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NHS Allergy Specialist Dietitian Tanya Wright shares her knowledge on children's nutrition.

Tanya Wright
– BSc Honours Nutrition and Dietetics MSc Allergy (The Mechanisms and Management of Allergic Disease) (Buckinghamshire )

  • Q: If your child is allergic to milk what should they eat or drink to make sure they are getting enough calcium and vitamin D?
  • If your child is allergic to cow’s milk there are various choices of dairy free milks. Whichever one you choose, do ensure it is enriched with calcium to around 100-120mg of calcium per 100mls and has added vitamin D. For infants under 12 months who are not being breastfed (or who are part breastfed and require a top up formula), use a suitable formula milk as this is designed to meet the nutritional needs of the growing infant.

    All formula milk compositions are regulated by strict Laws. A suitable formula for an infant allergic to cow’s milk will be either an extensively hydrolysed cow’s milk formula, an amino acid formula or a soya formula. A dietitian will help you choose a suitable formula. Usually these are then prescribed by the GP. Some children over 12 months stay on formula if their dietary intake is poor or if their diet is deficient in nutrition. Others have the choice of off-the-shelf milks based on soya, coconut (Kara), oats, hazelnuts, almonds, hemp, sesame, quinoa, potato or rice. Rice milks are unsuitable as a main milk drink for children under 4 ½ years. These replacement milks are often enriched with calcium, vitamin D and B vitamins to the same level as cow’s milk, however they are generally low in energy, protein and fat. If the child is eating a nutritious diet that is meeting their nutritional needs then these off the shelf milks are a suitable option.

  • Q: Should children take supplements if certain foods are eliminated from their diet?
  • There is no need for a child to take nutritional supplements if their diet is meeting their nutritional requirements. Children should be given foods of similar nutritional value to replace the foods excluded, for example soya milk and soya yogurts are given on a milk free diet. It is easy to adapt foods so that they are suitable for all the family such as using wheat free pasta and making a dairy free ‘cheese’ sauce when making a lasagne. For those who are finding it difficult to achieve their child’s requirements on a daily basis because of a child’s fussiness, lack of cooking skills, socioeconomic factors or if the child has multiple food allergies, then a nutritional supplement may be useful. It may be an isolated calcium or iron supplement or a multivitamin or multimineral supplement. Not all supplements are the same so check their nutritional content for the daily dose given and understand what it is you are trying to replace in the diet.

    For those who need help with this they can ask the GP to refer the child to a dietitian. The ingredients should be carefully checked in case they contain an ingredient that the child is allergic to. (For example, many supplements which are enriched with Omega 3, 6 or 9 fatty acids contain fish oil which could be a problem if the child is allergic to fish. Although some children with a fish allergy will tolerate this.)

    The one nutrient that all children should take until at least 5 years of age is a vitamin D supplement to prevent rickets. (Vitamin drops should not be used in infants who are taking 500mls or more of formula daily because this has already been added to the formula.) The main food sources of vitamin D are eggs, milk and oily fish but mainly the body manufactures its own vitamin D when the sun shines on the skin. Remember that clothes, sunscreens and darkly pigmented skins block the action of the sun on the skin, as does being indoors.

  • Q: What are your thoughts on supplementing key vitamins with actual foods rather than taking vitamin pills?
  • The vitamins from foods are much better absorbed than those in vitamin supplements. In addition, those foods will also be adding other important nutrients to the diet of the growing child. One way to improve the absorption of iron is to take vitamin C rich food alongside it for example taking orange juice as a drink with a meat meal such as bolognaise or steak.
  • Q: Are there any super foods that help build up a natural antihistamine in the body?
  • In reality the most important factor is for a child to eat a balanced diet that meets their nutritional requirements so that their body and immune system works as efficiently as possible.
  • Q: Some parents find it hard getting their child to reach the daily amount of vitamins and key nutrients needed by using actual food. Are there any tips you can share?
  • Parents worry that their children are fussy and don’t get enough variety in their diets. In reality it is the nutrients that are important and if the diet is limited, but it provides the child with adequate nutrition, then the parents should not fret. Parents have to be careful that food does not become a battleground as this will only have a negative effect on the child’s nutritional intake.

    To increase nutritional intake, parents should offer foods the child likes and also introduce a new food which could be placed in a bowl on the table for the child to try alongside the family. Children love to copy, so when they see parents and siblings eating this food (without comment) they will often want to try it. If they feel it is their idea to try it and they feel in control, the outcome is definitely much more favourable!

  • Q: This is not really a question but hopefully a little help as Tanya has written a cookbook to prove that meals do not have to be ‘boring, tasteless and poor in nutrition’ because of a child or parent’s allergies and intolerances.
  • Her book is available to buy by clicking this link
  • December 2012
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