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Ask the expert: Nutrition and food allergies

Linda Kirste

We recently spoke with Linda Kirste, a Registered Dietitian from British Columbia, about ways that individuals living with food allergies can establish and maintain a nutritious diet. Check out the interview below.

How can you help to ensure kids with multiple food allergies receive proper nutrition, given their limited food options – can you give a few examples, for instance, kids with dairy allergies?

About 8% of children have food allergy, of which about a third are thought to have more than one food allergy.

In theory, if a child has allergies to three or four foods, there are still plenty of nutritious foods left to choose from for healthy meals and snacks. But, as most parents quickly discover, multiple food allergies leave many family favourites off limits because the common food allergens, such as milk, egg, peanut, wheat and soy are found in many prepared foods that busy households often rely on. This can make it more challenging to meet nutrition needs.

There are, however, some strategies that parents can try to help their child with multiple food allergies get the nutrients they need to grow and thrive.

For all children with multiple food allergies

  • If you suspect a new food allergy, ask for a follow-up visit with your child’s pediatric allergist. Being clear on which allergies your child has is important so you know exactly what foods need to be avoided. Periodic follow-up visits also offer the opportunity to monitor whether your child has outgrown a food allergy.
  • Mastering multiple food allergies often involves an emphasis on homemade meals, snacks and baking. For some families, this may lead to eating less fat. While older family members with other health concerns may see this as a side benefit, young children thrive on a higher fat intake, as they are growing rapidly. Ways to add delicious, healthy fats to meals include drizzling olive oil on pasta, adding a wedge of avocado as a side dish, or melting margarine (milk and/or soy free, if needed) on steamed veggies.
  • Cooking meals from scratch at home takes extra time. You can lighten your burden with some extra planning, sharing of duties, and enlisting children to help with age-appropriate tasks. Getting kids into the kitchen turns food preparation into an adventure for everyone, while your children learn valuable skills. They are also more likely to enjoy eating what they’ve helped prepare. Aim to batch cook or prepare enough for leftovers to be frozen and used at another time.
  • Children with multiple food allergies who don’t feel left out are more likely to eat well and cope better with their food allergies. Try to eat together as often as possible and keep mealtime relaxing and enjoyable. Offer the same foods to all family members whenever you can. When a substitution is needed, offer a similar food to your child with food allergies.
  • Resist the urge to persuade or distract your child to get them to eat. While parents of children with food allergies may worry more about their child’s appetite, coaxing them to eat usually backfires. Be clear on who is responsible for what at mealtime. As the parent, you’re in charge of what foods are offered, while your child is in charge of how much they should eat. Sometimes, this is more easily said than done. Enlist help if you’re concerned. Your child’s doctor can refer your child to a Registered Dietitian (RD) for help.
  • Be patient with yourself, your child, and the rest of your family when dealing with multiple food allergies. Acknowledge successes, however small, as they will bolster your courage and help energize you, such as time spent together in the kitchen or an attempt at a new recipe.

Here are some more specific ideas for meeting the nutrition needs of kids with milk, peanut, tree nut, or wheat allergies:

For children with milk allergy

If your child has a milk allergy, offer an alternative beverage to help meet their calcium, vitamin D and other nutrient needs. The Nutrition Facts on the product label can be useful. Look for a beverage that offers 30% of the Daily Value (% DV) for calcium, 45% for vitamin D, 25% for riboflavin, 50% for vitamin B12 and about six to eight grams (g) of protein per 250 mL (1 cup).

Glass for glass, a fortified soy beverage provides similar nutrients compared to 2% M.F. (milk fat) cow’s milk. Children between two and eight years of age should aim to get two, 250 mL servings a day, and those over eight should aim for three to four servings. Even if your child with milk allergy meets these targets, they may benefit from a daily vitamin D supplement that provides 400 international units (IU).

If your child is also allergic to soy or you prefer to offer fortified almond, coconut, or rice beverages, keep in mind that these products generally contain very little protein. A child who drinks one of these beverages is likely to benefit from an additional serving from the “Meat and Alternatives” food group. For more information about the main food groups, see Canada’s Food Guide.

Children between one and two years of age need more fat than older children. Unfortunately, most milk alternatives are not good sources. A tolerated infant formula is recommended in place of milk until two years of age. If your child is still breastfed, an RD can help you make sure your child continues to meet their calcium and vitamin D after 12 months of age.

Be mindful of the ingredients and nutritional value of cheese and yogurt substitutes. As a general rule, these products are low in protein, calcium, vitamin D, riboflavin and vitamin B12.

Some children with milk allergy will tolerate milk when baked into foods like muffins or pancakes. Ask your child’s allergist whether baked milk is appropriate to offer your child.

For children with peanut and tree nut allergies

Peanut and tree nut allergies can limit healthy, quick, and easy breakfast, lunch, and snack options. Consider offering foods of similar nutritional value, such as soy sesame (tahini) or sunflower seed butters. Hummus and other bean dips can also add to mealtime fun, especially for younger children. Seed butters and bean dips are also sources of several essential minerals, including iron.

For children with wheat allergy

If your child is allergic to wheat, stock up on a range of other grains. As your family becomes familiar with one, add another. In general, the more variety the better. Some grains to explore include quinoa, pure (uncontaminated) oats, buckwheat, corn, brown rice, amaranth, millet and teff. Flours made from these grains pave the way to new or modified baking recipes for wheat-free homemade foods like pancakes, muffins, cookies, squares, and cakes for festive occasions.

Where can I find a RD who works with people who have food allergies? Are there free resources?

RDs work in a range of settings, including outpatient hospital clinics, community health centres and in private practice. Dietitians who work in hospitals and community health centres are free to access, usually with a referral. Private practice dietitians are also available, but they charge a fee.

Check your extended health insurance provider to find out if the fee to see a private practice dietitian is reimbursable. For a directory of dietitians in private practice, go to the “Find a Dietitian” page on the Dietitians of Canada website.

To arrange a RD visit for your child, ask your child’s family doctor, pediatrician, or allergist for a referral. Mention that you’d like a referral to a RD who works with children and ask that a report of diagnosed food allergies and other pertinent health history information be included with the referral.

Your child’s dietitian can help you generate a customized list of other resources, including free ones, that will help you support your child to eat well, grow and thrive.

Thank you Linda for your insight!