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Is Your Food-Allergic Child's Diet Nutritionally Balanced?
Is Your Food-Allergic Child's Diet Nutritionally Balanced?
When you have to eliminate foods from your child's diet, important nutrients for growth and development can be neglected. While a child with a balanced diet may have adequate nutritional stores to last through a period of testing and a short-term (2-week) elimination diet, a child with a long-term restricted diet must find safe sources of nutrients to ensure a nutritionally-balanced diet.
Restricted diets must have safe sources of nutrients.
One of the most common allergy-causing foods in children — and the leading cause of allergic reactions in very young children — is milk1. During peak growth periods especially, milk provides a good source of many nutrients essential for bone mineralization and growth. These nutrients include: protein, calcium, vitamin D, vitamin A, vitamin B12, riboflavin and phosphorus.
In order for your milk-allergic child to obtain these nutrients, you must carefully choose food substitutes. Meats, poultry, eggs, fish, nuts and legumes can easily provide needed protein. However, in order to obtain enough calcium, your child may need to consume lots of non-dairy food sources of the nutrient — more than a young child is capable of eating. Many of these non-dairy sources are not foods that are favorites of most children. For example, one cup of leafy greens contains as much calcium as 4 ounces of milk. A child who needs 500 milligrams of calcium daily would need to eat as much as 4 cups of leafy greens to meet the requirement. Would your child eat all of these leafy greens? Probably not. Read labels to carefully seek out a variety of calcium-fortified foods.
In some cases, you may need to give your child supplements. If he is at an age when a specialized milk-free formula is a large part of his daily diet, supplementation may not be necessary. You may be able to use milk alternatives as an acceptable substitute if your child is over one year old. Soy milk, fortified rice milk, grain and nut milks (such as oat milk and almond milk) can be substituted, if tolerated, but need to be fortified with additional nutrients. It is important, however, to review the nutrition information on the package to check the amount of protein, which should be 8 grams per 8 ounce serving. Calcium fortified juices will provide additional calcium but are not a good source of other nutrients.
Egg-allergic children must avoid whole egg in all forms. Even though the egg white is the part of the egg responsible for allergic reactions, it is impossible to separate the white from the yolk without the yolk containing egg white protein.
Eggs provide a source of quality protein as well as iron, biotin, folacin, pantothenic acid, riboflavin, selenium, and vitamins A, D, E and B12. Your child will still easily get an adequate amount of protein when egg must be eliminated if he is not allergic to other protein sources, such as: milk, meat, poultry, fish, nuts and legumes. Selenium and vitamin B12 can also be obtained from meat. Folacin can be found in legumes, fruits and leafy greens. If your child consumes a variety of other foods, an egg-free diet should not place your child at nutritional risk.
When your child avoids foods containing egg, including baked goods, he may lose essential nutrients from his diet. For example, most baked goods are made with enriched and fortified flour, which contains B vitamins and iron. If your child normally consumed a variety of baked goods prior to diagnosis, and must now avoid those containing egg, he will need to obtain calories, B vitamins, iron and additional nutrients from other egg-free sources.
Peanut and Tree Nut Allergy
Peanuts and tree nuts are a good source of protein in a child's diet. However, if your child needs to avoid nuts of any type, he should not be at nutritional risk since there are many other sources of protein as previously mentioned. Although peanuts also provide a source of niacin, magnesium, vitamins E and B6, manganese, pantothenic acid, chromium, folacin, copper and biotin, your child can obtain these vitamins and nutrients by consuming a variety of foods from other food groups.
Soybeans provide one of the highest quality proteins in a child's diet. They also contain thiamin, riboflavin, iron, phosphorus, magnesium, calcium, zinc and vitamin B6. Unless your child consumes specific soy foods, the small amounts of soy in processed foods do not supply a significant amount of these nutrients. If you emphasize eating a variety of fruits, vegetables, enriched and fortified grains, and tolerated sources of protein, restricting soy in your child's diet will not pose any nutritional risk.
Wheat is a grain that has been reported to trigger allergy symptoms. While grains, such as corn, rice, barley, buckwheat and oats, to name a few, are not common triggers, they need to be chosen with care as substitutes for wheat due to the possibility of cross contamination. Be sure to choose alternate grains from a reputable source.
Grains contain protein, and when fortified, a good variety of vitamins and minerals, including B vitamins and iron. You can substitute flours from alternate grains in recipes to provide the same nutrients as wheat; however, only the proper amounts of substituted flour will yield an appealing product — so follow your recipes carefully!
The milling process for grains can also remove important nutrients, so make sure you choose fortified and enriched grains. A serving or two of an enriched and fortified grain at each meal will contribute to meeting important nutritional needs for B vitamins, folacin and iron.
Fish, another good source of protein, contains the nutrients niacin, vitamins B6, B12, A and E, as well as phosphorus, selenium, magnesium, iron and zinc. If your child must avoid fish, you can find the same nutrients in other protein sources such as meats, grains and legumes.
For more information about food allergies and nutrition, sign-up to receive our free guide: KFA's Starter Guide to Parenting a Child with a Food Allergy.
To receive professional assistance with your child's diet, consider finding a dietitian who specializes in food allergy or pediatric nutrition. Read Is Your Dietitian the Right Fit? for guidance on how to find a dietitian that can help you.
1. Boyano-Martinez, et al. (2009). Accidental allergic reactions in children allergic to cow's milk proteins. Journal of Allergy and Clinical Immunology, 883-8.
Approved by KFA's Medical Advisory Team October 2009.