1. Prepare yourself—take time to get ready! Starting an elimination diet half-way will not benefit your child. It is an all or nothing effort.
As a parent, caregiver, or someone who loves a child that requires a special diet, learning that milk and dairy products could potentially cause your child great harm is very stressful. This stress can be multiplied ten-fold if this is the first family member that needs an elimination diet. There is so much to learn about cross contamination, alternative products, and providing a diet that meets the nutrition demands of a growing child.
Make sure you take time to mentally prepare yourself for some of the challenges such as preparing your family (see next point) and knowing what to do in the event of an accidental exposure. If your child is still on an infant formula, the first few months may be easy since your baby only drinks formula and is just beginning to eat single ingredient fruits, vegetables, grains, and proteins. As your baby gets older and is able to start self-feeding, be prepared to spend extra time at the grocery store as label reading becomes more critical (see point number 3).
As a parent, be sure to engage in regular self-care by talking to a counselor, pastor, friend, or family member when the stress becomes overwhelming. Find a support group so you can remind yourself that you and your family are not alone.
2. Prepare your family
A well-prepared family is often less likely to challenge the news that another family member needs to start avoiding milk and all dairy products. Members of older generations often question the need for such diets because they often were not exposed to this as children or young adults and the frequency of having a food allergy was much lower—even a decade ago. While their questions can be downright frustrating, try to remember their perspective; this is just as new to them as it is to you. And, chances are you are ahead of their thinking because you are the one that has seen the negative reactions related to food allergies and you have been to all your child’s doctor appointments that led to the food allergy diagnosis.
Regardless if your baby needs to drink an amino acid based infant formula or if you are trying your toddler (with your doctor’s or dietitian’s advice) on a milk elimination diet, your family needs to be prepared. If you have other children that are allowed all of the milk and dairy products they want, they need to understand that their sibling has to eat and drink different “special” foods. They need to be a “big boy” or a “big girl” and help keep their sibling safe by not offering to share and keeping their cups and food out of their sibling’s reach.
Placing all children in the home on a milk elimination diet regardless if they need it to accommodate one child’s special diet is not a good idea. Children that must avoid cow’s milk very often require supplements or a specialty formula to ensure their diet is nutritionally complete. In addition to the very high cost of supplementing all children, it places an unnecessary burden on the child/children without any food allergies.
Grandparents, aunts, uncles, cousins, siblings and close friends all mean well but it is critical that they understand that there are no cheat days and yes, just one cookie could in fact hurt. Help these extended family members find safe treats to provide as alternative since so many of us like to show our love through food.
3. Read every label every time.
I saw a family not too long ago in the allergist’s office because they were concerned that their child had developed additional food allergies beyond milk. The child was on a milk elimination diet for many months and the family was managing it quite well without too many issues or worries. The child was growing well and tolerating the amino acid based formula nicely.
During my nutrition assessment and diet review, we discovered that a normal “go-to” food was most likely the culprit. The manufacturer changed the ingredients and the family was unaware that this “go-to”food now contained whey protein (a component of milk). The best way to identify product ingredients is by reading the actual packaging label that corresponds to product contained within that packaging or call the product manufacturer. Product websites do often have ingredient information; however these sites are not always kept up to date and may misguide your label reading judgement.
Please remember that product manufacturers view their ingredients as commodity items. They know what ingredients can be changed or substituted and will do so when prices increase or supply is interrupted. Food manufacturers do what they can to continue to produce their products while making a consistent level of profit without changing the price on the grocery store shelf. As commodity prices change, their manufacturing process may change and they do not have to warn consumers about any changes in how they manufacture or in the ingredients they use.
Read every food label every time.
Fortunately, there are apps for smart phones that help track ingredients in products with a quick scan of a bar code or QR code. Technology can seem quite invasive in our lives today but in this case, it can be a huge benefit to someone who is buying groceries to accommodate multiple diets types within a family.
4. Avoid cross contact at home
Cross contact or cross contamination for example occurs when one food without milk touches a food with milk. Some children are so sensitive to milk proteins that this type of accidental exposure can result in anaphylaxis.
One way to help avoid cross contamination is by designating one shelf in the refrigerator as the “milk-free shelf.”
Here are things parents wished they knew before starting a milk elimination diet:
- (See point number 2: Creating a milk-free home with other children in the house that can drink milk is not a good idea)
- Designate a specific shelf in the pantry or perhaps an entire cabinet for milk-free dry ingredients. The benefit of making an entire cabinet a milk-free zone is that it also provides a space to include pots, pans, toaster, cups, cutting boards, knives, etc. if you have duplicates and have designated these as “milk-free equipment.”
- It is not necessary to purchase a second set of cooking tools and eating utensils to prepare and serve a milk-free diet if the tools and utensils have been washed in the dishwasher or washed thoroughly in warm, soapy water.
- Once a milk-free food has been prepared, cover that food and place it aside while preparing other food that contains milk.
- After the meal is over, remember to wipe down all kitchen surfaces including the kitchen table. It is better to do this when one meal concludes rather than trying to remember if that was done prior to preparing the next meal or snack.
5. Teach your child to be her own advocate
Knowledge is power and children are always learning. As soon as your child is old enough to walk and start feeding themselves, teach her to ask if it is okay for her to eat certain foods. Teach your child how to ask an adult if a food contains milk and never to take food offered to them by other children (even siblings) without an adult’s approval.
Teach children to be their own advocates and to respectfully ask questions as this will help keep them safe when you are not with them. I hope this will also help you, as a parent, feel more comfortable about giving them the freedom to be out in the world without you constantly by their side monitoring what is placed in their mouth.
Children have an amazing ability to adapt and view their allergy as just part of life. The adults in their lives more often have a much harder time with the diet.
6. Use supplements
I am a food first kind of mom and dietitian. I firmly believe that a diet can be nutritionally balanced and meet the needs of just about anyone. However, in certain situations, supplements are necessary to avoid placing children at risk for nutritional deficiencies. Children that have to avoid cow’s milk are at risk for poor growth, bone health and/or short stature if they do not consume adequate amounts of protein, calcium, and vitamin D among other nutrients that they would normally get by drinking milk and eating other dairy products.
Alternative milks such as rice, soy, oat, hemp, and coconut are an acceptable way to include variety in the diet, however, they are not nutritionally balanced enough for a baby or toddler to drink as a sole source or main source of nutrition. Please do not rely on these milks the same way you may have relied on cow’s milk and dairy products for your other family members.
Work with a registered dietitian to help you determine your baby’s nutrition needs and how food and supplements can work together to meet those demands. Remember to see a dietitian regularly since the needs of young children can change quite quickly as they grow.
Our guest blog today comes from Alexia Beauregard. Alexia Beauregard is a Registered Dietitian. The inspiration for this blog is based on her extensive experience working with the families of patients diagnosed with EoE. Please be sure to talk to members of your child’s healthcare team to determine if this information is appropriate for your child.