Woman's Hour - Parenting: Feeding a child with allergies

Episode Date: April 24, 2019

A paediatric dietitian gives advice on how to feed a child with food allergies.

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Hi, this is Jane Garvey, and this is the Woman's Hour Parenting Podcast. This week, this is about how you best look after your children with food allergies. They are common. 6% we're told of children in the developing world have an allergy of some kind. And we wanted to look at how you can feed your child well if they do have any allergies. My guest is Claire Thornton-Wood, paediatric dietician, and I asked her what were the common food groups that children were most likely to be allergic to? So the most common food group is milk, that's the most common one, and then following that it's eggs, and then it becomes peanuts, tree nuts, fish, a little bit less common, wheat.

Right. Let's start with milk, obviously. Can you be allergic to breast milk? You can be allergic to breast milk, and the reason for that is because the foods that the mother eat then pass through the breast milk and are consumed by the baby. So, yes, if we have a child that has an allergy to a particular food we would ask the mother to remove that food from from her diet right okay but not easy to do to put it mildly it depends what it is but no possibly not easy to do how would you know

actually if a very young baby was allergic to breast milk? I mean you would be looking at the kind of symptoms that they would have I think it's probably first of all important to say there are two types of allergy there's what we call an IgE allergy so that is the allergy most people would think of the anaphylaxis the potential swelling of the lips hives all over the body that's very sudden and happens often within minutes, but certainly within a couple of hours of eating a particular food. The other type of allergy is called a non-IgE allergy, and that's a kind of slow-burning allergy that sometimes can take days, even weeks, to appear and tends to manifest itself in things more like chronic eczema, constipation,

faltering growth, abdominal pain, that kind of thing. So clearly if you have the more immediate type of reaction, it's often quite easy to pinpoint what has caused it. So you can then quite easily... But the other type is actually actually no less difficult is it the other type is is more difficult so with an IgE allergy you would actually you can have tests for that you can have a skin brick test um you can have IgE blood tests and and that that can give you a very good um answer with the other type of allergy it's more like a trial and error so you have a look at a healthcare professional would usually and error. So you have a look at,

a healthcare professional would, usually a dietician would have a look at the diet, think the mother may even have an idea of what it is, and then you would remove that food from the diet. And if the symptoms then improve, the gold standard is to put the food back into the diet. If the symptoms reappear, then you know you've hit on the right food. If you have a family where there are a lot of people with even quite mild eczema should you be concerned you should you should be concerned um because there is something we we know called the allergic march where people who have eczema i mean i'm not talking about small patches i'm talking about sort of quite you know quite bad eczema yeah are i'm not talking about small patches i'm talking about sort of quite

you know quite bad eczema yeah are more likely to go on to develop other allergies like food allergies and asthma and hay fever so it's really important um if your child has got eczema to actually really get on top of that because if you think about it your skin is like a barrier it's like you're sitting in a plastic bag. And your plastic bag is designed, it's waterproof really, and it's designed to keep everything out. If you've got eczema, you've actually got really quite large areas of very exposed skin. And then the allergens are actually able to penetrate through. And we know that that then predisposes people to become allergic to

particular foods. The milk ladder is something that I honestly had never heard of what does that mean? Okay so the milk ladder is something that's been developed over many many years and refined and is a way of bringing milk back into a child's diet when they are we think that they're growing out of their allergy so it's really important to say that the milk ladder needs to be done under medical guidance usually a dietician and it should not be used for any child that has an IgE immediate type reaction so the milk ladder is where we use milk in very small amounts going up to larger amounts and we use milk that's very very well cooked like in a biscuit or a cupcake going up to yogurt and then a glass of milk and the idea behind it is it's the protein in the milk that causes the difficulty the protein

is a certain shape once you heat it or treat it by making it slightly more acidic the change the shape of it changes and then the receptors in your body don't recognize it in just the same way it's a bit like putting a lego brick if you've got them they go really well together if you were to put one of your lego bricks in the microwave and change its shape it then wouldn't fit together got you okay that's a really good way of describing it. So to peanut butter or peanuts, which obviously is a big, big area, I've heard the idea, it's what people purport to have done, that you give your child a peanut butter sandwich, but in the car park of a hospital with an A&E, and then see what happens.

Is that a good idea? I do know that mothers do do that. I mean, I... a good idea i i do know that mothers do do that um i mean i every a and e in the country is going to be going bonkers now um of course i traffic down in the car parks um i mean there's it used to be said that you shouldn't give your children um highly allergenic foods at a young age and certainly when i had my children it was the mother didn't eat peanuts the children didn't have peanuts when they were babies that advice has now changed and we are saying that children should be given there's the eat study and the leap study have shown that we should now be giving children foods that are potentially allergenic at a much younger age so around six months when you're weaning them you should start to offer them

things like peanuts obviously you mustn't give them whole peanuts so you use peanut powder which you can then mix into things like yogurt or drop it into casseroles things like that yes you you have obviously got to be very careful but at the same time being over cautious won't be a help either will it no i mean that that's that's i think part of the problem we think that perhaps we've been a bit over cautious previously and then that has caused perhaps more children to become allergic do you think that is that what people are saying i think that there are there is some evidence that they they that by excluding a food sometimes it does make a child more likely to become allergic. This isn't a criticism of you,

but it doesn't help that the advice just keeps changing. And I said we wanted to focus on eating well. I do think that's important. If your child, for whatever reason, allergic reaction or something else, can't eat a particular sort of food or chooses not to, how do you ensure they are getting all the right nutrients? It depends what the food is.

So obviously if you're not eating eggs or you're not eating peanuts, that's not so much of a problem. If it's a big food group like cow's milk, you need to take extra care to make sure they get everything. So with cow's milk, it's calcium that you would be looking at. And also taking cow's milk out from the diet excludes quite a lot of fat you know you wouldn't be having cheese you wouldn't be having yogurt yeah but it's perfectly possible to feed a child um without those foods is it so what do you give

them well you can use lots of um different milks if you've got a very small child they would probably be on a prescribed formula um older children can have oat milk or um some of the the other plant-based milk soya milk um not the nut milks and they're all fortified with calcium to exactly the same level as they are in cow's milk and if you don't want to eat meat or you i suppose some people could be allergic to meat couldn't they is that that is the thing is it You don't look very sure. Potentially. Potentially, yes, potentially.

OK, so pulses, lentils, but then you could be allergic to them too. You could. I mean, we do see children that do have multiple allergies and obviously the more allergies you have, the more difficult it is to find foods that you can eat. I just want to mention this email from Becky. My first child was allergic to cow dairy. I gave up dairy as the protein was passing

through my breast milk, ended up doing loads of baking and making food from scratch. Four years later and a hundred attempts at the milk ladder, we have finally completed it and he's okay with dairy in his diet. So that fascinates me. I mean, very briefly, Claire, why do some people then grow out of allergies?

A lot of people, yes, they do. They do grow out of allergies. It's just they gradually build up the tolerance, which is what the milk ladder does. It gradually builds up your tolerance to the foods that you've previously been allergic to. Claire Thornton-Wood, paediatric dietitian. That's the Woman's Hour parenting podcast for this week If there's anything you'd like us to feature in this podcast contact the programme via the website bbc.co.uk slash womanshour I'm Sarah Trelevan and for over a year

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