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For parents of children with food allergies, dietary counseling can help

By Krystnell Storr

NEW YORK (Reuters Health) - Children with food allergies have a tough time getting all the nutrients they need, but a small study suggests that working with a dietician could help parents provide their kids with a balanced diet.

After their parents were given six months of dietary counseling, children with food allergies began getting more key nutrients and eating as many calories as their peers without any food restrictions.

Food allergies cause the body’s immune system to have an abnormal reaction like vomiting, diarrhea, eczema or asthma to certain foods. But avoiding these foods means sacrificing the energy and nutrients they provide.

Researchers estimate that certain nutrient-rich foods such as cow’s milk, hen’s eggs, soy, peanuts, tree nuts, wheat, fish and shellfish are responsible for 90 percent of childhood food allergies.

“A wide variety of foods are needed for normal growth,” said Lynn Christie, a dietician at the Arkansas Children’s Hospital in Little Rock, who was not involved in the study.

Christie explained that children grow very fast during the first three or four years of life and being unable to eat these foods could keep them from getting enough calories and nutrients. That might have permanent consequences such as stunted growth, a reduced IQ and poor math skills.

For the new study, researchers recruited 157 children between six months and three years of age from two health centers in Italy. All of the children were generally healthy.

Ninety-one of the kids had food allergies and were being kept away from the foods that caused their allergic reactions. Parents of these children had never received counseling for their child’s dietary needs.

The other 66 children did not have a food allergy and were used as a comparison group.

At the beginning of the experiment, researchers used blood and other laboratory tests to evaluate what nutrients the children were getting from their current diets. They also had all parents keep a food diary and record everything their child consumed for three days.

Initially, the children without a food allergy had higher levels of nutrients like zinc and calcium and ate more calories per day than the children who had allergies. Protein consumption was about twice as high among children without a food allergy, on average.

The food diaries were evaluated by a dietician and parents of children in the food allergy group received personalized counseling.

Counselors used the child’s weight, dietary history and energy requirements to determine what kinds of changes to the diet could be feasibly made.

For instance, the parents of a child allergic to cow’s milk might be advised on the appropriate amount of a substitute formula to provide.

Parents of the children in the food allergy group met with the dietician to receive further counseling two and four months into the experiment.

Finally, at six months, the researchers ran all of the initial tests on the children with food allergies again and found there was a significant increase in their total calorie intake as well as carbohydrate, protein, iron, fiber, calcium and zinc levels.

There were no children with food allergies who did not get help from a dietician and this makes it difficult for the researchers, led by Dr. Roberto Canani of the University of Naples “Federico II” in Italy, to prove that the counseling itself led to the changes. But the report is supported by previous research that monitored differences in the growth of children with food allergies.

Having very few parents drop out of the study signified that the counseling was well received, the team reports in the Journal of the Academy of Nutrition and Dietetics.

The first step toward making dietary counseling useful in the U.S. is making sure children with allergies are properly diagnosed, Christie said.

According to the nonprofit organization Food Allergy Research and Education, food allergies affect one in every 13 children and the number of children with food allergies is growing, though researchers aren’t sure why.

Christie said registered dietitians that specialize in pediatrics are the best choice for diet counseling because they can identify where the problems are and provide safe, inexpensive alternatives that work for an individual household.

“Health insurance in the U.S. needs to cover counseling by a registered dietician any time changing the diet is part of a medical treatment,” she said.

She said nutrition interventions may require several appointments to ensure dietary recommendations are acceptable and address any new problems.

“Changing how one eats requires stepwise intervention,” she said.

SOURCE: http://bit.ly/1kEsMx7 Journal of the Academy of Nutrition and Dietetics, online June 5, 2014.

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