Dining Out With Your Young Food Allergic Child

Dining Out With Your Young Food Allergic Child

by Melanie Potock, MA, CCC-SLP

*This post was originally published on The Tender Foodie Blog.  The original article can be found here.

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DO YOU DINE OUT?

Many parents feel overwhelmed at the thought of bringing their child with food allergies to any restaurant for fear of exposing him/her to an allergen that could make them horribly ill or worse.  Yet, according to Restaurants USA Magazine,  Americans eat out for 4.2 meals per week! Dining out with our families and friends is part of our social routine.  It’s possible to enjoy this time together as a family, but it requires a bit of planning. One strategy that may soothe some fears is assembling your own “Restaurant Backpack” filled with everything you need to create a safe and fun dining experience for your entire family.

 

SETTING UP

While it might be tempting just to wrap the chair in your coat, as this parent has done (above picture), start instead with a washable highchair cover to shield your little one from those germy, possibly allergy-laced wooden restaurant highchairs.  Fisher Price™ makes a padded version that includes tether straps to attach to toys so they won’t fall on the equally dirty floors.  The carry pouch is included.  Tuck a package of sanitizing wipes in the carry pouch so that when you arrive at your seat, the first thing you do is wipe down the table, highchair and anything that is within reach of your child. Then add the cover, then add the kid. Speaking of toys, it’s ideal to bring quiet toys that won’t disturb the other patrons, lightweight toys that keep the backpack manageable and socially interactive toys that focus on you and your child being together and enjoying the moment.  My top three favorites?

MESS-FREE CREATIVITY!

Aquadoodle Travel N Doodle  is a soft, mess-free, portable and foldable drawing mat that includes a refillable “water pen” that magically makes red appear on one side of the mat and blue appear on the other.  The most your child gets on him/herself is a bit of water.  One suggestion: store the pen in a re-sealable plastic baggie or empty it before going home.  It can leak in the backpack.

 

To continue reading, please click here to be redirected to The Tender Foodie

 

It Takes a Village – And Then Some!

It Takes a Village – And Then Some!

by Erica Leon, MS, RDN, CDN

While not easy, I somehow launched my children into college and beyond. With fellow empty-nester friends who are also health professionals and moms—one a nurse, one a psychologist—I took a walk down memory lane. We reflected on teaching children good self-care, particularly when they have health concerns related to food.

Photo Credit: woodleywonderworks via Compfight cc

 

Peanut Allergy:

Carpooling was challenging enough, but when I thought three-year-old Thomas had shared my son’s peanut rice cakes, I panicked! Thomas was severely allergic to peanuts as well as tree nuts. Still parked at the nursery school, I hoisted Thomas like a football, screamed for the teachers, and rinsed his mouth, hoping I did not have to administer his EpiPen. He never ate any of the rice cakes, but I learned a valuable lesson on scrutinizing food items when you have or care for a child with allergies!

According to Hildie Kalish, RN, an elementary school nurse whose child has a severe nut allergy, “Keep your child safe by constantly checking and then rechecking ingredients in food products. Never assume an item is safe as it is not uncommon for food manufacturers to change ingredients or processing techniques. As soon as children are old enough to understand, teach them to read labels and avoid sharing food with other kids. When they are responsible enough, have them carry Benadryl and their own Epi-pen or Auvi-Q, and make sure they know how to use them.”

Dehydration:

My nutritional skills were put to the test when I rescued ten-year-old Luke, my son’s friend, who was dizzy from playing baseball in the summer heat. Driving up with hydrating sports beverages and a mom’s wisdom, I remembered that Luke had an endocrine condition that made dehydration particularly dangerous. When a child exercises, their muscles generate heat, which in turn raises body temperature. The body cools itself through sweating, which must be replaced by fluid or the body will overheat.

Dehydration is more common in children, and young athletes are particularly prone to dehydration. Encourage your young athlete to drink fluids before, during, and after sports to prevent heat-related illnesses. Recommend fluid-rich foods such as fruits and vegetables and have your youngster carry a water bottle and drink a sports beverage when his/her physical activity level exceeds one hour.

Celiac:

I became a celiac expert when Rachel, a good friend of my daughter’s, was diagnosed. From that day forward, I stocked my cabinets with gluten-free items and helped her mom educate other parents about which foods to keep on hand for play dates.

 Merle Keitel, Ph.D, counseling psychologist and parent of a child with celiac, says,

“It is important to establish a support system that is aware of your child’s dietary restrictions and has food on hand that your child can eat if at their homes for an extended period of time.  In the case of celiac, fruits and vegetables work but if other children are having sweets, it is helpful for there to be chocolate or other gluten-free sweets so the child does not feel cheated and self conscious about being ‘different.’ Friends and extended family who are educated and willing to help can be a gift to the child with special dietary needs.”

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These real-life scenarios portray what can happen when a child has a chronic health condition. Says Kalish, “At school I work with families of kids newly diagnosed with Type 1 diabetes. I always say that education is key. I see parents overcompensating with extra treats for fear that their child will feel deprived. Diabetic children do not need extra treats. It is important to treat them like any other child and learn the merits of a healthy balanced diet with plenty of ‘everyday’ foods and occasional ‘sometimes’ foods.”

While we can try to protect our children from all types of threats, educating your child, caregivers, schools, and trusted friends about a chronic health condition is essential. Allow your child to take the reigns and manage his/her own health as soon as he/she are emotionally and intellectually ready. We want our kids to remember the lessons that we teach them at home, as they will eventually leave the nest.

No Tricks, Just Treats!

No Tricks, Just Treats!

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Halloween is around the corner and kids are looking forward to trick or treating for their favorite candies! Trick or treating is a great memory for kids to make and can be so much fun, but for children with allergies, the candy they get in their bags matters more than those without them. So your child does not have to miss out on any of the fun, here are some great allergy free options for your favorite witch or goblin!

Though these products are reportedly allergy free, always check labels to make sure!

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Peanut and Tree Nut Free

  • Skittles
  • Peeps
  • Swedish Fish
  • Altoids Mints, Original & Cinnamon (not Chocolate variety)
  • Mike and Ikes
  • Hershey (plain) chocolate bars, personal size only (not King size, not Minis) 
  • Hershey (plain) chocolate Kisses (not King Size, not Holiday/Seasonal Bags)
  • Laffy Taffy
  • Runts
  • Dubble Bubble gum
  • Tootsie Pops & Tootsie Rolls (anything made by Tootsie) 
  • Junior Mints
  • Smarties
  • Sour Patch Kids – all kinds!
  • Whoppers
  • Sweet Tarts
  • Dum Dum lollipops
  • Jolly Rancher hard candy, lollipops and gummi candy
  • York Peppermint Patties
  • Twizzlers
  • Rolos

These candies contain no wheat, peanuts, tree nuts, milk, eggs, fish or shellfish:

  • Smarties
  • Dots
  • Pixy Stix
  • Ring Pops
  • Skittles
  • Sour Patch Kids
  • Mike and Ike
  • Jolly Rancher Hard Candies
  • Jelly Belly Jelly Beans
  • Charms Blow Pops

This year, the Food Allergy Research & Education organization is asking houses offering non-food treats, such as toys, stickers, or crayons, to paint a pumpkin teal to show to parents of young ones with allergies there are safe options available! Check out the initiative here: Teal Pumpkin Project

Photo Courtesy of FARE

 

Disclaimer:

We only call it treats due to Halloween but they are really candy, food, or food with lower nutrition.

 

A Creative Approach to Food Allergies and Trick-or-Treating

By Melanie Potock, MA, CCC-SLP

*This post was originally published on ASHA’s online blog. The original can be found here.

Photo Credit: Nomadic Lass via Compfight cc

Ever notice how many kids who are in feeding therapy also have food allergies?  With Halloween just around the corner, I’m encountering parents in my practice who are scared to let their food-allergic kids go Trick or Treating.  As their child’s feeding therapist, I try to offer creative strategies to ease their minds and still allow their little munch bug an evening of safe but spooky fun!

Trick or Treat Nirvana (What’s a Parent to Do?) 

Halloween is one of my favorite holidays. My neighborhood is a child’s Trick or Treating nirvana; street after street of tightly packed houses, much like enormous Pez® candies crammed inside a spring-loaded Casper the Ghost container. It’s the perfect setting for little fists holding giant plastic pumpkins to collect as many pounds of sugar as humanly possible in the shortest amount of time.  The neighbors are obsessed with decorating their homes to the hilt and consequently our sidewalks are packed with little Batmans, Disney Princesses and giant Rubik’s Cubes negotiating their way to each and every over-the-top decorated home and loading up on anything the neighbor’s offer when the kids shout “TRICK OR TREAT!”

So what’s a parent to do when their child with food allergies so desperately wants to join in on the door to door fun?  Well, keep this in mind: For the kids, Halloween is about ringing a doorbell, shouting “TRICK OR TREAT”,  remembering to say “thank you” as they scurry off to the next house and most of all – giggling non-stop with their friends.  It’s truly about the social experience, and not so much about what gets thrown in the bag.  But for many of my clients, what ends up in their bags is vitally important for safety reasons. Here a few strategies for parents to consider.

Enlist the Help of a Few Neighbors 

1.    Secret Passwords Nobody wants a child to miss out on the big night.  Most friends and neighbors will be thrilled to stash your candy alternatives by their front door.  If your alternative candy needs to be kept separate from other food substances,  be sure to let them know.  If your child is old enough and/or you are not present,  just tell them that  Mrs. Smith needs to hear the secret password (e.g. “monster mash”) because she is saving something just for them.  The last thing you want is Mrs. Smith accidentally giving some random fairy princess your child’s special allergen free candy!

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2.    Create a “TREASURE HUNT” with clues that lead your little pirate to the buried treasure where X marks the spot.  Give ten clues to ten neighbors; use brown grocery bag paper, black ink and even singe the edges for that authentic “treasure map” look.  Each piece of paper provides the next clue on where to go:  “Yo ho ho, ye pirate gents! Go to the next house with the white picket fence!”  Little do they suspect that the 10th clue will send them back to their own house, where they will discover a giant X and a special treasure buried beneath, just for them!

To continue reading, please click here to be redirected to ASHAsphere.

 

Disclaimer:

We only call it treats due to Halloween but they are really candy, food, or food with lower nutrition.

Food Cravings: Consuming Peanuts and Soy During Pregnancy

Originally published on NY Metro

Are you craving a peanut butter and jelly sandwich during your pregnancy? Did you religiously consume soy products like yogurt and milk before your pregnancy, but aren’t sure if you should continue to do so? Manhattan nutritionist and mother of two says it’s OK!

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My friends used to glare at me when I ate peanut butter and soy yogurt while pregnant. They, like many other moms, believed in the notions that parents should not introduce nuts or soy to children younger than 2, solid food to infants younger than 6 months, and food like nuts, nut butters, and anything with soy while pregnant.

I loved these foods too much though; peanut butter and soy yogurt remained a primary means for me to consume protein, fat, and calcium for the duration of my pregnancies. To my content, after giving birth, I received my Food Allergy and Anaphylaxis Network newsletter, confirming that there was no such relationship between these ingredients, food products, and allergies. Since then, neither of my boys has developed any type of severe food allergy either.

But enough about me. Let’s talk about you, your babies, and what the latest research says on consuming allergenic products while pregnant, breastfeeding, and in the first years of life.

Food Exposure While Pregnant

If you’re the kind of mom who, like me, relied on peanut butter sandwiches for simple grab-and-go lunches while pregnant, don’t feel guilty if your child has developed a food allergy. There is plenty of proof that ensures that this is not your fault.

Eliminating specific foods during pregnancy and/or while breast-feeding, prolonged breastfeeding, and delayed weaning have not been proven to prevent the development of food allergies. New research actually suggests the opposite—that this may be the ideal time to expose children to sensitive ingredients in order to induce a natural tolerance to such items.

Rather than obsessing over which foods to limit, focus on eating a variety of items on a daily basis. Identify your cravings, and be sure to consume enough calcium and omega 3 fatty acids in a moderate manner. Craving chocolate and peanuts? Don’t eat them in excess every day. Instead, rotate the foods you love and incorporate a variety of ingredients from one meal to the next.

If you are still afraid of what ingredients like nuts and soy may trigger, try using a four-day rotation that’s known to help individuals with food intolerances. For example, if you have eggs on Monday, don’t eat them again until Friday. While this may require extra thinking and work, the four-day rotation can help to calm even the most cautious mom’s fears.

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When to Introduce Food to Infants

Back in the 90s, when I studying nutrition and was pursuing my RD certifications, I learned that it was appropriate to introduce solid foods to babies between 4 and 6 months. By the time I had given birth to my first child in 2006, the word on the mommy block was to delay the introduction of solids until at least 6 months or older in order to prevent the development of allergies.

Current research conflicts with this proposal. Jonathan M. Spergel, MD, Ph.D., and chief of the Allergy Sector at the Children’s Hospital of Philadelphia says, “Delaying food introduction after 6 months could be even more detrimental in regards to developing a food allergy.” One study, reported in Pediatrics, supports this theory, suggesting that introducing solid foods at a later age was associated with an increased risk for allergic sensitization to food and inhalant allergens by the age of 5. Another proved that introducing cow’s milk, chicken, eggs, peanuts, tree nuts, soy, and gluten before 6 months was not significantly associated with eczema or wheezing at any age.

So remember, while there are always exceptions, the general consensus is that introducing solid foods between 4 and 6 months of age is actually associated with the lowest allergy risk. In other words, it’s during this time, before the 6-month-old mark, that it may be best to incorporate solid foods during mealtime.

How to Introduce Peanuts and Tree Nuts to Toddlers

Based on current research, parents do not need to delay the introduction of peanut butter or nut butters until their toddler is 2 or older. However, you should wait to introduce foods that may put your child at risk for choking, such as the actual nut itself.

Also take note that nut butters are highly sticky and can get stuck on the roof of your child’s mouth. If you do choose to feed them nut butter, be sure that they have developed sufficient tongue strength and motor skills to swallow the spread. Serving these sticky products in between two soft pieces of bread may help prevent choking or difficulty chewing as well.

If there is a family history of food allergies to peanuts, nuts, or any other food, a medical physician and registered dietitian should always be consulted. Many times, the pediatrician will try exposing the child in a medical setting if anaphylaxis is of concern.  Another option to consider, of course under the recommendation or supervision of your child’s pediatrician, is to test the potential allergenic food at home with an antihistamine available in case there is an allergic reaction.

Feeding your pregnant body and your growing baby can be a joyful and exciting, not to mention delicious, period of your life. Relax knowing that you can dine on your favorite foods while sporting your bump, introduce solid foods to your bundles of joy between 4 and 6 months old, and even let your little ones nibble on some nutritious nut butter at some point before age 2.

Formula Fed—Me and My Boys

Formula Fed—Me and My Boys
Not every mom must breast-feed.
By Laura Cipullo RD CED CEDRD CDN 

Photo Credit: nerissa’s ring via Compfight cc

I know as a registered dietitian I am supposed to encourage breast-feeding, but there are enough dietitians indoctrinating “breast-feed only.”  I am here to share the flip side. I don’t want moms to feel guilty for not breastfeeding because they cannot or simply because they choose not to. I have formula fed both of my sons, who are now ages five and seven. Neither have food allergies, and neither have been on antibiotics (recently, however, it was necessary for the eldest to take them). I, too, was formula fed and am a healthy individual. Opining for formula is based on my personal experience and not science.

 

But it can be heartbreaking to want to breast-feed your child and be unable to do so. Moms, please don’t feel guilty. Formula feeding is not to the detriment of your child. You can still bond, and you can still provide your child with nutrition. As a matter of fact, the first six months post birth are important, but our job as mothers is even more important as our babies get older. Providing pure nutrition goes beyond the breast and the bottle. How we feed the baby, what we feed them as their first foods, and the relationship between us and our food—and our child and his/her food—is a lifelong balancing act that is more crucial than breastfeeding.

 

There are also other times when it may be to the mom’s or the baby’s advantage to choose formula rather than breast-milk.

Photo Credit: nerissa’s ring via Compfight cc

Why it may not always be better to breast-feed:

  1. Mom may be malnourished and unlikely to give baby adequate nutrition.
  2. Mom may be decreasing her bone density, sacrificing her health in order to give baby enough calcium.
  3. Mom may not be eating fish, and therefore baby is not getting enough DHA, the essential fatty acid obtained through eating fish.
  4. Mom may be drinking diet soda and eating diet foods to lose the baby weight. (But do you want to bottle-feed artificial sugar to your baby? Is this different healthier than sugar in formula?)
  5. Pump and dump?? Let’s face it, many moms imbibe in drinks such as wine, while others even smoke tobacco and proceed to breast-feed!
  6. Baby may not be getting enough nutrition, and formula may be better choice.

 

Consider, are you doing this to benefit baby or yourself? If you do breast-feed, make sure you take a multivitamin with minerals, drink enough water, and eat enough real, wholesome food. If you choose formula, know your baby is getting calcium, DHA, and the necessary macronutrients. The sugar in formula is not ideal, but remember milk is a form of carbohydrate, which is sugar. The focus for you and all moms and dads can and should be on what you feed your child for the rest of his/her young adult life rather than on the first year alone.

 

More on breast-feeding: 

Healthy Quinoa and Mushroom Stuffing + Giveaway

With the holidays just around the corner, the MDIO kitchen has been buzzing with festive recipes. A recent idea we’ve been working on is feeding holiday guests who have food allergies, sensitivities or other food aversions. Therefore, we’ve whipped up a vegetarian, nut- and gluten-free dish that is just as delicious as traditional stuffing!

Healthy Quinoa and Mushroom Stuffing

Photo Credit: Dot D via Compfight cc

Ingredients:

-1 tbsp EV olive oil
-1-2 large onions, chopped
-3 cups or 1 24oz container of vegetable broth
-2 cups quinoa
-1 cup mushrooms, sliced
-1/2 cup parsley, chopped
-3 stalks of celery, chopped
-3 cloves garlic, finely chopped
-1/2 tsp ground cinnamon
-1/4 tsp ground allspice
-1 bay leaf
-salt and pepper to taste

 

Directions:

1) In a medium saucepan, add quinoa and 2 1/2 cups of the broth. Bring to a simmer, cover, and cook for 10-15 minutes (note: time varies by package/brand, so be sure to check the directions!), or until tender and all the broth has absorbed. Set aside.

2) Heat oil in a large saute pan. Add celery, onions, garlic, bay leaf, and seasonings, stirring occasionally. Allow to cook for about 3 minutes or until fragrant. Add the mushrooms and stir. When the mushrooms begin to brown, add the parsley.

3) Stir in the cooked quinoa with the remaining broth. Season with salt and pepper. Cook on low heat for an additional 5-10 or until all liquid is absorbed.

 

There you have it, an allergy-friendly twist on a traditional holiday dish. This stuffing is great to serve to gluten-free (as long as the quinoa package is labeled gluten-free), nut-free and vegetarian guests. This recipe makes about 4 cups, enough to serve 8 people as a side dish.

Giveaway: black + blum

We are giving away a black + blum water bottle to one lucky subscriber!

To enter you must do at least one of the following:

-Be a Mom Dishes It Out subscriber (you can do so at the top of our homepage)

-Tweet us @MomDishesItOut

-Like this Facebook post

Giveaway ends Monday, November 25th!

Going Nuts.

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Most parents are aware of the benefits of nuts, particularly almonds, peanuts and pecans, for our health and our kids’ health. These powerful pieces of nutrition provide essential fatty acids, proteins, fiber, and Vitamin E and help raise good cholesterol, known as HDL. However, the one drawback to this nutritious diet staple is that nuts can also cause a potentially fatal allergic reaction, known as an anaphylactic reaction.

Due to the potential seriousness of allergies, many schools have started to enforce restrictions on the kinds of foods students are allowed to bring to school. This raises some complicated questions for parents hoping to send their children off to school with healthy, nutritious food. What do we do as parents when our child’s school has banned nuts? For some kids, going without nuts means missing their vegetarian protein source. Should we pack our kids dairy every day and risk raising their LDL cholesterol? Should we send tofu and soy butter, which are more processed than natural nut butters? Should we send sunflower butter, which is also highly allergenic and can also cause anaphylaxis? Should we focus on peanut-free and not tree nut-free?

In addition to the immediate challenges these kinds of bans place on nutrition, they also have the potential to affect the ways our kids interact with one another.  Do we advocate for a nut-free table in the cafeteria, which would set kids with allergies apart? While a “nut-free” table would be organized with students’ safety in mind, in enforcing this rule we risk ostracizing them from their classmates. I have heard some moms in Connecticut are fighting with their children’s schools to allow their child with a nut allergy eat with the other kids. Do we go along with the nut -free school zone? Do we recommend establishing this nut-free zone on a class-by-class basis, pending if someone has an allergy?

Where do we draw the line? I understand this is a sensitive subject, and should be — the risks are very high. I do think a nut free elementary school is advantageous. However, when my son’s school proposed a ban on all food products made in a factory that may be in contact with peanuts (at a school where the children eat lunch in their classroom and there may be no allergy in many classrooms) I felt at a loss. I am a mom, RD, CDE and I am now going to have to take on the responsibility of feeding my kids as if they had an allergy, possibly decreasing their immunity to such foods. Busy parents are challenged enough as it is to feed their kids healthy, let alone nut- free food, and our choices are narrowed even further when we are expected to avoid products from facilities where peanuts may have been processed. I would gladly comply if a child in the class had a documented allergy, but to go through hoops and hurdles when it may not be necessary seems overboard.

This excessive caution seems all the more extreme when we consider how allergens and contamination are regulated (or aren’t).  Avoiding food processed in the same facility as nut products is not always effective. According to a recent article by a panel of experts from the National Institute of Allergy and Infection Diseases:

The FALCPA does not currently regulate voluntary disclaimers such as “this product does not contain peanuts, but was prepared in a facility that makes products containing peanuts” or “this product may contain trace amounts of peanut.” Such disclaimers can leave consumers without adequate knowledge to make objective decisions.

The EP identified 10 studies that examined whether standards for precautionary food labeling are effective in preventing food-induced allergic reactions. No study explicitly attempted to infer a cause-and-effect relationship between changes in frequency of severe symptoms from unintentional exposure (for example, to peanut) as a consequence of implementing food labeling. The identified studies mostly assessed knowledge and preferences for food labeling.1

If this labeling is voluntary, unregulated, and therefore possibly inaccurate, does it make sense for schools to use the kinds of labels to inform their policies regarding allergies? Many of my clients with peanut allergies still have tree nuts, and even peanut butter, in their homes and simply know how to prevent cross-contamination. Many of my clients with these allergies still eat foods processed in a facility that may share equipment with nuts, wheat and other common allergens.   So are our schools being too authoritarian? Are they smart for playing it safe, or is there such a thing as too much caution? Should sweets be forbidden from schools for fear of hyperglycemia or hypoglycemia, conditions that are just as threatening for someone with Type 1 Diabetes? Should grapes be forbidden since they are a choking hazard?

Instead, I recommend schools practice peanut/nut free or safe policies.  Focus on education, emergency plans for allergic reactions and having the epi pen to administer if there is an allergic reaction. Avoiding nuts or rather nut free facilities is not the best answer. Yes, precaution is necessary but we also need an action plan for as we know with voluntary labeling, kids still may be exposed and have an allergic reaction.

What do parents think? Do you believe in nut-free schools?  Do you believe in nut free schools banning food products made in a facility made that may have processed nuts?

 

1. “Guidelines for the Diagnosis and Management of Food Allergy in the United States” Report of the NIAID-Sponsored Panel.”  The Journal of Allergy and Clinical Immunology 126.6, Supplement (2010): Pages S1-S58.

Yummy for the Tummy and Allergy Free

Living with food allergies can be challenging but it doesn’t have to be boring. The boys and I took a walk to the lower east side to test taste the Famous Baby Cakes’ sweet somethings! Baby Cakes NYC is certified Kosher, parave and vegan. They are happy to overnight you their yummies. They have bakeries in NYC, LA and at the Walt Disney World Resort. Bobby, Billy and I loved the chocolate chop cookies and banana bread. Second place was the donut and third place was the cupcake. Baby Cakes also has a cookbook available if you want to try the recipes at home!! If not you can always check out the magazine Living Without for other delicious allergen free recipes.

Baby Cakes donut