Nutrition Tips for Kids with Food Allergies: Ensuring a Balanced Diet
At Free2b, we understand that navigating food allergies can be challenging, especially when it comes to ensuring that your child receives proper nutrition while avoiding allergens. That's why we are committed to not only providing delicious, allergy friendly snacks but also supporting families with expert advice and resources.
We’re thrilled to share this insightful article from Dr. Carina Venter, a renowned dietitian and researcher specializing in pediatric allergy and immunology. Dr. Venter's extensive experience includes her role at Children’s Hospital Colorado and the University of Colorado Denver School of Medicine, where she focuses on improving the quality of life for children with food allergies through safe and balanced nutrition.
In this article, Dr. Venter provides valuable tips on how to maintain a healthy, balanced diet for kids with food allergies, while ensuring their nutritional needs are met. Whether you're new to managing food allergies or have been navigating this journey for years, we hope you find these insights helpful and empowering.
Nutrition Tips for Kids with Food Allergies: Ensuring a Balanced Diet
Carina Venter PhD RD1
Affiliations
- Section of Pediatric Allergy and Immunology, Children’s Hospital Colorado; University of Colorado
Carina Venter PhD RD
Professor of Pediatrics, Section of Allergy & Immunology
University of Colorado Denver School of Medicine
Children's Hospital Colorado
Food allergies (FA) are on the increase and are a health burden for both children and their families. Food allergies (FA) consist of both immediate type (IgE-mediated) and delayed type (non-IgE mediated) food allergies. IgE mediated food allergies typically include cow’s milk, hen’s egg, wheat, peanut, tree nuts, fin fish, shellfish, sesame and soy. Symptoms often begin within minutes but can occur up to a few hours post ingestion. Symptoms can include e.g. hives, swelling of the lips or face, rashes and diarrhea. (1) The most severe symptom is anaphylaxis. (2) Non-IgE mediated food allergies can take hours or days to develop and may include e.g. stomach ache, reflux, vomiting, diarrhea and constipation.
All food allergies place children at increased risk for insufficient food intake and can have a negative effect on their growth and overall health, since food or food groups are being avoided. To minimize these negative effects, a consultation with a dietitian trained in food allergies is crucial.
What should happen during a nutritional food allergy evaluation and consultation?
Food labels should be discussed
Reading food labels is an essential skill for managing food allergies. As a parent, it’s important to know how to carefully read and understand food allergen labels to keep your child safe. It is important to always check food labels and check again. This is important as ingredients may change and label information during on-line shopping may be out of date. Translation cards can be obtained from food allergy organizations, which is very helpful when traveling abroad. Labelling laws covering which food allergens are listed, and how they are listed, differ world-wide and it is important to obtain information about country specific labelling when traveling. Whether at home or abroad, if there is any uncertainty about an ingredient, ask the manufacturer or do not eat the food.
Statements (3, 4) such as “May contain…” or “Manufactured on the same equipment as…” or “Produced in the same facility as…” indicates that a food may be contaminated by an allergen. The food may not be contaminated at all, may be contaminated with very small amounts or may be contaminated with larger amounts of the allergen. It is impossible to tell from the statement on the food label what the risk is.(5) Using these phrases are voluntary and some foods without any of these statements may also be contaminated. Eating or avoiding foods carrying warning labels needs to be discussed with an allergist as it is a very individual decision. Children who choose to avoid foods with any warning label may put themselves at nutritional risk and this needs to be discussed with a dietitian.
Information on foods to avoid and suitable alternative foods should be given
Families need information on which foods are likely to contain the allergen, suitable alternative foods, information on how to adjust recipes or other suitable recipes and lifestyle factors. (3, 6).
Which foods to avoid
The main sources of the major food allergens are listed below with suitable food suggestions.
Suitable alternative foods
When choosing foods for your child, their age plays an important role. Younger children and toddlers have different nutritional needs compared to older children or teens. As your child grows, their dietary requirements will change, so it’s a good idea to schedule regular check-ins with a dietitian to make sure their nutrition stays balanced and supports their development. (7)
Young infants rely on breast milk or infant formula for most of their nutrients. This change to infant foods once the child starts eating, toddler foods and eventually suitable foods for a young/older child. As the child becomes an adolescent issues such as longstanding food aversions (8) may become a problem, and nutritional requirements may increase with increased activity especially in athletes. (9) Social and school events away from the family, may increase anxiety. There may also be new food allergies which raise nutritional concerns. (10) The many different aspects of food allergy and changes as the child grows up should always be considered during a nutrition consultation.
Adjusting recipes or suitable alternative recipes
Home-made recipes can be adjusted by using replacement ingredients. Milk can be replaced with plant-based beverages, egg can be replaced with egg-replacers of fruit purees and nuts can be replaced with seeds.
Lifestyle factors
When eating foods away from the home such as outside of the home, such as someone else’s home, in restaurants, on vacation or at school/work it is important that families contact those preparing the foods before-hand. It is advised to speak the chef when eating in restaurants, but some chefs may lack the necessary information and understanding of food allergies too. It is advisable to take one’s own food if there are any concerns about the allergen content of the food provided. This is also important when flying. (12) Other factors that could lead to food restrictions personal reasons such as religious and cultural reasons, should be considered during a food allergy consultation.
Nutrient intake, growth and food refusal
Foods containing the top 9 major food allergens, are typically high in protein, nutrient dense foods. (3) Growth (growing in length and gaining appropriate weight) depends on adequate nutrient intake, which in turn depends on sufficient food intake. (13) Most food allergy guidelines state that it is essential to monitor growth and nutritional intake of children with food allergies, particularly if children have more than one food allergy or have a cows’ milk allergy. (14-16)
Food refusal is a common problem in children with food allergies, even the food allergies which they have outgrown. This can lead to mealtime anxiety, alter family relationships around food and disrupt the development of a positive association with food. (17, 18) Food refusal increases the risk of nutritional deficiencies. (19)
Introducing solid food in the child with food allergy
The infant with a food allergy should avoid the allergen, but other food allergens should be introduced in the infant’s diet without hesitation. There is no clear optimal time, amount of frequency for introducing other food allergens into a child’s diet; the main aim is to introduce the allergen and keep it in the child’s diet. (15)
Level of avoidance – it is not one size fits all
In terms of cow’s milk and hen’s egg allergies, children can often tolerate baked forms of either food, (20) while still having allergic symptoms to unbaked foods.(21) Baked milk and egg can be introduced using cookies, muffins, waffles etc. This is referred to as a milk or egg ladder and should be done under the guidance of an allergists when children have immediate type (IgE mediated food allergies). Introducing these foods can expand a child’s dietary intake a great deal and improve their quality of life. (22, 23)
Recipes available from: https://www.gwh.nhs.uk/media/hribpee4/imapmilkladderrecipes201119.pdf
Special considerations for cow’s milk allergy
Infants with cow’s milk allergy who are using an infant formula should be changed to a hypoallergenic formula by a health care professional. Children over one year of age, who are eating well and do not have any growth concerns, may use a plant based beverage if sufficiently fortified. Plant-based beverages can be based on soy, coconut, almond, rice, oat, hazelnut, cashew, walnut, pea, sesame, hemp, tigernut, quinoa or any combination of these. (24)
Immunonutrition
An aspect of FA management that is becoming more important is feeding for immune health or immunonutrition.(25) Clear information is currently lacking but factors supporting the immune system and microbiome such as prevention of nutrient deficiencies, reduction in ultra-processed food intake and diet diversity may improve overall health.(26-28)
In summary, managing a food allergy can impact your child’s nutritional intake and growth. It’s important to understand how to read labels, choose safe foods, and adjust their diet as they grow. Each child’s nutritional needs will vary over time, so staying informed is key. And as research continues to show how nutrition can influence the immune system, incorporating foods that support immune health is something worth considering for your child’s overall well-being.