Food Allergy Living Blog

Ask the Nutritionist

How to Travel with Neocate

Posted 2.27.15 | Rob McCandlish, RDN

by Kathleen Smith, RDN, LDN

As the weather starts to warm up and you start to consider travelling, you have lots to consider: where to go, how to get there, and what to pack. Whether you travel by car, bus, train or plane, an advance plan for the transportation and amount of Neocate you or your family member will need for your trip will save you from additional trip stress.

First things first, calculate exactly how much formula you will need for the entire trip. You don’t want to underestimate and run out of formula, as the chances of a local pharmacy having Neocate are small! (Check here if you find yourself in that situation.) We recommend packing an extra can just in case your travel plans change unexpectedly.

Next you will want to plan the amount of prepared formula to bring with you. Neocate powdered formulas can be prepared ahead of time and kept in a refrigerator for up to 24 hours. Neocate can be kept at room temperature for up to 4 hours as long as the bottle or container has not been “touched” (i.e. no formula has been consumed). So if you have a long flight or car trip, consider bringing a little cooler for your bottles; the cooler should be maintained at a temperature of less than 40°F. Also, pack some extra Neocate powder in your formula bag in case of lost luggage or spillage of formula.

If you are flying, the Transportation Security Administration (TSA) has regulations about flying with liquids for you or your family member. Formula, breast milk and juice for infants or toddlers are permitted to be brought on board the aircraft. Older individuals (older child, teen or adult) may also travel with Neocate. Travelers must tell the TSA officer at the beginning of the screening process that they wish to bring formula, breast milk and juice in excess of 3.4 ounces in their carry-on bag. These liquids do not have to fit within a quart-sized bag like other liquids. The formula, breast milk and juice are typically screened by X-ray, and any of these liquids in excess of 3.4 ounces will receive additional screening.

Travelers are encouraged to travel with only the amount of formula, breast milk and juice needed to reach their destination. Ice packs and other accessories required to cool formula, breast milk and juice are also permitted through the screening checkpoint but may be subject to additional screening. We’ve learned from Neocate families that some TSA officers may not have encountered an older individual requiring a medical food like Neocate before. If you or your loved one is older, it may also help to bring a doctor’s note explaining that Neocate is medically necessary. TSA recommends that if you plan to travel with large quantities of medically necessary liquids you should coordinate your screening by contacting a Passenger Support Specialist prior to your flight.

For more detailed information from TSA about flying with formula, visit http://www.tsa.gov/tsa-kids/parents-page prior to your flight.

For more information about the screening of passengers with disabilities and medical conditions, go to www.tsa.gov/traveler-information/travelers-disabilities-and-medical-conditions. Here, passengers will find information about the TSA Cares program, how to secure the services of a Passenger Support Specialist (who is trained in assisting passengers with disabilities and medical conditions through the checkpoint screening process), and what to expect during the security screening process. In addition, passengers may ask to speak to a Passenger Support Specialist or a Supervisory TSO while at the checkpoint if they need assistance. Passengers also may report concerns by emailing TSA’s Disability and Multicultural Division at TSA.ODPO@tsa.dhs.gov.

We hope you and your family have a safe and wonderful trip!

-Kathy

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Neocate Shipping and Storage

Posted 2.24.15 | Rob McCandlish, RDN


It’s a cold, blustery evening on your drive home from a long day at the office. As you approach your front door you notice the Nutricia North America box sitting at your doorstep. Your initial thought is, “Oh no, can we use this after it’s been sitting here in these cold temperatures all day?”

During these cold winter months (as well as those hot summer days that will soon be upon us) it is not uncommon to wonder if our products are safe after the temperatures they have been exposed to during shipping and delivery.

Short-term exposure to temperature extremes that our products experience during shipping (e.g. being left on a porch in cold or hot weather) typically does not pose a risk to product quality or stability. Those extreme temperatures would become a concern if the product is left at those temperatures for an extended period of time, for example several days or weeks.

The temperatures that are printed on our product labels are recommended storage temperatures, which cover long-term storage of the product. They are based on the effects that extreme temperatures can have on the products over extended periods of time, typically much longer than those experienced during shipping. (With this said, Nutricia’s products are not required to be shipped in a temperature-controlled environment.)

Of note, freezing Nutricia's liquid products may affect the product's consistency, as the thawing process can affect the ability of emulsifiers to maintain a stable solution. In addition, freezing of our liquid products could also have an impact on the water-soluble vitamins (specifically Vitamin C and the B vitamins) which is certainly important to take into consideration for those individuals who rely on our products as their sole source of nutrition.

If you are ever unsure as to whether or not the Nutricia product you have received is safe to use, please do not hesitate to call a member of our Nutrition Services team to discuss your concerns.

-Kendra Valle, RDN, LDN

 

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Tube Feeding: Troubleshooting Tips

Posted 2.3.15 | Mallory West

Many Neocate babies and children receive their formula through a feeding tube. Common Neocate formulas that are received through feeding tubes include Neocate Infant DHA/ARA, Neocate Junior, Unflavored, and Neocate Splash, Unflavored. Enteral tube feeding provides nourishment to individuals who are unable to consume adequate nutrition by mouth. If your child uses a feeding tube, you know that there may be some occasional tube feeding complications. This blog will provide some general troubleshooting tips for the most common tube-feeding problems.

Clogging of the Feeding Tube:

Sometimes a feeding tube will become blocked so that no food can go through.

How to Fix Clogs:

  • First, using a syringe to gently remove the liquid on top of the blockage, if possible (throw away the fluid removed).
  • Next, gently flush the tube using lukewarm water, using at least a 30 mL (1 oz) syringe. Gently plunge the water back and forth to clear the blockage.
  • Unless directed by a healthcare professional, do not use acidic solutions such as fruit juices or cola as they may curdle the formula.
  • If the tube is still clogged, clamp the tube for around 10 minutes and then try flushing it again.
  • If the tube the clog remains, gently squeeze the tube between your fingers along the length of the tube as far as possible.
  • If you are still unable to clear the blockage, contact your healthcare professional for advice. Sometimes, the physician will prescribe a special enzyme which can dissolve the clog. If the clog cannot be cleared, the tube will have to be replaced.

How to Avoid Clogs:

  • Tube flushing is the most important factor for preventing the feeding tube from clogging. Use a syringe to flush 20 mL of warm water through the feeding tube before and after feedings and medications (or as directed by your healthcare team). If your child receives a continuous feed, your healthcare provider may recommend flushing with water during the feed to prevent clogging.
  • Use liquid medications whenever possible. If pills are necessary, crush them well and mix them with a small amount of warm water. Use a syringe to draw up the solution and insert it into the feeding tube. If pills are coated or time-released, discuss this with the physician because these types of pills are typically not meant to be crushed.
  • Do not mix medications together and do not mix medications in formula unless instructed to do so by your healthcare provider.

Tube Site Irritation or Infection:

Redness, pain, swelling or unusual/excessive drainage, as well as fever, can all be signs of an infection at the stoma site (the surgical opening through which a gastrostomy tube (g-tube) or jejunostomy tube (j-tube) enters the stomach or small intestine).

How to Avoid Irritation or Infection:

To avoid infection, it’s important to keep the stoma site clean and dry. Your healthcare provider should give you specific recommendations for how to clean the stoma site each day. For more information on keeping the stoma site clean (from a parent’s point of view), check out this informative article from Complex Child E-Magazine.

A Dislodged Feeding Tube:

If the feeding tube comes out, call the doctor and go to the hospital right away. The stoma can close up very quickly so the tube needs to be replaced promptly. Cover the site with clean dressing or bandage to prevent leakage and immediately seek medical attention.

Sometimes the healthcare provider will train you to replace the feeding tube yourself (temporarily or permanently) but you should ONLY do this if directed and properly trained by your child’s physician.

How to Avoid:

Young children occasionally pull the tube out themselves. Keep the tube covered with clothing to prevent this. Onesies work well for infants and toddlers. It’s also important to secure the tube during activities so that it doesn’t get pulled out. You can use various methods to secure the tube. Some companies make special wraps and clothing for protecting and accessing the feeding tube:

Do you have any troubleshooting tips to share with other tube-feeding families? What problems have you encountered and what tricks have you learned?

- Mallory


Understanding Expiration Dates

Posted 1.27.15 | Nutrition Specialist


Is the expiration date really that important? Can we use Neocate after the expiration date? What will happen if my child consumes Neocate after it’s expired? These are questions we hear often here at Nutricia North America. In today’s post, we’re hoping to clear up any confusion regarding expiration dates.

An expiration date on any product, not just Neocate products, is based on several factors. One being the durability of the packaging materials. We want to ensure the packaging will keep the contents safe until the expiration date.

Another is the stability of the ingredients. For example, some ingredients break down over time which can affect the smell or taste of the product. We want to ensure that the product is at the highest possible quality during the duration of the shelf life.

A final factor which is probably the most important is to ensure that the nutrients in the product are present at the levels on the label. Nutrients, particularly vitamins, have a tendency to naturally break down over time, some faster than others. Especially since many individuals use our products to meet a large portion of their nutritional needs, it’s very important that the right amount of each nutrient is in the product. We conduct extensive testing under a number of conditions to ensure that the nutrients hold up through the expiration date.

Federal regulations require a "use-by" date on the product label of infant formula under FDA inspection(1), and rightfully so.  The ultimate intent of an expiration date is to keep our customers safe and ensure they receive the nutrients that they expect. With that being said, we cannot recommend using any of our products past the expiration date. If you still have questions, the best thing to do is to share this information with your healthcare team for their guidance.

-Kendra Valle, RDN, LDN


What Do Allergen Advisory Labels Mean?

Posted 8.12.14 | Rob McCandlish, RDN


Have you ever picked up a packaged food item and seen one of the following statements?

  • Made on shared equipment with peanuts
  • Made in a facility that also processes wheat and dairy
  • May contain tree nuts
  • May contain traces of egg

Confusing, right? I always wonder if manufacturers use such statements just to cover their behinds. Any one of these statements is completely voluntary and unregulated. These types of precautionary labels cannot be used to assess the risk of an allergic reaction. In fact, research conducted in 2007 found that many individuals with peanut allergy ignore these advisory statements.(1) The researchers tested 200 products with a peanut advisory statement and found that most (90%) did not contain detectable peanut protein. Of the 10% that did contain detectable levels, 65% had a "clinically significant" amount of peanut protein. This translates to ~7% of the 200 tested products (all carried a peanut advisory label) being found to have a detectable amount of peanut protein that would likely pose a risk to most peanut-allergic individuals, and about 4% with a detectable level that was deemed "not clinically significant."

Because these advisory statements aren't regulated, an expert panel has recommended avoiding any foods labeled with a precautionary statement related to your food allergens.(2) If you or a family member has a food allergy, you should ask your healthcare team whether you need to rely on these advisory statements. When in doubt, it can help to contact the manufacturer to ask what they mean by the statement they use. It is also wise to err on the side of caution and contact the manufacturer even if the product doesn't have an advisory label related to your food allergen, just to be safe.

For an even more in-depth discussion, please turn to one of our trusted resources, Kids with Food Allergies. They have a great article here that does a better job of explaining this topic than we could! Sharon Wong also offers an explanation on a page of her website, geared toward peanut-free recipes.

What sort of food allergen statements have you seen during your recent grocery trips?

-Rob

1. Hefle SL, et al. Consumer attitudes and risks associated with packaged foods having advisory labeling regarding the presence of peanutsJ Allergy Clin Immunol. 2007

2. National Institute of Allergy and Infectious Diseases - Guidelines for the Diagnosis and Management of Food Allergy in the United States. 2007.

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Web-based Food Allergy Resources

Posted 8.7.14 | Rob McCandlish, RDN


This is a guest post from Leslie Stiles. Leslie Stiles received her BS in English Literature at University of Illinois in Champaign-Urbana and obtained her Masters in Human Nutrition from University of Illinois in Chicago. She works as a Senior Clinical Nutritionist at a children’s hospital in Chicago, IL.


A diagnosis of a food allergy may come as a shock to your family, and that shock may continue when you go to the grocery store and start to look at nutrition labels. You might find yourself asking “What can my kid eat?!”, “Will they be able to eat typical kid food like birthday cake and pizza?”, or “What will I pack them for school lunches?” The list of questions can be endless and overwhelming to say the least. Luckily, thanks to the world wide web, there are some accessible resources that will both educate and inspire you about allergen-free cooking and shopping.

This blog post is intended to present some tried and true resources that I often share with families. I encourage you all, as readers and family members of children with food allergies, to share your own tried and true resources in the comments section. It’s important for us to share information and help each other stay informed.

For all things allergy-related, the Food Allergy Research and Education organization (FARE) website is chock full of useful information. I recommend spending some time exploring all it has to offer and bookmarking it to refer to later.

Allergy Free Recipes

The Kids with Food Allergies website has created an easy-to-use, searchable recipe database. You can search for recipes that are free of the top 8 allergens and corn.

The American Academy of Allergy Asthma & Immunology website has a lot of great information about food allergies, in addition to some tasty allergen-free recipes. Each recipe is marked with a key stating which allergens have been omitted.

Recipe Substitutions

If you think your child with a dairy and egg allergy has to miss out on your Great Aunt Mildred’s famous banana bread, think again… You may be able to substitute other ingredients for the butter and eggs. The Kids with Food Allergies website gives a good overview of the function of each allergen ingredient in a recipe and provides suggestions for good substitutions. Unfortunately, not all allergens have substitutions that will function in the same way, so the end product may not turn out exactly the same as the original, and you may want to find a new recipe.

Allergy Friendly Manufacturers

We are lucky to live in a time when there are more allergy-friendly manufacturers than ever before. Children’s Hospital of Orange County has created one of the best resources I’ve come across thus far listing all allergy-friendly food manufacturers. You can check it out here.

Eating out at Restaurants

Want to find allergy-friendly restaurants in your area? Then Allergy Eats is the place to go! You can simply select your food allergy, type in your address, and voila - you have restaurant options. Each restaurant receives a rating, both overall and per allergen. You can also rate a restaurant yourself. To make it even easier to use, Allergy Eats has created an app that can be downloaded onto your smartphone.

Again in the food allergy community, we rely on each other for information and to stay informed. Do you have a tried and true online resource that you’ve found helpful? If so, please share it in the comments section.

-Leslie Stiles, MS, RD, LDN

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Green is Glorious: Understanding baby poop and food allergies

Posted 1.14.14 | Nutrition Specialist


Baby DiaperOne of the most common questions we get from new Neocate Infant parents is “Is this normal?” Any difference from what they think a “normal" diaper should be can cause a lot of anxiety. So what exactly is a “normal” poop or bowel movement for a baby on Neocate? Every baby is different, so “normal” will vary from baby to baby. The color, consistency and frequency of bowel movements may differ. It can also be affected by the baby's medical condition and any solids she/he eats.

That said, we can give you some idea of what to expect. Below are some general guidelines to help you with your diaper expectations.

Color – Green is Glorious!

When a baby is on Neocate, the first stools tend to be green and can be dark - a lot of parents describe the color as hunter green (but contact your baby’s doctor if the stool looks black, which could be blood in the stool). Green is completely normal (Green is Glorious!) and is due to the special composition of Neocate and the way it is digested and absorbed in the body.

For most babies on Neocate, the green color will last for at least the first few days. It may fade after several weeks, but for some little ones stools will be green as long as they’re on Neocate. Often stools will change to a yellow/tan/khaki color if the green fades. This is normal, and is a result of the body adjusting to the way Neocate is digested and absorbed. Color can also change when solid foods are introduced into the diet.

Consistency:

The consistency of stools for babies on Neocate tends to be soft and somewhat pasty, though this can vary. For some babies the stools will be looser, and for others more solid or formed. Again, adding solid foods to the diet can affect consistency. Mucus in the stool is not typical so if you see this, you should let the physician know.

Frequency:

The frequency of bowel movements varies greatly from baby to baby. Some newborn babies may have a bowel movement after each feeding and others may have one daily or even once every two days. During the first weeks of life, before you have learned your baby’s stool pattern, the general advice is to call the doctor if the baby goes three or more days without a bowel movement.

Because Neocate is so broken down, it is very easily digested and there is very little waste leftover. Therefore it’s normal for bowel movements to be less frequent after a switch to Neocate. Most babies on Neocate have a bowel movement once every day or two, though again this varies. As long as stools aren’t overly hard and dry and the baby doesn’t seem to have trouble passing them, this is perfectly normal.

Constipation:

Regardless of whether your baby is on Neocate, hard or dry stools that are difficult to pass may indicate constipation. Talk with the doctor about what you can do to help. Sometimes the solution is as simple as providing extra fluid. Other times, the doctor may prescribe a laxative to make it easier for your baby to have bowel movements.

Diarrhea:

Because a newborn’s stools may be soft and slightly runny, it may be difficult to tell if they have diarrhea. A big increase in frequency or an extremely liquid bowel movement might indicate diarrhea. Severe diarrhea can cause dehydration so if you are concerned that your baby has diarrhea, contact the doctor.

With Baby Poop, Normal Depends on the Baby

The general message here is that every baby has their own “normal” poop and what’s normal for one Neocate baby may not be normal for another. The key is to look out for any sudden change in your baby’s normal bowel movements. Keep in mind that occasional variations are normal, especially once a baby begins taking solid foods.

Hopefully this gives you some idea of what to expect at diaper changing time. Keep in mind that you know your baby best, so if you’re ever concerned about your baby’s bowel movements, contact the doctor just in case.

What has your little one’s Neocate experience been like?

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What is Halal?

Posted 10.15.13 | Rob McCandlish, RDN


Over the past few weeks we’ve posted several blogs related to features of new and improved Neocate Infant DHA/ARA, such as the addition of nucleotides and an increase in the amount of DHA. Some of you may have noticed a tiny symbol on the front of the new can label (see the picture to the right). This symbol indicates that this product is certified halal. So what is halal anyway?

Halal

Halal is an Arabic word meaning “lawful” or “permitted.” The basic explanation is that halal is a food which is considered “clean” by people who follow Islamic dietary laws. Halal foods are essentially any food that is not haram, which means “unlawful” or “prohibited” in Arabic. For Muslims, haram foods include:
   -swine/pork or pork byproducts
   -animals improperly slaughtered or dead before slaughtering
   -animals killed in the name of anyone other than Allah
   -alcoholic drinks and intoxicants
   -carnivorous animals, birds of prey and certain other animals
   -blood and blood byproducts
   -foods contaminated with any of the above

You can read more about halal and haram foods where we found the above information, here or here. After receiving many inquiries from customers around the world over the years about whether or not Neocate Infant is halal, Nutricia decided to have the new version certified halal by the Halal Food Council of Europe. While halal is similar to kosher, in that both are religious dietary laws, the two are not the same: halal certification does not equal kosher certification. You can read more about kosher and Jewish dietary laws here.

Hopefully this helps to clarify what halal means. What other questions do you have?

Rob

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Transitioning from Breast Milk to Neocate

Posted 8.22.13 | Nutrition Specialist


You have always enjoyed breast feeding your little one. What could be better than some quiet time bonding with a snuggly bundle of love as many as 8 times a day? What a bonus that it’s the best source of nutrition for your little one. Recently though, it seems that the thought of weaning has crossed your mind once or twice. Maybe you’re going back to work and the long commute, crazy schedule and pumping is just more than you can bear. Or perhaps you have a very faint memory of what a full night’s sleep used to feel like and you are desperate to experience it once more. In addition, your child may have been diagnosed with a cow’s milk or soy protein allergy and despite an elimination diet, your LO can not tolerate your breast milk. Will the transition from breast feeding to Neocate be difficult? Not necessarily. If your LO’s healthcare team has recommended Neocate and you are considering a transition from breast milk, read on. Included are our best tips for a successful transition.

• First of all relax and be patient. The more relaxed you are, the more relaxed your baby will be.

• Feeding time is more likely to be a success if it’s a pressure free zone. Your baby may need time to get used to the new formula and bottle. If he doesn’t take it in 10 minutes, try again in an hour.

• A baby may be more likely to refuse a bottle if he has a choice between breast feeding and the bottle. It might be best to eventually bottle feed exclusively.

• A gradual transition may be best. For instance, you can prepare Neocate Infant and mix it with expressed breast milk, gradually increasing the amount of Neocate.

• A baby may be more accepting of a bottle the first time from someone other than Mom.

• A baby may have a preference for a particular nipple size and temperature so consider different nipple size, shapes and warming the nipple prior to feeding time.

• Your LO may be more accepting of the formula if she gets a small taste of what’s to come. Try putting a small amount of formula on her lips prior to offering the bottle.


You can find some more transition tips in 'A Guide to Transitioning to Neocate' on this page, which includes tips from a Feeding Specialist.

Do you have any ideas that have helped make for a successful transition from breastfeeding to Neocate? Please feel free to share them here.

-Yasmin

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When should my baby start solids?

Posted 5.30.13 | Rob McCandlish, RDN

 
Infant baby foodA time of high anxiety for families of infants using Neocate Infant is the introduction of solids foods, since they’re concerned about possible allergic reactions. Some recently published research from the Centers for Disease Control and Prevention (CDC) has uncovered that many families may be introducing solids too early, regardless of allergies. Here are some of the latest guidelines and results of research.
 

The recommendations

Last year, the American Academy of Pediatrics (AAP) changed their recommendations for introducing solid foods. Where they had previously recommended introducing solids no earlier than 4 months of age, they now recommend waiting until about 6 months. This is because the AAP recommends breast milk should be an infant’s sole source of nutrition through 6 months of age. (Many families that follow our blogs are aware that, for some infants, breast milk may not be an option, and Neocate Infant may be needed.) The AAP provides some other helpful information on introducing solids here. Starting solids too early can be dangerous, and the early introduction of solid foods has been linked to increased risk of obesity, diabetes, eczema and even celiac disease.


What researchers found

The CDC conducted surveys of 1,334 parents to see when they introduced solids foods and why. They published the results in the AAP journal, Pediatrics - you can find a summary of the results here. What the researchers found was that over 40% of the parents surveyed introduced solid foods before 4 months, earlier than the AAP recommends. Parents gave many reasons for introducing solids, including wanting to give something in addition to formula or breast milk. It’s important to note that infant formulas like Neocate Infant are nutritionally complete, and can meet an infant’s full nutritional needs until a member of the healthcare team recommends introducing solids.


What solid to introduce first

For infants using Neocate Infant, it’s normal for parents and caregivers to wonder what solid is “safest” to introduce first. The best thing to do is to check with your little one’s healthcare team to see what they recommend. Again, the AAP offers some great guidelines around introducing solids. For infants with severe allergies or who have trouble tolerating solid foods, the healthcare team may recommend Neocate Nutra. Neocate Nutra is the only amino acid-based semi-solid that can be given to infants 6 months and older.


- Rob

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About Us

Food Allergy Living is a resource for parents of children with food allergies, brought to you by Nutricia, the makers of Neocate. For more in-depth information about our purpose & authors, see our About Food Allergy Living page.