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The Food Allergy Challenge

The Food Allergy Challenge. Anna J Richards NZRD. Role of the Allergy Dietitian. Diagnosis Myth buster Crisis manager Counselor Educator Nutrition – adequacy, optimal growth. Issues for Children with Allergy. Early feeding experiences Orally defensive Tactile defensiveness

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The Food Allergy Challenge

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  1. The Food Allergy Challenge Anna J Richards NZRD

  2. Role of the Allergy Dietitian • Diagnosis • Myth buster • Crisis manager • Counselor • Educator • Nutrition – adequacy, optimal growth

  3. Issues for Children with Allergy • Early feeding experiences • Orally defensive • Tactile defensiveness • Textural hypersensitivity • Parental anxiety around food • Strong food boundaries • Delayed progression

  4. Children…… ……do something when it is fun

  5. …..and stop doing it ……when it is no longer fun

  6. Undiagnosed allergy…… ……often takes the fun away

  7. Undiagnosed allergy…… • Reflux • Eczema • Abdominal discomfort • Wind • Diarrhoea • Constipation

  8. Issues for Children with Allergy • Early feeding experiences • Orally defensive • Tactile defensiveness • Textural hypersensitivity • Parental anxiety around food • Strong food boundaries • Delayed progression

  9. Diagnosis

  10. Diagnosis in perspective • Accurate diagnosis • Interpretation of results • Clinical picture • Resolution of allergy

  11. Complete exclusion …. Correlates most strongly with resolution of allergy …..What does that mean for us????

  12. Risk Assessment • Household ? Structure, food habits of other family members, use of allergenic food, frequency, lifestyle, social activities, pets • Other regular carers? • Diet history • What is a reasonable risk?

  13. Understand the family

  14. Understand what is going on for the family

  15. Understand toddlers

  16. Toddlers are toddlers…..

  17. Minimizing anxiety • Plan for this child/family • Independence • Support

  18. Management Plan • Age • Co-sensitivites • RAST/ Skin prick results / significance/ parental understanding • Risk management • Breastfed – maternal diet

  19. Nutrition Complete exclusion -nutrition consequences Nutrition - Energy, protein, fat - Calcium - Riboflavin - Iron - Zinc Additional nutritional demands of eczema ? Malabsorption consequent to gastrointestinal food allergy

  20. Growth • Historical • Well Child Book – pattern of growth • Growth faltering ? Catch up growth

  21. Practical Application • Management vs current eating pattern • Family risk factors • Addressing nutrition deficits, supplements • Clear guidelines • Sample meal plan • Meal and snack alternatives/ brands • Recipe substitutions • Coping socially – family, friends, daycare

  22. Make feeding enjoyable again…

  23. Addressing feeding issues • Early feeding experiences • Orally defensive • Tactile defensiveness • Textural hypersensitivity • Parental anxiety around food • Strong food boundaries • Delayed progression

  24. Ongoing allergy issues • Feeding aversion • Anxiety • Food jags • Carbo kids • The protein challenge

  25. Feeding Aversions Reflux Failure to progress with solids Delayed solids Oral defensiveness Hypersensitivity to texture

  26. FOOD JAGS

  27. CARBO KIDS

  28. Remember …..allergy is a constantly changing picture • Accidental exposure • Importance of food challenges

  29. Reassure….. • Most children grow out of most allergies over their childhood years • Most children with allergy will never experience anaphlyaxis • We have not had any infant deaths from allergy in NZ • Although a childs diet might seem restrictive to us, usually they know no difference • Emphasize what children can eat not what they can’t

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