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

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.

photo credit: 11950mike

The recent recall of over half billion eggs due to an outbreak of salmonella has everyone worried about the safety of eggs they buy from the store. There is quite a buzz in the media over this recall, which is once again being used to create a sense of panic so people sit up and pay attention to the so called breaking news! Sure, there is reason to be careful, but there are many ways you can protect your family without giving up on eggs completely. Eggs are a good source of complete protein especially useful for growing children.

Recently I connected with Mitch Kantor, Ph.D., who is the Executive Director of the Egg Nutrition Center (ENC). He provided answers to a few questions about egg nutrition via email:

Question: What is the benefit of including eggs in my toddler’s diet? At what age should I start?

Answer: A  primary function at the toddler  stage is growth ,  and the high quality protein in eggs is an excellent source of all the necessary amino acids  needed  to promote growth. In  addition , choline, a nutrient found in eggs  (and not found in abundance in many other food sources) , helps support the development of the memory center in the child’s rapidly growing brain.

Question: Are there any egg allergies I should be concerned about?

Answer: The American Academy of Pediatrics no longer recommends refraining from introducing eggs beyond 6 months of age. Although eggs are one of the more common food allergies, pediatricians are now suggesting introducing small amounts of known allergens into the diets of children who are suspected to have allergic reactions in order to develop a tolerance.

Question: What is the benefit of organic eggs vs. standard eggs?

Answer: Organic eggs are eggs that come from hens whose diets contain grain grown without pesticides. Nutritionally, there is no evidence to support a nutritional benefit of organic vs standard eggs.

Question: What is meant by “free range”, “antibiotics free” on the label?

Answer: Free range eggs means that the hens have access to the outdoors. Their diets are uncontrolled so the nutrient value of their eggs may vary.  The use of antibiotics in laying hens is not a standard practice in the egg industry. So, for the most part, almost all eggs in the food supply are antibiotic free.

Question: I have heard that eggs contain a lot of cholesterol. Is that true?

Answer: A  large egg contains  around  212 mg of cholesterol according to the USDA. Scientific evidence has shown that dietary cholesterol like that found in eggs does not raise blood cholesterol in most people. Our liver makes most of the cholesterol that travels in our blood and unless there is an abnormality, excess dietary cholesterol is excreted by our body , or used in various bodily processes .

Question: What is the best way of cooking eggs to preserve their nutritional value?

Answer: The best way to preserve nutrients in any food is to keep it refrigerated until ready to use and cook it for a short time in a minimum of water. Using the microwave to quickly cook an egg would be the best way to preserve the many healthy nutrients in an egg.

Do you have an egg-related question not answered above? Leave it in comments below. I will follow up with Dr Kantor and get it answered. Feel free to also share any other comments or opinions.

©2010 Littlestomaks.com

We found these fig bars in a local allergy-free food store called Chase Foods. If you live in the Jacksonville, FL area, you got to check out this store!

The twins loved the free samples of these fig bars we received at an event so we decided to buy a whole box of 12 packs. Each packet contains 2 pieces which makes a nice built-in portion control feature. In the whole wheat type we are trying right now, the dough is made up of whole wheat flour, organic evaporated cane juice, canola oil, brown rice syrup, caramel color, apple fiber, sea salt, citric acid, baking soda, lecithin and baking powder. The filling contains fig paste, brown rice syrup, organic evaporated cane juice, rolled oats, molasses, citric acid and sea salt.

Here is what we like about this product -

1. A dairy-free option for people with dairy allergy
2. Simple, natural ingredients
3. Tastes good
4. Only 110 calories per bar
5. No saturated fat or trans fat
6. No cholesterol
7. Provides fiber, calcium and iron

Here is what we don’t like about this product -

1. Not organic
2. Label says it is made on equipment shared with peanut and dairy products. Can’t claim true “dairy free”
3. It could use a little less sugar – for a small 28 g bar, it has 11 g of sugar.

Overall, we like these fig bars a lot. Give them a try!

Disclaimer – Although we were introduced to this product through a free sample, I have not received any sponsorship or free product for writing this review.

©2010 Littlestomaks.com

photo credit: Aaron T. Goodman

The word protein brings images of strength, muscle and high stature to mind. As such, there is a common notion that children need to eat a lot of protein to grow strong. Although, it is definitely important to include foods rich in protein, there is no need to overdo it. Chances are your child is already getting sufficient protein from a variety of foods  including dairy, meat, fish, eggs and vegetarian sources of protein.

Here are a few handy facts to know about protein:

1. Chemically speaking, proteins are made up of amino acids joined together to make a chain like structure.
2. Human proteins are made up of 22 different amino acids. 13 of these can be produced by the body. The remaining 9 are called essential amino acids which we must get from food.
3. 1 g of protein equals 4 calories.
4. The daily amount of protein your child needs depends on age, weight and activity level. In general, children 1-3 years old need 0.5 g per pound of body weight, which comes to about 13-16 g per day. Children 4-6 years old also need about the same amount per pound, but since they weigh a little more, the daily amount is about 22 g. The Institute of Medicine has a good resource for recommended daily amounts (RDA) of macro-nutrients such as fat, proteins and carbs.
5. Foods that provide all 9 essential amino acids are called complete protein foods. Animal food sources such as meat, fish, poultry, eggs, milk and cheese fall in this category.
6. Proteins from plant sources are deficient in one or more of the essential amino acids; that is why they are called incomplete proteins.
7. It has been a common belief that vegetarians need to combine various foods to get all the essential proteins. For example, beans should be eaten with rice. Most experts now agree that there is no evidence to support this belief. As long as you are eating a broad range of foods in balance and moderation, you don’t need to worry about such rules!
8. The quality of proteins is measured by many different types of indicators which relate to how effectively the body is able to utilize the protein. Biological value is one of these indicators – egg whites are considered a standard with a biological value of 100. It means that nearly all of the nitrogen from its amino acids can be utilized by the body.
9. The body cannot store excess protein. Eating more protein than necessary will actually result in more fat!
10. Food allergies is a response to specific proteins in different foods. For example, milk allergy is a response to caesin and whey proteins in milk. Another problem protein for a lot of people is gluten, which is found in wheat and causes celiac disease.

©2010 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

Over the weekend we had dinner at a local pizzeria and Italian restaurant. We got the usual kid’s cheese pizza for the twins while we ordered fried calamari as an appetizer for the two of us. I was surprised to see my son dig into the fried calamari for the first time as he reached for the crispy rings several times. Even though we often enjoy calamari, I didn’t know much about its nutritional value. After researching various sources, I compiled these 10 facts that will interest you!

1. Calamari, usually deep fried, is a popular appetizer in many restaurants. The word calamari comes from Italian and refers to squid.
2. Squid belongs to a class of sea animals known as cephalopods found in over 300 different species.
3. Squids can range in size from a few inches to several feet; the largest squid found so far weighed over 1000 pounds!
4. Squids are capable of swimming fast and many species can actually fly through air. They can also change color to camouflage against both prey and predator. Another weapon in their arsenal for survival is an ink like chemical they release when threatened. This ink is safe for human consumption; in fact several pasta dishes are made with it in the sauce.
5. Most squids have 8 arms and 2 tentacles. Most of a squid’s body is edible.
6. Found in oceans all over the world, squids are popular in many cuisines in Europe, Mediterranean, Asia and Japan. Over 2 million tons of squids were harvested
7. As a food source, it is very rich in selenium, vitamin B12 and riboflavin.
8. Squids contain a lot of cholesterol. Depending on the composition of batter and oil used to fry the calamari, it can have a lot of sodium, trans and saturated fats. Certainly moderation is advised even though it tastes good!
9. Squids do not have a shell, but they are related to shellfish. Although not very common, they can be a source of food allergy.
10. Although fried calamari is most popular,  squid sushi is also common.

Have you tried calamari with your kids? Please share your experience in comments below.

Photo: Wikimedia commons
©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.

It has been an excellent year blogging about toddler nutrition! When I started writing back in the Fall of 2008, I did not realize how exciting it could be to learn and write about all aspects of a young child’s nutrition and growth. Blogging has also given me an opportunity to connect with both experts and moms in a unique way!

As we close on 2009, I would like to reflect upon the more than 220 posts I have published on this blog. Whether you are a brand new visitor, or a regular reader of this blog, I invite you to check out these top 10 posts of 2009 in terms of page views and comments.

Enjoy and let me know what is on your mind!

	Attachment Parenting and Toddler Nutrition This post by Annie of PhD In Parenting explains what it means to feed your child with love and respect. It is one of the 8 guiding principles of Attachment Parenting.
	All Natural Toddler Multivitamin My review of Floradix Kinder Love Children’s Multivitamin Liquid Extract Formula attracted a lot of attention because it is based on herbal extracts and fruit juices. It claims to be easy on the child’s digestive system while providing vitamins A, B, C, D and E. It is not a good source of minerals.
	Simple Recipes – Chicken with Quinoa This is a very easy recipe to make! Quinoa, in my opinion, is the unrecognized superfood because it is a good source of protein and low glycemic index carbs. It also provides a good mix of vitamins and minerals.
	Ask the Expert – Sushi and Toddlers If you are a sushi lover and you are thinking about introducing your toddler to sushi, you have got to read this informative piece from registered dietitian Janet Helm. She writes a great blog at Nutrition Unplugged with tons of excellent information about nutrition and food trends.
	Looking for a Multivitamin Supplement? This is a “mini” guide to toddler vitamin supplements on the market. If you are considering a supplement for your child, you can use a simple comparison chart in this post. Centrum Kids and Flintstones Complete offer a good balance of complete vitamins and minerals. But the most important advice is to rely on a balanced diet with plenty of fruits and vegetables.
	5 Reasons to Consider a Multivitamin Supplement I heard a variety of opinions from Moms who took my Global Toddler survey about use of multivitamins. In this post, I highlight 5 main reasons why you might consider it for your child. Vitamins should not be used to “fix” nutrition and eating issues; rather you should rely on them to supplement a balanced diet.
	Basmati Rice: It is Very Easy to Cook and You Will Love It’s Flavor and Fragrance We love basmati rice! It is an excellent source of low glycemic index carbohydrates. Try my simple recipe to cook it as a separate side dish. You can also try some of the links in this post for other great recipes.
	Help! My Kids Don’t Eat Enough Fruits and Veggies! This is a very common concern of most toddler parents. In this article, pediatrician Dr Ayala Laufer-Cahana offers a few practical tips to get your kids interested in fruits and veggies. Check out her blog at Ayala’s Herbal Water.
	Traffic Light and Food Labeling Clearly, consumers want simple and easy to understand front of the box food labels. FDA is worried about accuracy and manipulation by the food industry. A traffic light based food labeling system is gaining popularity in UK and Australia. It is not perfect, but clearly a step in the right direction.
	Think Play-Nutrition-Rest for Long Term Health of Your Children Play is an important part of your child’s physical, mental and emotional growth. Combine it with good nutrition and enough rest for long term health of your toddler.

Web statistics are surely important, but there are a lot of other articles which I am particularly very passionate about. Here are a few of my favorites. I hope you will check them out and leave me a comment with your opinion!

1. Twinkie tax will do nothing to reduce the sweetness
2. Shaking off a sweet addiction
3. Why we must address childhood obesity NOW
4. Good nutrition key to managing food allergy
5. Healthy fats for children

©2009 Littlestomaks.com

Greetings! Hope you all are having a great week so far. We are getting ready for Thanksgiving, which happens to be my favorite Holiday. I am looking forward to it next week. What are your plans?

Here are 5 nutrition related articles that caught my eye this week. Enjoy and drop me a comment to share your thoughts.

Vitamin D deficiency linked to heart disease

Vitamin D deficiency is in the news again! The American Heart Association had its annual conference in Orlando this week where a study presented a link between low levels of vitamin D and increased risk of heart disease and stroke. This study looked at tens of thousands of adults 50 years or older, a majority of whom had lower than healthy levels of vitamin D. Within 2 years, those who had extremely low levels of vitamin D were twice as likely to die or suffer a stroke compared to those who had normal levels. They were also more likely to develop coronary artery disease and heart failure.

The unanswered question is whether a lack of vitamin D increases the risk of heart disease, or it just happens to be a condition of people with such diseases. If it is not a cause, then the risk of such diseases cannot be lowered simply by increasing the vitamin D levels from sun exposure, diet or supplements. Most of these studies have an underlying implication that current recommendations for daily intake of vitamin D be increased to improve public health. I still remain unconvinced that a sweeping policy change is necessary at the moment.

I do agree that it is important to maintain healthy vitamin D levels especially in growing children. The focus should be on balanced nutrition from a variety of food sources, plenty of physical activity – out in the sun if possible, and reduction of sugar, salt and fat (saturated and trans).

Interesting food trends to watch in 2010

Yet another great article from Registered Dietitian Janet Helm on her Nutrition Unplugged blog this week highlights several predictions for food products in 2010. Based on a report from Mintel, the prediction is that next year’s food products will focus on health, wellness, convenience, sustainability and affordability. Sodium reduction, simple ingredient list, locally sourced, eco-friendly, multipurpose, private label, functional packaging, simplified labeling are likely to be the features that will dominate the store shelves next year.

I think that no one should underestimate the Marketing skills of the major food companies. They clearly know how to play the game and they keep a sharp eye on consumer trends. I fully expect them to bundle their products to not only capitalize on these trends, but also make sure they continue to up-sell across various consumer groups. Private labels will grow for sure, but I don’t think they will overwhelm the giants anytime soon.

I think there is a place for packaged foods in lives of busy parents. Just don’t fall for the fluff, read the labels and mix these products with fresh foods, especially fruits and vegetables. As a consumer, you have enormous power because the food companies are quite good at listening to you.

Low sodium sea salt promises the gift of health and flavor

Using a mixture of salts from the Dead Sea and the Red Sea, Nutrasalt is a new product which claims to contain 66% less sodium than common table salt while providing a healthy balance of sodium and potassium. The target, of course, is the food industry desperate to claim a lower sodium content in their products without giving up on taste. Claims of heart health, natural, perfect balance of sodium and potassium should be very appealing to the food industry.

The nutritional facts label for Nutrasalt shows that it contains sodium chloride, potassium chloride and natural flavors. It is one of the simplest tricks to lower sodium by replacing it with potassium chloride. I reviewed the latest in salt reduction technologies in Can Salt be Any Saltier? article recently. The problem with potassium chloride is that it gives a bitter after-taste, which needs to masked by flavors or bitterness blockers. I do not know what kind of “natural flavors” this salt contains to maintain the natural salty taste. But I do think that their high volume natural claim is not that credible.

Also, this salt is not iodized. Bottom line – reduce your intake of table salt and processed foods even if they claim to be made from this so called healthy salt.

A new survey of Americans shows strong support for investment in prevention related programs and strategies as part of the new Health Care reform. The Robert Wood Johnson Foundation and The Trust for America’s Health sponsored this survey which polled about 1000 registered voters about their opinions on various priorities. 71% favor more funding for prevention programs while only 23% do not support any more extra funding.

Although it sounds good, I don’t think there is enough awareness and support for nutrition and physical activity, especially in schools. Out of all the prevention proposals, it ranked third by a large margin compared to the top 2. There is more emphasis on public health workers and their resources when it comes to prevention.

Also, only $34 billion out of the total of about $900 billion are allocated for prevention programs. That is not even 5% of the total! I do not believe that prevention is top of mind among our lawmakers. Public support will need to be much stronger and much broader than this survey data. I think we have a long way to go before we truly embrace the notion that prevention is better than cure!

Food allergy among US children rising

A recent paper in the journal Pediatrics reports that nearly 4 in 100 children under 18 years old reported some kind of food allergy in 2007. This was an increase of 18% over the 10 year period between 1997 – 2007. The researchers, however, are not sure if this increase is real from a clinical point of view or simply a result of better tracking and awareness among parents and healthcare providers.

Although troubling, I am not surprised by the recent results. In my article Good Nutrition is Key to Managing Food Allergy, I presented similar statistics. Some experts believe that poor quality of early childhood nutrition is to blame. Also, it is easy to confuse food intolerance with food allergy and most parents may not know the difference. Good nutrition builds a strong immune system, although it probably cannot help if there is a genetic reason for food allergy.

Whatever the reason, living with food allergy is challenging. I cannot claim to have first hand experience of that. But ify you do, I would love to hear from you.

Enjoy and do let me know what you think. I would love to have you share your best tips in comments below.

Photo source – Paul Davidson on Flickr  everystockphoto
©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 Elizabeth Rahavi describes why omega-3 fats are essential for children and how you can include them in your child’s diet.

Question: Is Omega-3 proven to be helpful for children? Are there any concerns I should be aware of?

Answer:

Fat is an important yet often overlooked nutrient that is needed for an overall healthful diet. In fact, a certain type of omega-3 fat known as linolenic acid is essential for healthy growth and development in children. According to the latest Dietary Guidelines for Americans report, released in 2005, children are encouraged to get most of their fats from unsaturated fats, including omega-3 fats. Food sources of omega-3 fats include soybean and canola oil, flaxseed and flaxseed oil, walnuts, and fish such as salmon, trout, and herring. For people who do not like fish, certain eggs, milk and other products have been reformulated to include omega-3s.

While fish is an important part of a healthy diet, and many organization such as the American Heart Association recommend consuming fish at least twice a week. The U.S. Food and Drug Administration (FDA) and U.S. Environmental Protection Agency (EPA) recommend that young children avoid certain species of fish such as swordfish, shark, tilefish and king mackerel and limit their consumption of other fish to an average of 12 cooked ounces per week (that’s about two six ounce servings of fish per week). The reason for this recommendation is that, while nearly all fish contain some trace amounts of methylmercury, an environmental contaminant, large fish that are higher up in the food chain such as swordfish, shark, tilefish and king mackerel contain the most. Excess exposure to methylmercury from these species of fish can harm a young child’s developing nervous system. For most people, the risk from mercury by eating fish and shellfish is not a health concern.

What’s next?
One thing that is often over looked in conversations about nutrition is that, indeed it is a science. To help provided consensus on the state of nutrition science, the United States Department of Agriculture and the Department of Health and Human Services enlist a group of nutrition and food scientists to serve as members of the Dietary Guidelines for Americans Advisory Committee. The Committee comes together every five years to develop a report that makes nutrition recommendations for all Americans ages 2 years and older. This Advisory group is currently in deliberations, and we look forward to an upcoming review of the state of science for dietary fats that is scheduled to be released next year.

©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.

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