Food Allergy Living Blog Tagged Results

Happy New Year! Before we jump into 2011 on Food Allergy Living, we wanted to recap our top ten blog posts of 2010. We tackled topics from food allergy recipes to tube feeding and everything in between and had some excellent guest bloggers share their stories. Based on reader traffic, here were our most popular posts:

1) Baby Rashes (when is it a milk allergy?)

In this post, Christine talks about how to tell if your child has a typical rash or if it is a sign of an allergic reaction to cow’s milk.

2) Dysphagia, GERD and Silent Aspiration

Mallory tackled the topic of GERD, or gastroesophageal reflux disease, and two other conditions commonly associated with it: dysphagia and silent aspiration.

3) Accidental Injections of Epinephrine from an EpiPen

If you or your child uses an EpiPen, this blog is a must-read in case you ever have an accidental injection.

4) Fun Summer Camps for Kids with Food Allergies

Children with food allergies don’t have to miss out on summer camp fun with these allergy-friendly options.

5) How Can Duocal Help My Child Gain Weight?

If your child is underweight or has been diagnosed with failure to thrive, the supplement Duocal can help provide extra calories in their diet.

6) Baby Formula and Food Thickeners: What are the Options?

Thickeners can help treat reflux, but children with food allergies often react to the rice cereals or oatmeals that are commonly recommended. Christine offers some other options that are allergy-friendly.

7) Guest Blog: Living with Eosinophilic Esophagitis - Norman’s Story

Kendra Tiedemann shared her son Norman’s journey with eosinophilic esophagitis.

8) Understanding How Infant Taste Buds Work

If you’ve ever wondered if your baby can taste her food, then be sure to read this post from Mallory.

9) Failure to Thrive: My Child is Underweight, What Should I Do?

In this post, Nita helped to clear up some common confusions about what a failure to thrive diagnosis means and how it is treated.

10) Guest Blog: Food Protein-Induced Entercolitis Syndrome – Roland’s Story

Lorelei Alvarez, one of the founders of the Reflux Rebels group, shared her son Roland’s journey with FPIES in this guest blog.

Which blog posts were your favorite over the last year? Are there any topics you’d like to see us cover in 2011?

- Sarah

We would like to thank Kendra Tiedemann for guest blogging for us and sharing her family’s allergy story. In case you missed it, be sure to read last week’s entry about her other son Paulie.

This is Norman. He is three years old and has the spirit of a child who sees the world as his playground. He also sees much of the world through a looking glass. When he hears the ice cream truck, he runs to watch children gather with dollars in hand for treats that he may never taste. Norman is a boy with eosinophilic esophagitis, known as EE or EoE for those averse to tongue twisters.

Eosinophilic esophagitis is a condition of the gastrointestinal tract caused by an immune system gone awry. Eosinophils, white blood cells charged with fighting off parasites, mistake food proteins as foreign invaders. They flock to the esophagus to attack “invading” food proteins and remain there long after the food has passed through to Norman’s stomach. The eosinophils cause inflammation and other damage to the esophagus. The inflammatory process interferes with the body’s ability to properly utilize food that is taken in, causing a variety of symptoms that can make eating difficult or even impossible. Some EE patients must exclude just a few foods from their diets. Some, like Norman, react to every food and must rely on elemental formulas as the sole source of nutrition if they are to avoid life-long steroid treatments. Most are somewhere in the middle.

“But he looks so healthy!” That is the universal response to the above explanation for why Norman drinks formula rather than eating with the rest of us. That is true when he is on a diet consisting only of Neocate One Plus, Neocate Nutra and cane sugar. Those who have known Norman since birth know that it is complicated.

As an infant, Norman rarely slept more than 20 to 30 minutes at a stretch. He screamed in pain every time he soiled his diaper which, for many months, was more than a dozen times each day. His skin was burned and blistered despite our attempts to protect it with creams. Skin infections were not uncommon. When he wasn’t taking a cat-nap or screaming in pain, Norman was nursing. He pulled away frequently, arching his back and turning his head at an awkward angle. Seizure-like shaking was another indicator of severe reflux that was unresponsive to prescription medications. Despite the constant feedings and extreme modifications to my diet, Norman failed to thrive. The introduction of solid foods to his diet was disastrous. He delighted in each new food…until the pain of eating overcame the joy. Food trial after failed food trial, we could do nothing to ease his pain.

The day of Norman’s diagnosis was a day of celebration. We stopped giving him food and switched him to an elemental formula. Within a few days, he was sleeping longer and crying less. For the first time in his fifteen months, he began to thrive!

To those who say that Norman looks healthy, I say this: “Yes, he is healthy, but his eosinophils are still poised for attack. He is healthy because he doesn’t eat food."

- Kendra Tiedemann

I often get asked whether our Neocate^® formulas have all the vitamins and minerals a child would need to thrive for all stages throughout their lives. The answer is yes; but I thought I should explain further what the term “nutritionally complete” really means.

If a formula is considered nutritionally complete it can be used as a sole source of nutrition because it will provide all of the important carbohydrates, protein, fat, vitamins and minerals a child needs to grow and thrive. For a nutritional product to be nutritionally complete and say so on its product label, it should be age-appropriate and provide all the nutrients a child would need for that specific age. For example, infant formulas are designed specifically to meet the needs of infants. As the infant grows into a toddler and older child, their nutritional needs differ and age-specific nutritionally complete products are needed to ensure they are meeting all their nutrient needs.

Having complete nutrition is important for children who are on very restrictive diets because of conditions such as food allergies, eosinophilic esophagitis (EoE) and short bowel syndrome (SBS). When children cannot eat a wide variety of foods, it is common for them to have nutrient deficiencies as a consequence. One study¹ found that in children with food allergies, many were not receiving enough vitamin D, calcium, iron, vitamin E and zinc. This is a serious problem because inadequate nutrition in children could have long-lasting implications such as poor growth, delayed development, and failure to thrive.

One way to avoid nutrient deficiencies is by having a registered dietitian involved in your child’s care – they can assess your child’s nutritional status and give recommendations on what options may work for you and your family. Your chosen nutritionist can also help you to properly read food labels and really understand what is being put into your child’s food. Just as important, finding a nutritional formula that has adequate (and even higher) amounts of important nutrients (such as calcium, iron, vitamin D, phosphorus and zinc) can help you ensure your little one is receiving proper age-specific nutrition to grow and thrive.

As I mentioned, all of the nutrition formulas in the Neocate family are nutritionally complete. If you are also using Neocate Nutra (a semi-solid amino-acid based medical food) don’t forget that it is meant to supplement formula and not replace it. Nutra contains lots of important nutrients like protein, fat, calcium, and vitamin D but just not enough to be the only source of nutrition.

Are there any vitamins and/or minerals you are worried your little one may not be getting enough of due to a restricted diet? Let us hear about it!

Christine

1. Salman et al, Dietary intakes of children with food allergies: comparison of the food guide pyramid and the recommended dietary allowances, J Allergy Clin Immunol 2002.

As a follow up to our “Failure to Thrive: My child is underweight, what should I do?” blog, I would like to further explain the product Duocal. It may be a good option for a child with failure to thrive (or FTT) as well as other conditions such as multiple food protein intolerance and conditions related to food allergies such as Eosinophilic Esophagitis (or EE), Gastroesophageal reflux disease (or GERD), and Atopic Dermatitis (or AD).

Duocal is a high calorie, protein-free powdered nutritional supplement that can be added to foods or beverages when additional calories are needed to gain adequate weight. Keep in mind that Duocal is not a formula and should not be used as a sole source of nutrition.

Duocal is made up of carbohydrates and fats. It is flavorless and super soluble so there are no changes to the taste and/or texture of the food it is being added to (which also helps with diet compliance). The Duocal 400g can comes with a scoop which provides about 25 extra calories per scoop.

The reason Duocal is unique is the fact that it does not contain proteins. This is important for a child who needs extra calories due to FTT or weight loss secondary to severe food allergies (keep in mind; only proteins can cause an allergic reaction).

Duocal is 100% milk free and is made in a milk free environment to ensure tolerance. Duocal is for children ages 1 and over. The amount of Duocal you or your little one may need per day is to be determined by your doctor or dietitian. The amount of Duocal needed per day really depends on what the specific nutritional needs are for the patient. Duocal is for children ages one year and older, so it can be used throughout ones life stages.

Duocal can be mixed with a wide variety of foods. Here are some quick tips on how to use Duocal to get you started.

(These are approximations, please check with your doctor or dietitian for exact amounts) When using

Duocal for:

· Beverages: Add 2 scoops of Duocal per 4 fl oz.

· Toddler Foods: Add 2 scoops of Duocal per ¼ cup of food.

· Mashed potatoes: Add 3-4 scoops Duocal per ½ cup of mashed potatoes.

· Soups: Add ~6 scoops of Duocal for a 16 oz serving (or one can) of soup.

The MyDuocal.com site has a lot of helpful recipes and complete nutritional information to help you better understand how to incorporate Duocal into your child’s diet.

Have you tried Duocal before? What kind of recipes did you make with it? We are always excited to hear of new ways to use Duocal in helping patients thrive.

Christine

As a parent, it’s hard to hear that your child has been diagnosed with Failure to Thrive, often written as “FTT.” I often talk to parents who are confused by the diagnosis and not sure exactly what it means, so I thought I’d take the time today to answer some basic questions.

For those who don’t know, FTT is a medical term and is used to describe poor weight gain over an extended period of time. It is often used when diagnosing infants, children and the elderly.

What’s the background on Failure to Thrive?

FTT has been used for more than a century when diagnosing those who are unable to grow or maintain their weight properly; however, it still lacks concise guidelines because it describes a condition and not a disease.

Most diagnoses of FTT are in infants and children and can be a result of something else that may be going on -- such as food allergies. The first few years of life are very important for growth and development; therefore it is important to ensure that your little one is gaining the proper amount of weight and has proper nutrition. Most babies double their birth weight by 4 months and triple it by age 1; however, children with FTT often don’t meet those milestones and are lagging on their growth charts.

What causes Failure to Thrive?

FTT can be the result of a variety of social and medical factors.

Social Factors. With obesity on the rise, many parents fear that they are “over-feeding” their children, so they may restrict calories. You will be happy to learn that children (especially young ones) are excellent self-regulators. They lack the desire to eat simply because food is present or out of boredom, which many of us do not! They eat out of necessity and because their body needs the nutrients the food will provide. With that said if you have a young child, follow their hunger cues. If you feel that they are gaining weight too quickly later in life, you may want to consult your doctor or dietitian.

Medical Factors. Most often FTT is caused by allergies or GI conditions such as:

• Gastroesophageal Reflux Disease (GERD), which can cause an irritated esophagus which may cause a child to refuse to eat;
• Chronic Diarrhea which causes the body to rapidly lose important nutrients and calories provided by food;
• Food Allergies to proteins in things like milk which require a restrictive diet that may lead to the inability to maintain or gain weight; or
• Illness when the body goes into overdrive trying to fight the infection, using up all of the nutrients it has stored to do so.

How is Failure to Thrive treated in infants and children?

Depending on the cause of FTT, it may be easier than you think to help your little one gain the proper weight he or she needs to get back on the growth charts. If it’s caused by a disease or condition such as GERD, Short Bowel Syndrome or a milk protein allergy, you may want to introduce an elemental formula such as Neocate. This will not only aid in weight gain, but can also help with the condition itself. Another option would be to add a product that contains additional fats and carbohydrates like Duocal. It is protein-free and virtually tasteless, allowing you to add it to foods or drinks consumed by the most picky and allergy-ridden eaters.

If you have been told that your child has FTT, make sure that you have your doctor note it on any medical necessity letter or documentation. This may provide some leverage when applying for reimbursement for elemental formulas.

Have any of your little ones been diagnosed with FTT? How are you helping them to gain weight?

-Nita

References:

http://kidshealth.org/parent/food/weight/failure_thrive.html# http://www.lpch.org/diseasehealthinfo/healthlibrary/growth/thrive.html

Hearing “failure to thrive” (FTT) from a doctor can be disheartening for parents. Unfortunately, when babies and children have food allergies, it can be hard to make sure they are getting all of the nutrients they need to grow. And I often get phone calls from confused parents who are not sure what they can give their child to ensure they get all the necessary nutrients when they are allergic to so many key foods.

Because of this, FTT, a term used to describe the children who have failed to develop and grow as expected, is a common, but extremely fixable, symptom of babies and children with food allergies.

For more information on FTT, click here.

Since FTT often occurs because a child is not receiving adequate calories, a high calorie supplement is needed. This is where Duocal, a high calorie, protein-free nutritional supplement that can be added to foods or beverages, comes in. This milk-free product is great for little ones who have milk protein allergies and are on specialized formulas. However, it can be given to children who are not taking formula as well and is perfect for those children who just require a little catch-up growth.

Do you want to know the best thing about Duocal? It’s an unflavored powder so you can add it to your child’s normal diet! That’s right busy moms — there isn’t any additional cooking on your end and you don’t have to worry about your child not liking it. You can just add it to whatever your child is eating.

If you feel like your child has been missing that one last piece of the nutritional puzzle, a supplement like Duocal, or a similar supplemental medical food, could be right for him or her. And remember, products like this should be taken under medical supervision. For complete information on Duocal, click here.

Do you have any questions about FTT or Duocal? Please send them my way!

- Christine

The first eight months of Sean’s life were grueling.  He experienced the discomfort and pain of vomiting up to three times a day, unable to tolerate his formula.  Six months of very little weight gain left Sean feeling weak, while his gastroesophageal reflux condition fuelled his asthma symptoms.

At nine months old Sean was diagnosed with failure to thrive; a description given to children whose current weight or rate of weight gain is significantly below that of other children of similar age and sex.

“We didn’t understand why he was vomiting so often and his lack of weight gain,” said Rebecca Sparks, Sean’s mother.  “It was heartbreaking on us as his parents to see him go through that all, we felt helpless.”

To combat Sean’s persistent vomiting, his parents tried Zantac and Prevacid, which seemed to soothe his symptoms for some time, but they ultimately returned.  

Since his symptoms kept reoccurring, Sean’s pediatrician referred his parents to a gastroenterologist, who tested for allergies, cystic fibrosis and eosinophilic esophagitis.  Sean tested negative, increasing his parents concerns.  With little options left, Sean’s doctors recommended a surgery, nissen fundoplication, which treats gastroesophageal reflux by stitching the upper part of the stomach around the lower end of the esophagus, reinforcing the closing function.

In an attempt to exhaust all other options, especially surgery, Rebecca turned to Neocate Junior.  After a month and a half, Sean only vomited a total of three times compared to three times a day prior to Neocate.

“I definitely wish we had switched to Neocate sooner,” says Rebecca.  “Sean is gaining weight and drinking more formula.  He was averaging 20 ounces per day and now he chows down 30!” 

Neocate has improved Sean’s life and offered him an alternative to surgery and for that his parents are grateful.

“Sean doesn’t have to experience the pain of vomiting so often and can tolerate all his formula,” says Rebecca.  “Sean has always tried to be a happy camper despite his symptoms, but with Neocate, he can be happy and healthy." 

If you want to share your before and after photos, we’d love to see them! Send us an email at FoodAllergyLiving@neocate.com. 

Sean After Neocate 

Failure to thrive (FTT) is a term used to describe a child who fails to gain weight at the expected rate or who loses weight over time. At each doctor’s visit, a child’s height, weight and head circumference are measured to make sure they are growing appropriately. Children come in all different sizes of course but the general growth trend during infancy and childhood should be fairly consistent.

Pediatricians use growth charts to track the growth of infants, children and adolescents. The growth charts are created by the National Center for Health Statistics at the Center for Disease Control.  FTT is often considered when a child is below the 3^rd-5^th percentile for age or weight or has fallen 2 major percentile lines on the growth charts[i].

What Causes FTT?

FTT occurs when an infant or child is unable to consume, retain, or utilize the nutrition and calories that they need to gain weight and grow appropriately.  Infancy and early childhood are a crucial period of physical and mental development, so doctors are concerned when growth is impaired.

There are many different causes of FTT but most often, it occurs as a result of an underlying medical issue[ii]. Below are some examples of conditions which can lead to the development of FTT.

• Food allergies: Until they are diagnosed, food allergies can impair the body’s ability to absorb nutrients from food properly. Once food allergies are diagnosed, entire food groups may be eliminated from the diet. Such a restricted diet can make it difficult to get enough nutrition.
• Gastrointestinal conditions(such as GERD, chronic diarrhea, celiac, etc)
• Metabolic disorders
• Infections/illnesses
• Physical conditions (such as heart conditions, cleft palates, etc)

How is FTT Managed?

The child’s healthcare provider will determine the best course of treatment, depending on the underlying cause for the FTT. If the problem is caused by malabsorptionassociated with food allergies, dietary changes alone may resolve the issue. If the child has difficulty eating enough with such a restricted diet, they may need to supplement with an allergy-friendly formula like Neocateor E028 Splashin order to fill in the nutritional gaps.

When a child is having difficulty consuming enough calories, their healthcare provider may recommend some high-calorie snacks to boost their intake. For infants, they may recommend a high-calorie infant formula or they may recommend concentrating the current formulato make it more calorie dense. For older children who eat table foods, they may recommend adding a calorie supplement, like Duocal, to foods and trying to add high-calorie foods to their diet.  

Allergy-Friendly, High Calorie Foods:

The high-calorie foods you can use obviously depend on which foods your child is allergic to so if you are unsure which foods are safe and which are not, always consult with your pediatrician or other physician before adding any new foods.  Cheese, cream, milk powders and other dairy-based foods may be recommended for adding calories but since most of our readers have little ones with milk and other food allergies, we will list some high-calorie options not containing the top 8 allergens.

Avocados:I think avocados are the perfect food. Many adults avoid them because they think they are fattening, which in a sense they are, but they are packed full of the good fat (and tons of other important nutrients). Avocados are a healthy way to boost your child’s calorie intake. A 1 oz serving (about 2 tbsp) of fresh avocado contains 50 calories. You may be surprised to find that kids often love avocados. For the little ones, you can mash avocados and mix them with baby food fruits and vegetables or rice cereal (or Nutra). For older kids, you can mix them with table foods or make a guacamole dip.

Homemade fries: Make your own French-fries by slicing potatoes or sweet potatoes and frying them in a heart-healthy oil, such as olive oil. You can also fry other vegetables like zucchini, eggplant, mushrooms etc. Each tablespoon of olive oil contains nearly 120 calories!

Sunflower seed butter:Nut butters are often used to add calories and protein to a child’s diet but peanuts and tree nuts are among the top 8 allergens. Instead, you might consider sunflower seed butter, which has a similar flavor and texture. 2 tbsp of sunflower seed butter contains 200 calories and 7 g of protein.

Smoothies:Smoothies are a great way to pack in a bunch of nutrients.  Add fruits like bananas, berries, peaches, etc. I like to use frozen fruits so that you don’t need as much ice.  Add a liquid of choice, such as fruit juice or a milk-alternative such as rice milk, coconut milk or Neocate.  If desired, add some ice. For some more bulk, you can also add an allergy-friendly yogurt or frozen dessert, like coconut yogurt (dairy-free) or sorbet (be sure it’s a dairy-free, soy-free brand). Add a few scoops of Duocalto pack some extra calories (each scoop adds 25 calories; Duocalis milk protein-free).  Blend it all together and you have a tasty, high calorie, easy-to-transport drink.

Dried fruits:Dried fruits are a high-calorie, nutritious snack that is easy to take along with you on the go. Dried fruits lose their water content so you get the same calories as fresh fruit in a much smaller volume. Just one dried apricot contains about 10 calories!

Again, I want to stress that these are only suggestions of high-calorie foods that do not contain the top 8 allergens. Every child’s allergies are unique so always check with your child’s healthcare professional if you are unsure whether or not a food is appropriate for your child.

Do you have any tips on boosting calories or high-calorie snack ideas to share? What has helped your child to gain weight?

-Mallory