Food Allergy Living Blog Tagged Results

To follow up on Mallory’s post on Dysphagia, GERD, and Silent Aspiration in children, I wanted to discuss the use of thickeners to help with the treatment of GERD/GER, dysphagia and aspiration.

If your little one is showing signs of GERD/GER, dysphagia or aspiration, you should always see a doctor to determine exactly what condition needs to be treated. One thing to remember is that children with Eosinophilic Esophagitis (EoE) can also have symptoms of dysphagia and often have symptoms very similar to that of GERD. EoE is caused by food allergies and can be treated effectively by eliminating the allergens in your child’s diet. Thickening their food or formula may not be needed once the allergens are removed. Be sure to check with your doctor or speech pathologist to see if a food thickener is appropriate for your little one before trying one.

Thickening Foods and Liquids

If your child does have GERD/GER, dysphagia or aspiration, altering the thickness of food and liquids can help make them easier to swallow. When fluids are too thin, some children have trouble using their tongues correctly, causing liquid to get caught in the airway passage and then get into their lungs. Thickening the formula and other fluids will help to ensure that the liquids stay together in the esophagus, decreasing the risk of aspiration.

For infants with GERD symptoms, using rice cereal in their formula to thicken it may help. The recommended amount to add to formulas is one tablespoon per 2 to 4 ounces of formula to reduce vomiting. (Rudolph et al 2001). There are also other thickeners on the market to choose from. It is important to read labels and call the company if your child has food allergies to ensure that they aren’t ingesting any allergens in the thickener. A few options include:

• Thick-It
• ThickenUp
• Simply Thick

Have you used a thickener before for your child? If so let us know which you tried and how it worked!

- Christine

Ever wonder if your infant has the capacity to really taste his or her food? Well, this post will address the sense of taste in infancy!

To start, let’s review the basics of the “gustatory system”. Taste buds on the tongue relay information to the brain, which is perceived as taste.

The 5 basic tastes of any human are:

• sweet
• salty
• sour
• bitter
• savory (aka umami).

Research shows that infants are born with a predisposition to accept sweet tastes, such as breast milk. Infants also have a predisposition to reject new foods, a phenomenon known as “neophobia”[1]. During infancy, almost all foods are “new” so it’s no wonder that introducing a new food or formula may result in some resistance from your baby.

The good news is that this neophobia can be overcome by repeated exposure to the food. In other words, taste preferences aren’t set in stone; they are constantly evolving. With repeated experience, infants accept and may even prefer the previously rejected food. One study observed mothers who presented a particular food daily over a period of time. The researchers found that it took 15 feedings for the infants to accept the new food readily.

Therefore, whether you are introducing solids or switching over to Neocate from another formula, don’t be discouraged! It is not only ok, but normal for your little one to reject the new food at first. Just be patient and persistent and continue to present the food in a positive manner.

An interesting tidbit: An infant’s perception of bitter taste is developed several months after birth. A study found that newborn infants did not reject the taste of bitter, while older infants did[2]. Another study identified the time period for this developmental change to be around 4 months of age[3]. The researchers found that infants who were put on a specialized, broken down formula (which have a slightly bitter taste due to the broken down protein) before the age of 4 months transitioned to the new formula with no resistance.

After this age, the infants identify the change in taste and moms may have to be a bit craftier to transition their little one onto the new formula. The researchers pointed out that a gradual transition, where the new formula is mixed with the previous formula, helps older infants to accept the new formula. This allows infants taste buds to gradually and repeatedly be exposed to the new flavor and associates the flavor with something that they already like (the previous formula).

What tastes did your child prefer when you first began introducing foods? Have you noticed any change in their taste preferences as they get older?

- Mallory

[1] Birch, L. L. (2002). Acquisition of food preferences and eating patterns in children. In C. G. Fairburn, & K. D. Brownell (Eds.), Eating disorders and obesity (2nd ed., pp. 75-79). New York, NY: The Guilford Press.
[2] Beauchamp GK, Cowart BJ, Kajiura H. Early developmental change in bitter taste responses in human infants. Dev Psychobiol. 1992 Jul;25(5):375-86.
[3] Beauchamp GK, Griffin CE, Mennella JA. Flavor Programming During Infancy. PEDIATRICS Vol. 113 No. 4 April 2004, pp. 840-845

Recently I was volunteering at a local organization which provides respite care to families of children with special needs. There was a baby in the center who had recently been switched from a milk-based formula to a soy-based alternative. The caregiver was explaining that the baby didn’t seem to like the formula and that she didn’t blame him because it tasted awful. Everybody smelled the formula and made disgusted faces, making a huge deal about how terrible it was that the baby had to drink it. And all I kept thinking was, well of course the baby doesn’t like it! How many of us would want to eat or drink something when everyone around us thinks it’s gross.

I wanted to share this with you because parents often call us for advice on transitioning their baby to Neocate. Hopefully, this entry will provide some helpful guidance if you are making that switch.

First and foremost, it’s important to remember that if your baby is prescribed a special formula, it’s because of a medical condition which makes him or her unable to tolerate typical formula. The special formulation of Neocate makes it taste different from standard formulas, but it’s also this special formulation which provides relief and allows your baby to grow, thrive and be healthy. So how can you help make the transition smoother?

The answer is a lesson of developmental psychology! Research shows that although children are born with predispositions for certain food preferences, the majority of food preferences are shaped by experience¹. A child’s food acceptance and preference are strongly influenced by the way their parents present these foods. Children learn to accept and prefer foods which are presented repeatedly and in a positive manner. At the same time, if a food is presented in a negative context, the child is likely to dislike and reject the new food (which is the most likely reason for the baby I described above not wanting the formula).

Therefore, if you present the new formula positively, even tasting it yourself and showing a pleasant response, your child is much more likely to accept and even like it. Likewise, if you display your distaste for the formula in front of your baby (for example making a disgusted face and exclaiming “this formula tastes gross!”), your baby is likely to learn to dislike it as well.

So, the takeaways are:

1. When introducing a new formula to your baby, remember to keep a positive and supportive demeanor. Try not to make unpleasant facial expressions or negative comments in front of the baby.
2. Remember that children learn to accept foods which are presented repeatedly so don’t be discouraged if your baby doesn’t accept the new formula right away.

Keeping these tips in mind will hopefully make the formula transition much more pleasant for your baby and as a result, much more pleasant for you too!

Do any of you have tips for helping with the transition to Neocate? We’d love to hear them!

-Mallory

1. Birch, LL. Development of Food Acceptance Patterns in the First Years of Life. Proc Nutr Soc. 1998 Nov;57(4):617-24.

Happy Thanksgiving! This month, my colleagues Sarah, Mallory, Christine and I decided to do a series of “Why I’m Thankful” blogs. I hope my post finds you in good health and enjoying the long, holiday weekend!

To start off, I am thankful for my family and friends — without them I would not be the person I am today. They bring support, happiness and laughter into my life.

Like Mallory, I am also thankful for the improvements in science and how far we’ve come. When I was a little girl, I suffered from milk allergies and was very underweight. My family did everything they could to ensure I gained weight properly and I was able to thrive without milk in my diet. Still, it was quite a struggle, as I’m sure you know firsthand from your experiences with your little ones! Like so many allergy kids, as time passed I finally outgrew my allergies and eventually I even outgrew my nickname “Spaghetti Legs”. This came as a huge relief to both me (after years of being unable to do so, I could finally eat ice cream!) and my family.

Neocate formulas and Duocal would have been optimal for my growth; however, they were not available when I needed it. Both Neocate and Duocal provide families with options I did not have when growing up with a milk allergy and underweight. Families can rely on our hypoallergenic, amino acid-based formulas and not have to worry that their child isn’t getting the proper nutrition they need to grow properly. Although I wasn’t able to benefit from Neocate or EO28 Splash, I am so thankful the families I talk to everyday are able to feed their children these formulas which are able to alleviate some of the stress of parenting a child with food allergies.

Lastly, I’m thankful for you! Since starting here at Nutricia, I have learned more about your families, and been able to provide resources and assistance to make your lives easier. It has been a joy getting to know you and helping your little ones!

What are you thankful for this Thanksgiving?

- Nita

You may have read Sarah and Mallory’s “Why I’m Thankful” posts over the last couple weeks. In case you missed them, we are sharing what we are most thankful for in our lives. Here are my reasons for being thankful this Thanksgiving!

First and foremost I am thankful for my family and friends. I am fortunate to have such a supportive and loving family.

Another important thing I am thankful for is my health When I was just 8 years old I was diagnosed as a type 1 Diabetic. At the time it was a very new and frightening thing. The fact that I had to live with diabetes for the rest of my life (and give myself insulin injections on a daily basis) was a big adjustment for me and my family to deal with.

Although I have been diabetic for about 20 years, I have made it my goal to make sure my diabetes is controlled. Besides the fact I have this condition, I am fairly healthy otherwise. I always feel it could have been much worse for me, and I am thankful that it wasn’t. With the future of medical science, more and more tools are being introduced to help diabetics control their sugars (as well as help manage other conditions). I make sure to eat a balanced meal and exercise daily (although that may be easier said than done!). With the help of my family I have been able to live a full life regardless of my condition.

Finally, I am thankful for the fact that I can help families in need. As a nutrition specialist for Nutricia North America, specializing in infant nutrition, I am able to help many families by educating them about our formulas. Everything from explaining to parents and caregivers how to use and mix the formula correctly, what to expect when their child is on it, and how to make sure they are doing everything correctly, has truly helped Neocate families and it’s extremely rewarding to know that I’m a part of that process. I have always wanted to use my knowledge of nutrition to help people make the best decisions for their health. Being a nutrition specialist has helped me to do that and I am so thankful for it.

- Christine

Over the last year I’ve received several phone calls from parents asking whether or not they need to sterilize the water for their child’s infant formula. And the confusion is completely understandable…depending on who you are talking to, you’ll most likely get a different answer.

I always recommend that parents take the extra precaution and boil the water for all preparations of the formula – In my mind, better to play it safe when it comes to your child’s health. (And as a side note, purified water, bottled water and nursery water, are not sterile, so make sure you boil them as well).

However, I’ve seen other manufacturers of infant formula state on their cans to “Ask your baby’s doctor if you need to boil (sterilize) water for formula and bottle preparations.”

Since this seems to be a topic of confusion, I thought I’d share some recommendations from the World Health Organization that I typically provide parents:

Sterilizing

Cleaned equipment can be sterilized using a commercial sterilizer (follow manufacturer's instructions), or a pan and boiling water:

Step 1: Fill a large pan with water

Step 2: Place the cleaned feeding and preparation equipment into the water. Make sure that the equipment is completely covered with water and that no air bubbles are trapped. Step 3: Cover the pan with a lid and bring to a rolling boil, making sure the pan does not boil dry.

Step 4: Keep the pan covered until the feeding equipment is needed.

If you are interested in checking out the World Health Organization’s pamphlet with these steps and other guidelines for preparing formula for bottle feeding at home, click here.

If you have any questions about proper sterilization techniques for your child’s infant formula let us know. I encourage you to post a comment so others can see your question as well.

- Christine

To read the entire article, click here.

• This is just a friendly reminder about the dangers of buying formula from bidding sites:
• While you might find prices to be slightly cheaper on these sites, you have no way of verifying who is selling you the product;
• The formula may not have been stored properly, which could cause the ingredients to be altered;
• The person selling the formula could have tampered with the product making it dangerous for your little one to drink; and
• The formula could be expired.

To be on the safe side, purchase your formula from the manufacturer’s Web site or from your local pharmacy so that you are confident that the formula is safe and that you are getting what you ordered.

- Christine

Often, I get calls from curious parents regarding up-age products, which are products for babies that are one year of age and up. Our conversation is very similar to this:

“My little one with an allergy is about to turn one years old. Can I keep him on the same formula or should I switch to a different one? If I have to put him on a new formula, how do I do it?” – Parent

“The answer is simple and only involves two things: New formula and weaning.” – Nutrition Specialist

Of course, it’s not that simple. But it isn’t as hard as many would think. And honestly, the process usually depends on your child.

Depending on what formula your child is on now, you can usually just switch it to the product next in line. Here at Nutricia infants with milk protein allergies are on Neocate Infant. Once a child turns one, parents can then switch their formula to Neocate 1+, Necoate Junior or EO28 Splash.

Since each child is different, my formula suggestions are always on a case-by-case basis and of course depend on a doctor’s recommendation. However, for instance, if your child still has malabsorption issues, I would often recommend Neocate Junior because it contains a higher amount of vitamins and minerals.

After you make the formula choice, you need to begin weaning your little one. Again, the process of weaning is not set in stone; however, you usually start by giving your child a combination of new formula and old formula until he or she is completely comfortable on the new formula. For example, you could start off with 25% new formula and 75% old formula. If that works for your little one, slowly keep increasing the amount of new formula. If your child gives resistance, switch to less of the new formula and more of the old. Basically, you can create your own weaning recipe!

What have your experiences been like switching to up-age formulas? I’d love to know!

And as always, if you have any questions, send them my way!

- Christine

I know it might seem like we write about formula fraud quite often, but we just want to make sure your little ones are safe! Here’s another warning from the U.S. Food and Drug Administration (FDA) about avoiding infant formulas imported from China.

To see the official FDA warning, click here.

The warning does not affect any of the six companies regulated by the FDA that have been approved to distribute formula in the U.S. (Abbott Nutrition, Mead Johnson Nutritionals, Nestle USA, PBM Nutritionals, Solus Products and SHS/Nutricia) so don’t be too alarmed! I would suggest, however, avoiding any formula not made by these six FDA approved manufacturers.

To make sure you are getting the safe and appropriate formula for your little one, check out these reminders:

Know where your formula comes from;
- Be aware of online formula scams;
- Be wary of borrowing or buying formula from a friend; and
- Check the expiration dates.

It might seem OK to borrow some formula from a friend or buy it from a Web site like eBay; however, you can never know if it was stored properly or exactly where it came from. It’s always better to err on the side of caution and purchase a formula from the proper Web site, store or pharmacy.

If you have any questions, shoot them on over!

- Nita

When my wife and I were expecting our first child, a lot of questions went through our minds, such as “My God, what have we done!”

Just kidding, we knew from the first kick Vincent would be awesome.

But we did ask ourselves a lot of big questions, including just how many ways are there to manufacture a sippy cup? And how do two people choose one from the entire wall of sippy cups at Babies R Us? What exact temperature should the bath water be? And how many IQ points is the kid going to lose if we paint the nursery the wrong color?

When you find out your baby has a food allergy, there’s a whole new set of questions. And just what exactly do you feed the little guy or gal is at the top of the list.

If you’re a breastfeeding mother, you’ll need to work with your healthcare team to identify everything the baby is allergic to and remove all those foods from your diet. If the baby relies on formula for some or all of his diet, you’ll need to make a formula change. But what do you change to?

Here’s the 411 on the different types of formula and what you should know about them if you’re a food allergy family.

Cow’s milk formula
This is most of the formula you’ll find in the grocery story aisle. It’s based on cow’s milk and fine for most healthy babies. But milk allergy is the most common food allergy among babies. So that milk, which contains full protein chains, is bad news for a food allergy baby.

Soy formula
This formula is based on soy instead of cow’s milk so it is dairy-free, but it is still not recommended for a food allergy baby, since as many as 70% of babies with a milk allergy also have a soy allergy.

Hydrolysate formula
Instead of the full protein chains in cow’s milk formula, hydrolysate formulas have protein chains that are broken into smaller pieces. This makes the formula easier for some food allergy babies to digest, but it doesn’t help everyone.

Amino acid-based formula
This formula doesn’t contain any protein chains at all. Instead it contains the individual amino acids that make up a protein. Essentially, it is baby’s nutrition in its simplest form and the absolute easiest thing for a milk allergy baby (or any baby with gastrointestinal issues) to digest. Using an amino acid-based formula like Neocate typically clears up a milk allergy baby’s gastrointestinal symptoms in 3-5 days and any skin rash associated with the food allergy within 2 weeks.

This is the basic rundown. If you have any further questions, feel free to post a comment below.

Be well,
Dr. Y

These words are music to allergy parent’s ears…

However, did you know that some formulas made for babies with milk allergies are NOT produced in an entirely milk-free environment? Many allergy moms and dads don’t realize this.

We surveyed parents of kids with food allergies recently and were surprised at the results:

57% of parents thought their child’s formula was manufactured in a 100% milk-free environment, but when we asked about the specific products, only 38% of them were actually manufactured 100% dairy-free.

At the same time, 99% of the parents surveyed said they were concerned about the risk of their children consuming a food allergen. No surprised there!

Vigilant allergy parents have a lot to look out for – from the fine print on food labels to how/where everything you put into your child’s mouth is manufactured. It is definitely tiresome, but definitely worth it.

Since food allergies cause roughly 30,000 emergency room visits a year, this is something to take note of! As an allergy parent, remember that advertising can be tricky. As of right now, Neocate Infant, Necoate Jr. and EO28 Splash are the only amino-acid based products that are manufactured in a 100% milk-free environment.

Overall, make sure you double check your choice of formula for your child with your pediatrician. You can never be too careful with food allergies!

- Sarah

Milk in bottled water! CVS selling expired baby formula! Recently, there have been a few news stories that are quite shocking.

As an allergy parent, you’re a pro at reading food labels. However, most people wouldn’t think to check the label on a bottle of water. Now, you might have to. Click here to check out the article on Allergy Moms. Apparently, Special K Protein Water contains milk!

Some people are big on checking expirations dates. However, others don’t think twice about it. This is causing a big stir in New York where both CVS and Rite Aid have been selling expired products. Click here to read the article from Reuters. The expired products being sold included milk, eggs, baby formula, cold medicines, allergy treatments and other over-the-counter medicines.

It’s important to remember to be a conscious consumer -- especially when shopping for your little one! If a bottle of water has milk in it, I wonder what else does?

- Sarah

If you’ve ever tried to prepare a meal for a picky eater, you know that the process can be a handful. But what do you do when your little one has a very limited diet and they do not find the things they can eat appetizing? That’s just one of the many things we here at Nutricia have in mind, so we try to offer as many options to our customers as possible. Our goal is to make meal time as stress-free as possible for a diet that is difficult, but necessary. One of the easiest solutions we offer is our Flavor Packets.

What makes our Flavor Packets so great? They come in 3 flavors (cherry-vanilla, grapefruit and lemon-lime) that are different from the Neocate Junior and Splash flavors. Each packet adds only about 15 calories and contains no protein, making them perfect for an elemental diet. This gives more variety to a formula-based diet for children over one year.

The best feature of the Flavor Packets is that you can use as little or as much as needed to match your child’s flavor preference. For instance, some children who start using Neocate Infant at a young age and then transition to unflavored Neocate Junior make the switch with no problem. However, as they get older and experience new tastes (like fruit juice) they may not like the taste of an unflavored elemental formula as much. But it’s also possible to find one of our flavored formulas a bit overpowering. In this case, you can add just enough flavor to help mask the taste of the amino acids, but not so much that the flavor or sweetness is overwhelming.

Not sure how much of a flavor packet to use? Each flavor packet is designed to mix with about sixteen ounces (or two cups) of prepared formula. For a child who is accustomed to unflavored formula, a good suggestion might be to start out at half-strength and see what they think. If your child is old enough, you could set up a blind taste test “experiment” for them with a few different concentrations and flavors to see what they like best and make the experience more fun! Also, for children over a year old you can use Flavor Packets with Neocate Nutra. We suggest experimenting to see how much flavor is right and a good place to start might be ⅛ or ¼ teaspoon per serving of Nutra.

Have you found the Flavor Packets to be helpful with keeping your little one interested in their elemental formula? Let us know in the comments section below.

- Rob

If your little one uses any of the Neocate products, you’ve probably heard the term “elemental diet.”  And if your son or daughter has eosinophilic esophagitis (EoE), you’ve probably also heard of an “elimination diet.”  These two aren’t always the same, so here’s a quick primer on the two.


Elemental Diet

The term “elemental diet” is a historic term that was used to refer to diets where the component nutrients were broken down into their “elements.”  Another term is “semi-elemental.”  In terms of nutrition, a semi-elemental formula, or hydrolysate, is one that has proteins that are partly broken down, or hydrolyzed.  These can be partially or extensively hydrolyzed.  An elemental formula, then, is one that contains only amino acids, the building blocks of protein.  Elemental formulas can also have some fats which are easier for the body to absorb than those found in the standard diet.

Now, technically speaking, elements are atoms, like you would see on the Periodic Table of the Elements.  So, technically, Neocate is not elemental, because it’s made of molecules, not individual atoms.  So in the strictest sense Neocate isn’t elemental: no formula is!  But, many health care professionals still use this term.  The more accurate term for Neocate, which you’ll see on our website, is amino acid-based formula.


Elimination Diet

An elimination diet is one in which one or several foods are eliminated from the diet.  There is no one “elimination diet:” it often varies from patient to patient.  Elimination diets can be based on the results of specific allergy testing (a tailored elimination diet), or more loosely based on common food allergies.  For instance, a six-food elimination diet is often used.  The idea behind an elimination diet, commonly used with EoE, is that you give the body a break from certain offending foods so that inflammation can calm down.  This works best if ALL foods that are causing a response are eliminated, which is why the six-food elimination diet isn’t quite as effective as a tailored elimination diet.

Where the lines get blurry between these two terms is that sometimes an elemental diet is used as a total elimination diet (so ALL food is eliminated!).  Basically a child might go on an elemental diet for a period of weeks, after which they usually start adding foods back to the diet one at a time.  That way there is no mistaking an allergic response to a specific food.  On top of this, an elemental formula like E028 Splash might be added to a six food or tailored elimination diet, to help make sure a child gets all of his/her essential nutrients when foods like dairy are removed.  What’s interesting is that studies have shown that the best response in EoE is to a fully amino acid-based diet.

Do you have any questions about the differences between elemental and elimination diets?

- Rob


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