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food refusal

Food Aversion
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making mealtimes better

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Making Mealtimes Better : Structure, Nurture & Boundaries

Accessible and full of sensible evidence-based information to support feeding young children well.  Making Mealtimes Better is an on-line workshop series of 3 x 1 hour sessions for parents and carers of pre-school children. Written with highly selective eaters in mind, Making Mealtimes Better provides a guided space alongside others to share your experience, explore new tools and develop and create your own nutrition-focussed plan for your child and family.

Delivered by Carine Henry RD, paediatric specialist dietitian, with 30 years of practical working with children and families, in areas of feeding difficulties, feeding skills development, addressing growth faltering, food allergies and tummy troubles.

Carine uses themes of Structure, Nurture and Boundaries to help guide topics including:

  • meeting your child’s nutritional needs : key nutrients and food groups
  • expanding food experience : where you are right now, your next steps and forward planning
  • giving right attention to food and feeding : mindful tools
  • learning to enjoy food and feeding : agency and satisfaction
  • awareness of how your own emotions impact food and feeding times

Making Mealtimes Better offers support for families of young children with heightened sensitivity to foods and feeding, and where nutritional wellbeing and growth may be compromised, such as those experiencing :

  • food refusal, feeding aversion, food fears, feeding anxieties
  • prolonged difficulty with expanding to mixed textures of food
  • difficulty introducing new foods and & limited experience of a range of foods
  • prolonged illness at developmentally important phases in feeding
  • highly selective eating and sensory difficulties
  • tantrums at the table, feeding behaviours
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identifying the symptoms of cow’s milk allergy

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Identifying the symptoms of Cow’s Milk Allergy is the 1st part in this 5-part blog series about Cow’s Milk Allergy in Infancy.

Cow’s Milk Allergy (CMA) is an immune reaction to the proteins found in cow’s milk affecting 1 in 20 infants in the UK.  There are two distinct types of cow’s milk allergy: IgE reactions with immediate onset of symptoms and non IgE reactions with delayed onset.  In both types, symptoms range from mild-moderate to severe and persisting with potentially life-threatening reactions such as anaphylaxis. The following table will help you in identifying the symptoms of Cow’s Milk Allergy.

Delayed Onset Symptoms

Non-IgE Cow’s Milk Allergy

2 – 72 hours after milk intake

 Immediate Onset Reactions

IgE Cow’s Milk Allergy

Minutes after milk intake
Affecting formula-fed, exclusively breast fed infants or at the onset of mixed feeding/solids Affecting formula-fed infants or at the onset of mixed feeding
Gastrointestinal symptoms may be mild-moderate or severe and persisting
colic, reflux, loose, frequent stools, soft stool constipation, painful wind,  blood or mucous in nappy, food refusal, feeding aversion, poor growth vomiting, diarrhoea, colic
Skin symptoms can be mild-moderate or severe and persisting
itchy, raised red rash, atopic eczema intense itching, erythema (raised red rash), urticaria (flushing, spreading rash), flare up of atopic eczema, angioedema (facial swelling)
Respiratory symptoms are confined to IgE reactions
acute rhinitis (hayfever), conjunctivitis (swelling in and around the eyes) ANAPHYLAXIS

This blog series will focus on non-IgE CMA with delayed onset, which although less severe can be more complex and difficult to diagnose.  This is due to a number of issues: the similarity to other common conditions during infancy such as colic, reflux or loose stools and also the symptoms being mistakenly treated as lactose intolerance. Again this is due to the similarity in gut symptoms such as colic, bloating, discomfort and diarrhoea.  Unlike IgE CMA, there is no diagnostic allergy test for non IgE CMA and because reactions are delayed up to 72 hours after intake, cause and effect is not quite so clear. Lactose intolerance does not involve immune reactions, but results from lack of the digestive enzyme lactase, with malabsorption of the “milk sugar” lactose  causing discomfort and diarrhoea. A lactose free formula (which normally contains cow’ s milk protein) will resolve lactose intolerance but not Cow’s Milk Allergy,

Non IgE Cow’s Milk Allergy in infancy responds extremely well to prompt dietary treatment, with the majority of infants outgrowing their allergy within 6-12 months.  Delays in diagnosis and treatment lead to symptoms becoming severe and persistent, with feeding difficulties and growth faltering more evident.  Identifying the symptoms of Cow’s Milk Allergy early and discussing an allergy focused history with a trained GP or Paediatric Dietitian will assist making a diagnosis and accessing prompt appropriate treatment.

Next Confirming a diagnosis of Cow’s Milk Allergy.

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portion sizes for your toddler

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How confident do you feel about portion sizes for your toddler?  In a recent survey from the Infant & Toddler Form, 73% of mums felt that they their toddlers were not eating enough.  Toddlers appetites vary depending on how they feel, what’s on offer, how tired they are  Some days there is no feeding them.  Fussy eating and food refusal during the toddler years is a great cause for concern with parents, but it is a normal part of childhood development. Toddlers can be be tricky feeders at mealtimes, with food refusal gaining attention and often resulting in a battle of wills.  Use this portion size guide to help guide you.

Can giving toddlers large portions cause excess weight gain and obesity?
Large portion sizes for toddler meals are linked to obesity development says another recent survey.  There is however no single cause for obesity, just as there is no single correct portion size for toddler. Meal times are good opportunities to eat nutritious food, and portion sizes of nutritious food should not be limited.  Foods high in fats and sugars, deep fried and battered should be kept to a minimum, as these are very high in calories and do contribute to obesity if eaten regularly. But, it’s often the food eaten outside of mealtimes that is high in calories with low nutritional value.  For all you worried mum’s out there, its good to know that nutrient deficiencies are rare in the UK, and children who are eating a variety of foods from the 5 food groups will not need a vitamin supplement.

Need further advice?  Contact Carine to book an appointment.

 

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