higher fat requirements, adequate protein and vitamins, and sufficient calories for growth. Additionally, liquid milk still provides the majority of nutrition (up to 60-70% of total caloric intake) in a given day for the younger toddler.

After a year of drinking breast-milk or infant formula, most emerging toddlers are ready to make a transition.  The gold standard, whole cow’s milk, has been the fluid milk of choice for many years, and many generations, and remains so in the eyes of the American Academy of Pediatrics (AAP).  Whole cow’s milk, when included with a variety of foods, can support the growth and development of children over one year of age. Whole cow’s milk contains about 150 calories per 8 ounces and is a good source of calcium, protein, fat, and Vitamins A and D.

Soy milk is an alternative to cow’s milk, readily available, and is utilized frequently for children who are intolerant or allergic to cow’s milk, or who are following a vegan diet.  Soy milk is fortified with calcium and Vitamin D, and can provide adequate protein and calories for the growing toddler. Soy milk is processed to match the nutrient content of cow’s milk and often, sugar is added to mask the bitter tasted of the soy bean.  Research indicates that ~40% of children who are allergic to cow’s milk are also allergic to soy milk.

Rice milk is used in children who are allergic to both cow and soy milks, and also may be used with the vegetarian child.  Caution should be used when choosing rice milk for the younger toddler, as it contains low amounts of protein, fat, and calories.  Some research has shown evidence of growth failure in young children consuming rice milk due to its poor protein, fat, calorie, and vitamin/mineral content.  If it is necessary for your young toddler to consume rice milk, be sure to consult with your Registered Dietitian (RD) or your pediatrician (MD) so that proper attention can be given to assuring your child’s liquid and solid food intake will meet their nutritional needs.

Hemp milk is yet one other milk available in stores.  Hemp milk is a grain milk, from the cannabis plant, and contains many nutrients found in cow’s milk.  The flavored hemp milks (150 calories/ounce) are similar in caloric content to whole cow’s milk and soy milk, however, the unflavored variety (100 calories/ounce) is considerably lower in calories.  Protein and fat content are lower than cow’s milk, but higher than other grain milks.  Hemp milk can be a nutritious part of your toddlers diet when coupled with a variety of foods.

Nut milks, such as almond milk, also tend to be deficient in protein and fat when compared to the unique nutrient needs of the younger toddler.  Caution should be used in introducing nut milks to the toddler before the age of three, due to risk of allergic reaction.

Young toddlerhood is an important time for establishing healthy eating habits and is also a critical time for adequate nutrition, specifically fat, protein, and calories.  As the younger toddler is in the process of being introduced to new foods and establishing eating patterns, a nutritious milk is an important component of the daily diet.  Evidence of steady growth and acceptance of a variety of solid foods are good indicators that your young toddler is receiving adequate nutrition from all food sources.

©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.

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 Preethi Rahul explains how you can manage the vitamin D intake of breastfed infants and children.

Question:Is it true that breastfed babies need more vitamin D and can it be obtained through breast milk if the mother increases her vitamin D intake?

Answer:

Yes! Definitely breastfed babies need more vitamin D as human milk contains five metabolites of Vitamin D, providing 40-50 IU/ L of vitamin D activity. The need for additional vitamin D becomes progressively important with increasing age. Cow’s milk is usually fortified with 400 IU/L of vitamin D.

Vitamin D does not occur naturally in foods that humans normally eat. Moreover, the widespread use of sunscreens and public health recommendations to avoid sun exposure reduces dermal synthesis of vitamin D₃. Most people therefore get vitamin D₃ by taking a vitamin D supplement or by consuming vitamin D–fortified milk.

Vitamin D is undoubtedly important for fetal development and for bone development in childhood; it plays a much wider role in health and disease prevention. Vitamin D is essential for cell differentiation, the functional maintenance of membranes, as well as the functions of several organs including skin, muscle, pancreas, nerves, parathyroid gland and the immune system. It is important to understand that vitamin D is not really a vitamin; vitamin D₃ is a pre-pro hormone made in the skin in response to ultraviolet-B light exposure. Vitamin D3 is the precursor to form 25-hydroxyvitamin D₃ [25(OH)D₃], a pre hormone, which is ultimately converted to 1,25-dihydroxyvitamin D₃ [1,25(OH)₂D₃]. One of the most potent steroid hormones known, 1,25(OH)₂D has the capacity to affect many bodily functions beyond calcium metabolism.

All infant formulas sold in the United States must have a minimum vitamin D concentration of 40 IU/100 kcal (258 IU/L of a 20 kcal/oz formula) and a maximum vitamin D3 concentration of 100 IU/100 kcal (666 IU/L of a 20 kcal/oz formula).All formulas sold in the United States have at least 400 IU/L of vitamin D₃. Because most formula-fed infants ingest nearly 1 L or 1 qt of formula per day after the first month of life, they will achieve a vitamin D intake of 400 IU/day. Infants who receive a mixture of human milk and formula also should get a vitamin D supplement of 400 IU/day to ensure an adequate intake. As infants are weaned from breastfeeding and/or formula, intake of vitamin D–fortified milk should be encouraged to provide at least 400 IU/day of vitamin D.

Although vitamin D concentrations can be increased in milk of lactating women by using large vitamin D supplements, such high-dose supplementation studies in lactating women must be validated and demonstrated to be safe in larger, more representative populations of women across the world. Recommendations to universally supplement breastfeeding mothers with high dose vitamin D cannot be made at this time. Therefore, supplements given to the infant are necessary.

Check out the following articles related articles on vitamin D

Ask the Expert – Vitamin D Deficiency
40% of infants and toddlers have vitamin D deficiency – should you worry?
5 reasons to consider a multivitamin supplement

©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