Food Allergy Living Blog

Ask the Nutritionist

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, RD


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.


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, RD

 
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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How much should my baby eat?

Posted 12.12.12 | Nutrition Specialist

                                    

  How much Neocate does my child need?

  Q: After going through almost every formula, my baby’s allergist told me I should give him/her Neocate Infant DHA/ARA. I need to know how many cans to buy and how much   does my baby need to drink?

  A: Many parents of infants, toddlers and children new to Neocate have this question. There’s never an exact answer, so here’s what you need to know:

  We are always happy to help, but this important question about your little one’s health is best answered by the members of his/her healthcare team. They know your child’s medical history and needs, have lots of experience, and can give you the best guidance. With that in mind, we can offer some general guidelines.

  The volume of Neocate needed depends on calorie needs, which can vary a lot from person to person. Factors that affect calorie needs include age, weight, gender, height, and activity level. Another term you might hear is “catch-up growth,” which can come up if your little one has trouble gaining weight. It can mean he/she will need additional calories from Neocate in the beginning to catch up, especially if he/she is a little behind on the growth curve.

  Neocate Infant

  If your little one is bottle-fed, you can expect that he or she will probably consume about the same volume of Neocate InfantDHA/ARA as of the current formula. The amount of Neocate may increase or decrease a little bit, especially in the beginning. And over time, as your babies calorie needs grow, the amount of Neocate per day will also grow. Without being too specific, here are some general ranges for daily amounts of formula by age*. These ranges are for infants who are exclusively formula-fed:

            1 – 3 months……..20 to 30 ounces

            4 – 6 months……..24 to 34 ounces

            7 – 9 months……..29 to 39 ounces

            10 – 12 months….34 to 44 ounces

Neocate Nutra

As the only amino acid-based semi-solid that can be spoon-fed, Neocate Nutra has been a big help for many families dealing with severe allergies. Nutra has high levels of several key nutrients, but is not meant to supply all of a child’s nutrition. For infants six months and older, Nutra is used along with Neocate Infant. Follow your healthcare team’s recommendations for a serving size of Nutra to offer your little one and how many times a day to offer it. Many healthcare teams suggest starting with a small serving size (about four scoops) and offering it two or three times a day.

Neocate Junior and Neocate’s E028 Splash

While Neocate Junior and Neocate Junior with Prebiotics can meet a toddler or child’s full nutritional needs, it is often used along with solid foods or other beverages, such as with an elimination diet. This can make the Neocate serving amount per day a bit tricky. It often depends on the foods your child avoids and any nutrient gaps in their diet. For instance, many children with milk and soy allergies use Neocate Junior as their main source of protein, calcium, and other nutrients important for bone health. The same is true for Neocate’s E028 Splash.

Some children require an elemental formula to meet their full caloric needs. Some examples would be a child with eosinophilic esophagitis (EoE) that is on a strict elemental diet for six weeks, or a toddler with severe allergies who hasn’t yet found safe foods. The following are some general ranges for daily amounts of formula by age* for active children who are strictly on Neocate Junior and often drinking Neocate’s E028 Splash as well:

            1 to 3 years…….27 to 47 ounces

            4 to 8 years…….50 to 62 ounces

            9 to 13 years…..65 to 81 ounces

Again, these are general guidelines. Your little one’s healthcare team can take all of these relevant factors into account to provide you with a tailored recommendation. They will also monitor your child’s growth on Neocate and adjust the amount of formula as needed to meet thier calorie and nutrient needs.

*Ranges for formula are extrapolations based on “Dietary Reference Intakes for Energy,” Food and Nutrition Board, Institute of Medicine of the National Academies.


Hydrolyzed Formulas vs. Neocate: When to Change

Posted 10.6.12 | Nutrition Specialist

In order to understand the difference between hydrolyzed formulas and amino acid-based formulas like Neocate, it’s important to understand the basics of protein and the role that it plays in food allergies.

Proteins are made up of little particles called amino acids.  There are 20 different amino acids. All types of protein are by variations of linked amino acids. Protein is in the foods we eat and also in our bodies. Every cell, tissue, and organ in our bodies is made up of protein. Our body proteins are constantly being broken down and replaced. The protein in the foods we eat is digested into amino acids that are later used to replace these proteins in our bodies, which is why it is so important for us to get enough protein from our diets.

Most people get plenty of protein in their diet from foods like dairy, meats/poultry/fish, legumes, nuts & seeds, tofu, eggs and grains.  But, for people with food protein allergies, it’s more difficult to get adequate protein because many forms of protein are restricted.  Babies who are allergic to milk or soy proteins often need a specialized infant formula in order to get their nutrition.  Sometimes the doctor may recommend a hydrolyzed formula. With hydrolyzed formulas, whole proteins (which are made of long chains of linked amino acids) have been broken down into shorter chains of amino acids to make them easier to digest.

Some babies improve with hydrolyzed formulas but others continue to have problems because their body’s still identify that the broken down protein comes from milk.  For these babies, an amino acid-based formula like Neocate is helpful.  As the name suggests, amino acid-based formulas are made up of free amino acids, not linked together but broken down into their simplest form. This allows babies to get all the nutrition they need in an elemental, hypoallergenic form that is easy for the body to digest and absorb.

If your baby is taking a hydrolyzed formula and continuing to have some symptoms of a food allergy, it may be a good idea to discuss an amino acid-based formula with their pediatrician. 

- Mallory

Sources: Nutrition for Everyone: Protein, Centers for Disease Control and Prevention, October 31, 2011


Can Neocate products be used by adults?

Posted 6.15.12 | Nutrition Specialist

Q: I see that Nutricia only has amino-acid based products that are designed for children.  Can the Neocate products be used by teenagers or even adults?

A: We get questions about using Neocate for older children, teenagers, and adults pretty often.  This is especially common when folks are diagnosed eosinophilic esophagitis (EoE) beyond childhood and an elemental diet is recommended.  Here’s what you need to know:

Neocate’s RightAge approach

The Neocate products are all designed and tailored for specific age ranges.  This helps ensure that growing children who need elemental formula get the right nutrients at the right age, especially when formula is their only source of nutrition.  For instance, Neocate Infant and Neocate Junior products have different levels of vitamins and minerals to meet the different nutrition needs of infants versus toddlers and children.  With this in mind, there are two ways that Neocate products, primarily Neocate Junior and Neocate’s E028 Splash, can be used beyond childhood.

Neocate products can be used for supplemental nutrition

For many people with severe food allergies or conditions like EoE, it can be difficult to get 100% of the essential nutrients from diet.  This is because many foods that have to be avoided are rich in important nutrients like protein, calcium, vitamin D, iron, essential fats, and more.  For many folks who avoid these foods, Neocate Junior is a source of those nutrients.  For instance, many of them consume it with their meals in place of cow’s milk to ensure a more balanced diet.  Neocate Junior and Splash are often used this way with elimination diets, such as the six-food elimination diet.  Neocate products can be useful as supplemental nutrition for folks of all ages.                                                    

Can Neocate products be used “sole-source” beyond childhood?

Using a product “sole source” means that a person gets all of his/her calories from that product.  The product should be “nutritionally complete,” meaning that it provides 100% or more of all vitamins and minerals.  Neocate Junior products are commonly used as the only source of nutrition in children over 1 year.  Neocate Junior was formulated to provide all of the essential vitamins and minerals children need.

Whether or not Neocate Junior can meet 100% of nutrition needs beyond childhood depends on a few factors.  Our nutrient needs change as we age, and are also different for women who are pregnant or nursing.  Also, everyone has different calorie needs, and the number of calories you consume of Neocate Junior determines the amount of each nutrient you get.  Therefore, it’s important to check with your health care team to see if Neocate Junior can meet 100% of your nutrition needs.  They will consider the nutrient levels in Neocate Junior, your calorie needs, and your specific nutrient needs to make their decision.  Some teenagers or adults, especially those with high calorie needs, might be able to use Neocate Junior as their sole source of nutrition to meet 100% of their needs.  Other folks might need to take a vitamin or mineral supplement along with Neocate Junior to meet 100% of their needs.

The good news is that amino acid-based formulas have come a long way in the past 20 years.  Neocate Junior now comes in versions with or without prebiotic fiber (to help promote gut health and regularity), as well as Unflavored, Vanilla, Chocolate, and Tropical flavors.  Neocate’s E028 Splash comes in drink boxes in three great flavors: perfect for busy teens and to add variety.  Neocate Nutra can be mixed with the other products to provide some texture to an otherwise liquid elemental diet.  And don’t forget that our Flavor Packets offer even more options to help make an elemental diet just a bit easier to stick with: take our word for it!                                                             

What if I or my health care team have questions?

As always, families and health care providers are welcome to contact us with questions.  We are available through three routes:
-by email: we try to return emails within 1 business day
-by phone at 800.NEOCATE, option 2: 8:30 am to 5:00 pm, EST, and
-by chat: 8:30 am to 5:00 pm, EST


Neocate® Mixing Instructions – Household measurements

Posted 3.24.12 | Nutrition Specialist

We receive a fair amount of questions from parents and healthcare professionals on how to mix our Neocate products at specific concentrations and volumes. Our Nutrition Specialists can help with any Neocate mixing concentration you want and on whatever size serving Neocate needed based on your doctor’s or dietitian’s recommendations. At times, we will be asked to give mixing instructions for larger serving sizes of Neocate*. In these cases we may typically use household measurements (HHM) as requested by the healthcare professional or parent.

By far, the best way to measure the amount of Neocate powder needed is to use the enclosed scoop provided in each can or to use a gram scale. This will ensure the most accurate amount of powder is used for you or your child. 

Household measurements may be used to mix Neocate in large quantities but we would encourage that this be the last resort. The amount of Neocate powder in a ½ cup, for example, could vary based on the individual, if there were any air pockets in the powder when measuring, if the HHM is US standard or European based, and even on the brand of the measuring cups. There may be a wide discrepancy in the weight of the powder with using HHM. So with that in mind, we would highly encourage that you either use a gram scale to weigh the Neocate powder, or use the enclosed validated scoops in the cans of Neocate to provide the most accurate serving of powder.  If you and your healthcare team decide mixing Neocate will be most useful for you using household measurements, we will be happy to help.

Here are a few tips for you when using household measurements with Neocate powder:

  • Use standard US, dry household measurements (240mL). Some HHM may say 250mL which would not be appropriate to use. Do not use liquid measuring cups.
  • Household measurements are to be leveled and unpacked. Do not pack powder into cups. You may tap the side of the HHM to eliminate air pockets. Level with a clean flat utensil.

For questions and instructions on how to mix Neocate, please call us at 1-800-Neocate!

- Christine

*Including Neocate Infant DHA ARA, Neocate Jr, Unflavored, Neocate Jr Tropical or Chocolate flavored, Neocate Jr with Prebiotics, Unflavored or Vanilla flavored

 


Cross Contamination: Safety Tips for Those with Food Allergies

Posted 2.2.12 | Mallory West

Cross contamination is a big concern among food allergy sufferers.  According to Kids with Food Allergies, cross contamination can be defined as “a food being inadvertently contaminated with food proteins other than those listed on the food label during the course of its being prepared, stored or served”.

During Manufacturing and Production:

One way that cross contamination may occur is during the manufacturing of a food. For example, when a safe food is manufactured on the same equipment as an unsafe food, there is a chance for trace amounts of the unsafe food to end up in the safe food. For those with food allergies, even trace amounts of an allergen can lead to serious allergic reactions.

Although the Food Allergen Labeling and consumer Protection Act of 2004 (FALCPA) requires manufacturers to clearly list the top 8 allergens on the food label, this rule does not account for cross contamination. Sometimes you will see “may contain (allergen)” or “made in a facility that also produces (allergen)” on a label but the manufacturers are not required to list this information. If you have any doubts, call the manufacturers and ask about the possibility of cross contamination. If your child’s allergies are severe and the manufacturer can’t guarantee it is safe, its probably not worth the risk.

By the way, this is why we are proud to say that Neocate is the only amino acid-based infant formula prepared in a 100% milk-free manufacturing site, eliminating the risk for cross contamination!

At Home:

Cross contamination can also happen in your home. Kids with Food Allergies provides some helpful tips on minimizing this risk: http://www.kidswithfoodallergies.org/resourcespre.php?id=65.

Eating Out:

Eating out can be intimidating for those with food allergies because you have less control over how foods are handled and efforts to minimize cross contamination. For helpful tips, check out this article from Food Allergy Gourmet.

Food Safety for Everyone:

The risk of cross contamination is not limited to allergy sufferers. Cross contamination of bacteria from foods (such as raw meat, seafood and eggs) is a concern for everyone. To keep you and your loved ones safe, follow these tips from the USDA Food Safety and Inspection Service.


Have any of your children experienced an allergic reaction as a result of cross contamination?  Any advice to offer other parents?
 

-Mallory


Taking a Leap to Try New Food

Posted 1.19.12 | Mallory West

As we enter the new year, which just so happens to be a leap year, it’s a great time to take a “leap” (pun intended) and resolve to add new foods to your little one’s diet.

When your child has multiple food allergies, you have to work within the range of safe foods so as always, if you are unsure if a certain food is safe or not, always consult with your child’s healthcare professional first.

Be persistent!

One important thing to remember is that if you don’t succeed with a certain food, don’t give up on it or assume that your child doesn’t like it. A certain degree of “neophobia”, or fear of new foods, is normal for toddlers and young children. According to Angela Haas, a speech language pathologist and feeding therapist with over 18 years of experience, children may need up to 20 exposures to a new food before they will accept it. So, if the first try fails, continue to present the food occasionally in a non-forceful manner and eventually, you might be surprised to find that your child accepts and even enjoys it.

Give choices!

Another tip for introducing new foods is to always provide choices so your child feels in control of what they are eating. Instead of saying “You are going to try sweet potatoes today!” ask “Would you like to try sweet potatoes or squash today?”

You may choose to present a small amount of several different foods (only those which are allergy-safe of course). Include a few familiar, preferred foods and a few new ones that they can choose from. Again, this makes them feel in control of what they are eating and less resistant to try new things. You may think that children would be overwhelmed by multiple foods at one time but a recent article reports that on average, children prefer a plate with 7 different items and six different colors (while adults prefer a plate with 3 different items and 3 different colors)[1].

Baby steps!

With toddlers and young children, its important not to pressure them to eat a certain food. Give them the option to say “no, thank you” (but not, “eww gross”) if they aren’t ready to try it. Depending on how resistant the child is to new foods, there are different levels for gradually getting them to accept them. You can start by presenting a new food, along with other familiar foods. They don’t have to eat it but they have to allow it to remain on the plate throughout the meal. Continue to present a new food along with familiar foods and allow your child to get acquainted with it. This might mean smelling it, touching it, playing with it and once they are ready, tasting it. We’ve always heard “don’t play with your food!” but for very young children at this stage, the goal is get them comfortable and familiar with a new food, however that may be.

For more tips on expanding your child’s diet, here are some resources which might be helpful:

Please remember that these are general guidelines for expanding your child’s diet. Always ensure that you only introduce foods that are safe for your child’s specific food allergies and when unsure, consult with a healthcare professional.
 

What challenges do you have with expanding your child’s diet? Any tips for other parents?

 

-Mallory

 



[1] Zampollo F, Kniffin KM, Wansink B, Shimizu M. Food plating preferences of children: the importance of presentation on desire for diversity. Acta Paediatr. 2012 Jan;101(1):61-6.

Photo: Flickr user



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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.