Food Allergy Living Blog

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Enteral Tube-Feeding: Understanding the Basics

Posted 1.29.15 | Mallory West

Although most Neocate users drink their formula, many patients receive Neocate through a feeding tube. This is referred to as “enteral nutrition”. Those of you with tube-fed family members are already experts on the subject, however, I hope this post will be useful for those of you who are new to tube feeding or for those of you who are just interested in learning how it works.

Tube feeding provides nutrition to someone with a medical condition that impairs his/her ability to eat or drink (or impairs their ability to consume enough to sustain his/her nutritional needs). Nutrition is provided by a special liquid food that is given through the feeding tube.

The liquid food contains all components of nutrition (protein, fat, carbs, vitamins and minerals) so it provides everything a person needs to live and be healthy. Some people are exclusively tube-fed while others continue to eat food while supplementing with tube-feeds. Fluids and medications (most of them) can also be given through the tube (which is a nice perk for kids who require some bad-tasting meds!).

Types of Feeding Tubes

There are various types of feeding tubes. A nasogastric or nasoenteral tube is inserted through the nose into the stomach or small intestine[1]. Alternatively, a tube may be surgically inserted through the skin and directly into the stomach or the small intestine in a procedure called a gastrostomy or jejunostomy, respectively. You may hear these refered to as a “g-tube” (short for gastrostomy tube) or a “j-tube” (short for jejunostomy tube). Patients with g-tubes may get a feeding port (commonly known as a MIC-KEY button or a mickey tube), so that the outside feeding tube only needs to be attached during feedings.

Methods of Tube-feeding

There are 3 ways that tube-feeds are administered:

  • Gravity: With gravity feeds, a bag of formula hangs above the patient so that the formula flows down the tube.
  • Syringe: With syringe feeds, formula is administered by hand using a syringe to push the formula through the tube.
  • Feeding pump: An electronic pump moves formula through the feeding tube at a controlled rate. Common brands of feeding pumps include the Kangaroo pump and the Infinity pump.

Feeding Rates

  • Bolus feedings: Bolus feedings are relatively large in volume and given over a relatively short period of time. Feedings are given several times a day and the schedule more closely resembles “mealtimes” in comparison to a continuous feed.
  • Continuous/drip feedings: Feedings that are given at a slow rate, over a relatively long period of time. Continuous feeds may be indicated for patients who are unable to tolerate large volumes.
  • Combination: Some people may do a combination of both types. For example, they may receive bolus feeds during the day and a continuous feed overnight.

Enteral nutrition is such an amazing example of the impact that medical technology has on our lives. Before there was enteral nutrition, the inability to eat was a life-threatening situation. Although nobody wants to rely on a feeding tube unnecessarily, it is such a blessing for those who could not live without it.

My younger sister Caroline got her G-tube about 6 years ago (she was 11). We tried to avoid it for so many years but once she got it, it turned out to be such a blessing in disguise! She has never looked healthier; she gained some much-needed weight, her hair and skin look so much healthier, and she’s so much stronger. Our family is so thankful for it! If you have come across this post because your little one is getting a feeding tube, I hope this gives you a new and optimistic perspective!

Do any of you have experience with a feeding tube? What impact did it have on your child’s life? What are the biggest obstacles you experience with a feeding tube?


[1] American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.).


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

Your Hands and Your Baby’s Formula

Posted 1.22.15 | Nutrition Specialist

by Kathleen Smith, RDN, LDN

In your daily rush to take care of your baby along with all your other responsibilities, sometimes we take shortcuts to accomplish everything or just forget about certain safety steps that will decrease your baby's risk of foodborne illness and exposure to allergens.

Germs and allergenic proteins can easily be transferred from hands to formula and food. One of the best ways to help decrease the risk of foodborne illness and allergic reactions is for mothers and caregivers to wash their hands with soap and water before preparing baby formula and food. 

Healthcare providers are concerned about hand washing because of a study by the Food and Drug Administration and Center for Disease Control about the infant formula feeding practices of 1,533 mothers. The study found that over half of the mothers, of even young infants, did not always wash their hands with soap before preparing formula for their babies (1). 

How should you wash your hands?(2)

·         Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.

·         Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.

·         Scrub your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice.

·         Rinse your hands well under clean, running water.

·         Dry your hands using a clean towel or air dry them.

Hand-sanitizers will not get rid of food protein residues and do not eliminate all types of germs. Washing hands with soap and water is the best.

When should you wash your hands? (2)

·         Before, during, and after preparing food

·         Before eating food

·         Before and after caring for someone who is sick

·         Before and after treating a cut or wound

·         After using the toilet

·         After changing diapers or cleaning up a child who has used the toilet

·         After blowing your nose, coughing, or sneezing

·         After touching an animal, animal feed, or animal waste

·         After handling pet food or pet treats

·         After touching garbage

We hope you find this helpful!


(1) Labiner-Wolfe L, Fein SB, Shealy KR. Infant Formula-Handling Education and Safety. Infant Formula – Handling Education and Safety. Pediatrics 2008; 122; S85

(2) Center for Disease Control and Prevention. Hand Washing: Clean Hands Saves Lives.  Available at: Accessed on July 25, 2014

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Families Value Dietitians

Posted 1.21.15 | Rob McCandlish, RDN

In our previous post, we heard from a Registered Dietitian Nutritionist (RDN or RD) who helps families to manage food allergies. She explained the role of an RD in her post. This week, we wanted to share some research out of the United Kingdom that reveals the value families find in working with an RD to manage a child's food allergies. You can read an abstract of the research here

Background: We know that there are ways that an RD can help families with food allergies to manage their diet, both in planning to avoid foods as well as ensuring adequate nutrition. We can see how this might improve quality of life, but is there any proof? The research team set out to explore the benefits families get from meeting with an RD regarding the child's food allergies.

How: The research team met with 17 mothers, all of whom attended the same allergy center for dietary advice. They conducted focused discussions on various aspects of dietary advice to manage food allergies.

Outcome: The moms revealed that two of their main goals were to protect their child from the food allergy and to keep life as normal as possible. The RDs that they met with helped them to become experts in their child's food allergy so that they could ensure a safe and nutritionally sound diet. Dietitians also provided these moms education as well as advocacy and emotional support.

So there you have it - dietitian's provide real value to families who are managing food allergies! Have you or your family gotten to work with an RD in managing food allergies? If so, what value did it bring to you?



Guest Blog: The Role of a Registered Dietitian in Food Allergies

Posted 1.7.15 | Neocate Admin

Our guest blog today comes from Raquel Durban, a Registered Dietitian specializing in immediate and delayed food allergies in Charlotte, NC.  Raquel is a medical advisory board member for the Food Allergy and Anaphylaxis Connection Team (FAACT) and an active participant in the American Academy of Asthma, Allergy and Immunology (AAAAI), American Partnership for Eosinophilic Disorders (APFED) and International Network for Diet and Nutrition in Allergy (INDANA).  We would like to thank Raquel for this post.  

How do I know if I need a registered dietitian?

Food allergies result in the elimination of more than just food, they can lead to decreased quality of life and nutrition. A registered dietitian can ensure adequate nutrition, aid in meeting feeding milestones and improve quality of day to day living with food allergies.  You can also be educated on how to find appropriate substitutions and label reading.  Whether you have just been diagnosed with a food allergy or have been embracing one for years, a consult with a registered dietitian would be beneficial.

How to find a registered dietitian?

First let’s start with why a registered dietitian is the best choice for nutritional counseling. We have degrees in nutrition, dietetics, public health or a related field from well-respected, accredited colleges and universities (  We are also required to recertify our credentials every five years through a minimum of 75 continuing education credits.

The Academy of Nutrition and Dietetics website offers a list of registered dietitians in your area with a variety of expertise.  You may also contact your health care provider to see if they may refer you to an RD specializing in food allergies.

Preparing for your appointment

Providing the RD with a list of what is typically eaten in a day or over a few days is a great starting point.  I like to start by asking what the patient eats during a weekday versus a weekend day.  I also like to include beverages.  For children, a growth chart helps to assess weight and height over time.  You can ask your primary care physician for a copy.  A copy of all current medications, vitamins and supplements is useful to complete the nutrition picture. If you are able to bring pictures of the labels or the containers for vitamins and supplements that is a bonus!

How has your food allergy dietitian helped you or your child?

Preparing for the New Year with Food Allergies

Posted 12.19.14 | Nutrition Specialist

New Years Eve has always been a time to look back to the past and more importantly, forward to the coming year. A new year is a good time to reflect on the changes we want or need and resolve to follow those changes. It’s the time of the year where we ponder upon the mistakes we have done and work towards not repeating them.

We understand living with food allergies is not easy, but by following a few steps we can make this journey much easier into the new year. Here are some tips:

  • Don’t Lose Hope:When a child is diagnosed with food allergies, everyone in the family meets with new challenges. You have been dealing with these challenges in an exceptional way.Accept food allergies to be a good part of your life and stop feeling sorry for yourself and your little one.
  • Set up a System:  Set up a regular system that works best for you and your kids. This system may include establishing a day to plan meals for the entire week and grocery shopping with food allergies. Also have a plan in place in the event of an anaphylactic shock, including emergency numbers.
  • Factsheet of food allergies: Educate your kids with facts about food allergies. This way, it will be easier for them to explain their food allergies to others. It is helpful to provide younger children with a medical alert bracelet.
  • Find Community:Managing a family with food allergies can feel like a task being done in a vacuum. The good news is you are not alone. It is good to join a community or support group when managing food allergies. Organizations such as Food Allergy Research and Kids with Food Allergies offer both a plethora of information as well as a community groups. The Neocate Facebook page is also a great way to connect with other families managing food allergies.

We hope that with these tips you and your family will have a safe, food allergy-free and proposerous new year!



Living Dairy-Free in a Crazy-for-Dairy World

Posted 12.16.14 | Nutrition Specialist

Rachel is a mother of two, and is married to her husband, Brent. Her son has life-threatening allergies to dairy, egg, peanut, carrot, celery, and pumpkin.  She blogs at Mom Vs. Food Allergy, home schools her children, and is a No Nuts Moms Group Support Group Leader.  It is her passion to encourage other mothers and caregivers in their food allergy journey.  Follow her on Facebook, Twitter, and Pinterest.  

It seems that the world is crazy for dairy, dairy, and more dairy!  I’ll be the first to admit that I love a delicious slice of cheese. Once my son was diagnosed with a severe, life-threatening dairy allergy at nine months old, sitting down to make that first grocery list post-diagnosis was quite difficult. Four-and-a-half years later, we’re getting used to living and cooking without our beloved dairyladen recipes.

Where is dairy hiding?

Dairy hides in all sorts of products, and not just food products. I polled readers of my blog, Mom Vs. Food Allergy, for places they had found dairy and here’s what they came up with:

•    Allergy medications

•    Asthma inhalers

•    Soap

•    Clothes (yes, this is for real)

•    Hot dogs

•    Bouillon cubes

•    Antibiotics

•    Instant rice

•    Fresh, whole turkey

•    Baby lotion

•    Fresh chopped basil (in squeezable tube)

•    Taco seasoning

•    Salt & vinegar chips

•    Dramamine

•    Wine

•    Deli meat

•    Chicken broth

•    Theater paint

This list is really just the beginning, and is dependent on brands, certain flavors, and where things are processed.It does reveal, though, just how many products that need to be on your radar as someone dealing with a dairy allergy. It’s a perfect reminder to read every label, every time.

How do you avoid dairy?

•    Read every label, every time

•    Use safe substitutions for milk

•    Be on the lookout for words such as “creamy”

•    Know alternative words for dairy such as whey, ghee, and casein. See a more complete list here

•    Don’t eat food that doesn’t have a label

•    Be conscious of cross-contamination


What are safe dairy substitutions?

Thankfully, there are many dairy alternatives these days. I’ll never forget when I discovered vegan “cheese”that allowed me to make favorites like Macaroni-n-“Cheese” and Goldfish crackers for my then preschool son. I really thought I’d died and gone to dairy-free heaven. Here are my favorite brands for living a dairy-free life to the fullest:

•    Daiya Foods (frozen pizza, cream cheese style spreads, and shredded, sliced and block “cheese”)

•    So Delicious Dairy Free (ice cream, yogurt, and milks that are coconut based.  They produce some nut products as well, but have a great allergen statement on their website)

•    Silk (milk and yogurt from a variety of dairy free sources.  Read labels if you have other allergies)

•    Tofutti (dairy-free soy based products)

**If you have more than dairy allergies, please read labels carefully and call companies if you are uncertain about cross-contamination

What are some resources for dairy-free living?

•    Kids With Food Allergies

•    Go Dairy Free (book and website)

•    Vegan Cooking & Baking Books

•    The Neocate Food Allergy Cookbook

Living with a dairy allergy can be challenging. If you are diligent, you still can live a healthy life that is full of tasty treats and meals.  My most important tip of all, is to ALWAYS carry your epinephrine (call 911 after administering), asthma medication, and antihistamine. Also, read every label, every time to stay safe while managing your dairy allergy. Lastly, focus on the foods you CAN have to have a positive outlook on living a dairy-free life in a crazy-for-dairy world.

Special Giveback this Holiday Season

Posted 12.10.14 | Nutrition Specialist

From filling stockings to filling up on a pie, the holiday season ingrains the spirit of giving back. The holiday season is about practicing gratitude, empathy, thoughtfulness and spreading happiness.

Our business partner UPS, took their commitment of delivering smiles to another level, with their #WishesDelivered campaign.

UPS granted a four-year-old’s wish of becoming a UPS driver. Like many of our Neocate little ones, when Carlson was born, he was not able to drink milk or any form of milk protein. UPS would deliver Carlson his formula milk for four years through regular deliveries by Mr. Ernie- the UPS driver.


Carlson dreams of becoming a UPS driver so much that he has a UPS uniform of his own. Last month UPS surprised Carson with a special delivery.  Inside Mr. Ernie's delivery truck was a smaller UPS truck for Carson to drive around his neighborhood. Carlson’s wish was granted and he became a UPS driver for a day delivering packages in the neighborhood in his little UPS delivery truck.

Your Wishes Delivered is a UPS campaign designed to invite the public to share their wishes during the holidays. This year, the company will donate $1 for each wish submitted using #WishesDelivered to one of three charities - The Boys and Girls Clubs of America, The Salvation Army or Toys for Tots Literacy Program.

Spread happiness this holiday season and don’t let food allergies come your way. Neocate will always step in and help you make this journey much easier. Watch the complete video by clicking the picture above. We are sure you will go “awww!”


Food Allergy Winter Recipes

Posted 12.10.14 | Rob McCandlish, RDN

With the change in weather, maybe you’re looking for some good recipes for cool weather, like I do. Here are some great recipes that are food allergy-friendly and ideal for the colder months. As always, make sure these recipes are alright based on your allergens.

After being outside

Is there anything better than coming back into a warm house after building a snowman, skiing, sledding, ice-skating or just being out in cold weather? Yes, if coming back into the house also involves a warm drink! Here are some ideas that don’t involve allergens:
                -Heat up some apple cider, serve with a cinnamon stick
                -Brew up some peppermint, decaf chai, or herbal citrus tea
                -Make hot cocoa from scratch using a dairy substitute, here’s a recipe that looks good
                -Make an allergen-free hot chocolate using Neocate Junior, Chocolate and serve in a thermos
                -Add a drop of peppermint oil or artificial peppermint flavor for a change

Wintery breakfasts                                                      

It can be hard to get out of bed when it’s cold outside. A nice, hot breakfast makes at least a little easier (and slippers don’t hurt!). Here are a few ideas that we’d love to wake up to:
                -Add cut fruit and cinnamon to hot oatmeal
                -Toast and enjoy a Pumpkin Banana Flourless Muffin
                -Fruity Apple Cereal or Applesauce Oatmeal (In our Neocate Nutra Recipe Guide)
                -Fruity Tutti Pancakes (In our Neocate Recipe Booklet)
                -Cinnamon Breakfast Bread or French Toast (In our Food Allergy Cookbook)

Main Meals

Nothing hits the spot when the days are short like a hearty soup. Here are a few we’d be happy to pull a chair up to at the dinner table:
                -Chicken Noodle Soup (from Eating with Food Allergies)
                -Taco Soup (from Real Food Allergy Free)
                -Cream of Broccoli (In our Food Allergy Cookbook)
                -Butternut Squash Soup (In our Neocate Recipe Booklet)

Seasonal Desserts

And even though waistlines suffer at this time of year, who can pass up dessert? Here are a few ways to wrap up a meal:
                -Serve a Milk-free Peppermint Shake
                -Try a great recipe for Gingerbread Cookies (replace egg with appleasauce, if needed)
                -Cinnamon Chocolate Swirl Smoothie (In our Neocate Recipe Booklet)

What are your favorite allergen-free recipes at this time of year?


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How Children Can Explain Food Allergies

Posted 11.19.14 | Rob McCandlish, RDN

Many parents of children with food allergies figure out over time how to explain the allergies to others. But what happens when your child is on her/his own? How do you prepare your child to explain food allergies to other children?

1 – Role Play

It may seem simple, but one of the best methods to prepare your child to answer questions is to practice. You can take a turn being the child with food allergies to give your little one a chance to see an example. We got this idea from Linda Cross in her post on the Kids with Food Allergies site: Raising a Well-adjusted Child Who Happens to Have Food Allergies. It’s full of a lot of other great, practical tips!

2 – Read about it

Children love reading from a young age. Why not read a book together about a young boy’s food allergy? Peter Can’t Eat Peanuts was a book Nadine Reilly wrote to help others work through the same experience her family had. We learned about this great book through a blog that Wendy Mondello wrote, that’s full of a lot of other great tips about managing food allergies as a family, especially emotions.

3 – Share a Video

Videos can be great teaching tools, especially for young children. Your child could share this video, narrated by a pair of pediatric allergists, with his/her classroom during ‘Show and Tell’ or could share it with a friend when asked about why certain foods are ‘off-limits.’

What have you found helpful in empowering your child to explain food allergies to other children?   


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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.