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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 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 • Textural hypersensitivity • Parental anxiety around food • Strong food boundaries • Delayed progression
Children…… ……do something when it is fun
…..and stop doing it ……when it is no longer fun
Undiagnosed allergy…… ……often takes the fun away
Undiagnosed allergy…… • Reflux • Eczema • Abdominal discomfort • Wind • Diarrhoea • Constipation
Issues for Children with Allergy • Early feeding experiences • Orally defensive • Tactile defensiveness • Textural hypersensitivity • Parental anxiety around food • Strong food boundaries • Delayed progression
Diagnosis in perspective • Accurate diagnosis • Interpretation of results • Clinical picture • Resolution of allergy
Complete exclusion …. Correlates most strongly with resolution of allergy …..What does that mean for us????
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?
Understand the family
Minimizing anxiety • Plan for this child/family • Independence • Support
Management Plan • Age • Co-sensitivites • RAST/ Skin prick results / significance/ parental understanding • Risk management • Breastfed – maternal diet
Nutrition Complete exclusion -nutrition consequences Nutrition - Energy, protein, fat - Calcium - Riboflavin - Iron - Zinc Additional nutritional demands of eczema ? Malabsorption consequent to gastrointestinal food allergy
Growth • Historical • Well Child Book – pattern of growth • Growth faltering ? Catch up growth
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
Addressing feeding issues • Early feeding experiences • Orally defensive • Tactile defensiveness • Textural hypersensitivity • Parental anxiety around food • Strong food boundaries • Delayed progression
Ongoing allergy issues • Feeding aversion • Anxiety • Food jags • Carbo kids • The protein challenge
Feeding Aversions Reflux Failure to progress with solids Delayed solids Oral defensiveness Hypersensitivity to texture
Remember …..allergy is a constantly changing picture • Accidental exposure • Importance of food challenges
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