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Sharlene Coombs, RD, CD, CSP, CNSD Primary Children’s Medical Center Sharlene.firstname.lastname@example.org 6-25-2011
Foods, liquids, supplements andmedications are taken by mouth (or by tube). Digestion and absorption occur in the gastrointestinal tract.
Immune system responds as “foreign but safe”.Food components are taken to body sites via blood for cell renewal and energy. OR Immune system responds as “foreign and a threat!”Immune system defends thebody. Inflammatory mediatorsare released into local tissues and transported to distant sites in the body via blood.
Inflammatory mediators are released and transported to distant sites in the body via blood. Allergy symptoms develop in bodyRespiratory: congestion, runny nose,asthmaGastrointestinal: pain, upset stomach,diarrhea, nausea, vomitingSkin and mucous membranes: hives,itching, swelling, rashesCardiovascular: low blood pressure, rapidand /or weak pulse Systemic: Anaphylaxis
Restriction of offending food(s) Adequate calories and protein Adequate vitamins and minerals Establish and maintain good health
“Life with food allergies remain difficult, with the only reliable therapy being complete restriction or elimination of the responsible food(s) allergen and emergency management of reactions when allergens are accidentally ingested……Ultimately, the balance must be found between efforts to mitigate the disease and to sustain the overall quality of life.” www.allergyadvisor.com
Seek appropriate medical help Follow recommendations- get in writing Follow thru on appts and/or call if problems continue It does help to have food log or record of problems Learn all you can about the foods to avoid Learn to cook from “scratch”- back to basics though not easier than eating out or processed foods.
Caregivers need to support one another Caregivers need to have eating plans All caregivers need to understand emergency plan Infants and children with allergies may need more frequent weight and height evaluations Provide the “best” nutrition you can- this may include high calorie foods- not just fruits and veg.
Buy & prepare appropriate/safe foods Offer meals and snacks every 3-4 hours apart, for 5-6 opportunities to eat and drink each day Do not allow sipping and grazing all day At each meal and snack, offer protein, starch, fruit or vegetable and 4-6 oz milk or milk substitute 1 Tbsp of each food group per year of age of the child
To eat or not to eat It is ok for them to feel hunger-a natural driving force to eat and drink
Do Don’t Offer reasonable Force, punish or choices, ie white or demand the child eat/ chocolate milk, not drink water instead Give in to child’s It helps to be a good demands- even if role model underweight Meal times should be pleasant, not centered on what the child is or is not eating
Sugars, starches, fibers Glucose is preferred source of energy Many vitamins and minerals in CHO foods Excess intake is stored in liver and converted to fat Foods: Sugars, starches, grains, fruits, vegs & dairy
Essential and non-essential amino acids Amino acids build, repair and maintain body cells Provide energy when CHO and fat are missing Participate in chemical reactions in the body Foods: Eggs, meats, fish, poultry, dairy, nuts, beans, grains
Essential and non-essential fatty acids Integral to the nervous system; insulation More calorie dense than CHO or protein Foods: Dairy, butter, nuts, seeds, animal fat, coconut milk/oil, vegetable oils
Vitamins 13 chemicals; various functions Fat and water soluble Essential for health Minerals 15 elements: various functions and structure Major and trace elements Essential for health Water Provided from food and fluids Essential for health
Vitamin A Function: Vision, skin, membranes Food sources: liver, fish oil, dairy products Vitamin E Function: Antioxidant, improves immune system Food Sources: nuts, seeds, oils, wheat germ Vitamin K Function: blood clotting Food sources: Dark green veggies, liver, wheat bran
Vitamin D Function: Bone health, immunity, reproduction, insulin secretion. Maybe prevents certain cancers. Children with low levels have higher incidence of food allergies. Dietary Reference Intake: increased to 400-1300 IU Food sources: egg yolk, liver, fish oil, fortified milk and milk substitutes. Also the “Sun”. Supplements: Liquid- “Wellesse” 2 tsps = 1000 IU. Tablets: 500-50,000 IU.
Thiamin, B1 Riboflavin, B2 Niacin, B3 Pyridoxine, B6 Biotin (found in eggs, leafy greens) Pantothenic Acid All function as coenzymes in metabolism Destroyed with overcooking, light and heat Foods: dairy, meats, legumes, whole grains, nuts
Vitamin C Function: Antioxidant, healthy bones, gums, teeth, blood vessels, brain function, iron absorption Foods: Citrus fruits, bell peppers, tomato, kiwi, red berries Folate, folic acid, B9 Function: Synthesis for DNA, gene expression & regulation. Critical 21-27 days after conception. Foods: Orange juice, leafy greens, yeast, liver, soy, fortified grains, broccoli, eggs
Calcium Function: Bones, muscle contraction, blood clotting Vitamin D helps absorption. Excess protein, salt, caffeine and alcohol decrease absorption. Foods: Dairy, fortified foods and drinks, nuts, legumes, dark greens ( limited absorption) Dietary Reference Intake: (recommended intake) Age Calcium, mg/day 1-3 years 700 4-8 years 1000 9-18 years 1300 19-50 years 1000 51 + years 1200
Phosphorous Function: Bones, teeth, cell membranes, enzymes Balance of calcium and Vitamin D needed Diet often restricted in kidney failure Foods: Dairy, meats, poultry, fish, eggs, soda pop Not usually supplemented
Iron Function: transports oxygen, picks up CO2, healthy immune system, growth, cognition, DNA synthesis Foods: meat, fish, poultry, dark green leafy veg. Vit. C increases absorption. Calcium prevents. Zinc Function: DNA/RNA, cell division, wound healing, part of enzymes, needed for bone growth. Foods: meats, wheat germ, shellfish, liver, cheese, eggs, whole grains, nuts/seeds, legumes
Magnesium Function: enzyme systems, glucose metabolism, bone health, prevent dental caries, muscle function Foods: Beans, whole grains, seafood, leafy greens Iodine Function: Essential for thyroid hormones, regulate body temp., metabolic rate, growth, reproduction Foods: iodized salt, saltwater fish/seafood Iodized salt is not used in processed foods.
Fluoride Function: Interferes with plaque formation Foods: Fortified drinking water, small amounts in fruits & veg. Sodium Function: acid-base balance, fluid balance, muscle/ nerve activation- small amount, but essential. Foods: table salt, cheese, dairy, processed foods Potassium Function: similar to sodium Foods: vegetables, fruits, dairy, meats, grains
Optimal amount based on weight (textbook) 0-10 kg= 100 ml/kg 10-20 kg= 1000 ml + 50 ml for every kg >10 kg 20+ kg= 1000 ml + 20 ml for every kg >20 kg Weight in lbs divided by 2.2 = kg Divide total ml’s by 30 ml/oz = ounces
Fiber Prebiotics and Probiotics Omega 3 fatty acids
Replace with comparable foods or drinks Look for fortified products Take vitamin/mineral supplements Monitor weight/growth Consider monitoring blood work for key nutrients Vit D, iron, zinc
40-50% of infants with cow milk allergy, will also have soy allergy. This is why soy formulas are not recommended for infants with CMA Soy can be found in most shortenings, margarines, vegetable sprays, Asian/oriental foods Soy protein is added to processed and commercial foods to improve nutritional quality. Soy oils and soy lecithin usually safe- if very sensitive, then avoid. Soy restricted diet alone should not compromise nutrition intake
Avoid eggs from all bird species Look for “egg” in baked goods, sauces, salad dressings, breaded foods, pastas, candies, desserts, used as binders as in meatloaf, used as garnish, washed on bread, rolls, pies. Learn to cook with substitutes for egg as leavening agent or as binders. Egg restricted diet alone should not compromise nutritional intake.
Peanuts are not related to Tree nuts. However, there is high chance of cross-contamination. Refined peanut oil should be safe, but no guarantee, so avoid it if high risk of anaphylaxis. Peanut or other nuts can be found in or cross contaminated in candies, ice creams, some cheese spreads. Seeds or seed butters may be alternatives. Peanut or tree nut restricted diets alone should not compromise nutritional intake.
Know the species you are allergic to. If allergic to one type of shellfish, avoid all. Do not always need to restrict other fish if allergic to one species. Fish oil likely to be contaminated with fish protein, including Omega 3 fish oils, so avoid if allergic. Fish or shellfish may be in Asian, Thai, Chinese foods, baked goods, cookies, candies, any food containing gelatin. Be aware of Omega 3 fish oil added to many foods for health benefits. Fish and Shellfish restricted diets alone should not compromise nutritional intake.
Do we need them? No- If taking 32 oz/day of “complete” formula or If eating wide variety of foods, from all food groups Maybe- if avoiding one major food group Probably- if avoiding two major food groups Definitely- if avoiding 3 or more food groups Everyone needs calcium/Vit D supplement- if avoiding milk and not taking 32 oz/day fortified milk substitute or ”complete” formula
What kind? Generic might be ok if hypoallergenic Hypoallergenic are available- Costly Online: www.solacenutrition.com read labels carefully or ask pharmacist “Complete”- should have 100% of RDA, including iron and zinc. Most won’t have much calcium. ½ to 1 tablet/day of Children’s chewable “complete” Gummies type are not “complete” May need additional nutrients, (Vit D, iron) if lab data indicate deficiencies.
Take in divided doses, no more than 500 mg at a time, preferably with food. Vit D and Vit C improve absorption. High fiber diet decreases absorption Iron competes for absorption. Pills, chewable candies or liquid forms available. Calcium carbonate, calcium citrate Read labels carefully for allergen ingredients Usually <100 mg in children’s chewable vitamins. Calcium is not in infant/children’s liquid vitamins.
FDA regulated Infant (0-12 months), Pediatric (1-10 year), Adult meets RDA for nutrients in ~1000 ml’s (33.3 oz) for ages one year and older. Standard and special needs: For drinking or tube fed Care for just like food- re: handling, mixing, storing Powder, liquid concentrate, ready to feed Can Sustain life- provide “Total” nutrition
Elemental formulas 100% amino acid, most simple form of protein Useful in milk, soy, or hydrolysate formula allergy and intolerances, GERD, poor growth, EOE Total nutrition in ~33 oz/day Taste Varied flavors or unflavored for tube feeds Cost Very expensive. Medicaid and some insurance will cover, (depending on diagnosis) Availability Not available in grocery stores Is available from WIC (1-5 years old), Homecare pharmacies, mail order pharmacies, web based companies, and thru manufacturers
Abbott Nutrition: www.abbottnutrition.com Infant Infant Elecare: unflavored, powder, 20 kcal/oz Pediatric – 1-10 years Elecare Jr(new name): vanilla and unflavored, powder, 30 kcal/oz Nestle: www.nestlenutritionstore.com Pediatric – 1 year or older Pediatric Vivonex: unflavored, powder, 24 kcal/oz, Adult Vivonex plus: 30 kcal/oz, adult Tolerex: 30 kcal/oz, adult All unflavored, powder, used for tube feeds
Mead Johnson: www.enfamil.com Infant Nutramigen AA: 20 kcal/oz, powder, unflavored, Nutricia North America: www.nutricia-na.com Infant Neocate with DHA and ARA: 20 kcal/oz, powder, unflav. Neocate nutra: corn based semi-solid food for >6 month Pediatric Neocate Jr: 30 kcal/oz, 3 flavors, powder EO28 Splash: 30 kcal/oz, 3 flavors, juice box