Food Allergies and/or Intolerances and their impact on Feeding

Common referalls: child not progressing to age appropriate textures and would rather graze throughout the day than sit for meals. Often have high intake of dairy, such as yogurt, pudding milk, goldfish crackers. IgE allergy testing reveals no allergies, however there may be a strong indication of food intolerance as congestion is increased when these foods are eaten, darker areas or lines (Denni morgan lines) appear below the eyes, Constipation that has to be stimulated by thermometer or Miralax or other treatment.. or Diarrhea that has been persistent. May have diaper rash and eczema or just one red cheek or ear that seems 'flushed' and is hot to the touch, not to mention recurrent ear infections. Does anyone have this experience and if so do you mind sharing?

This is a scenario that has repeated time and time again over the past 7 years in my work and more likely than not the above mentioned symptoms subside, or at least lessen with a milk elimination trial of 2-4 weeks. You would not expect to see any sudden changes in the eating, other than a possiblity of the Willingness to try foods that would have otherwise been put on the back burner. We all know how huge that is though! I hope to post a letter I am writing to area physicians on this particular topic of food allergy and its impact on feeding development, specifically the sensory component of feeding--at a later time.

If a child were to have a food intolerance that in turn leads to silent, non regurgitant reflux, it may not be too much of an issue in some children, but in others it seems that the sensory aversions are heightened and sensory feeding information is processed in a very different way. That statement is based on numerous cases over the years in which a child with reflux and/or food intolerance had accompanying sensory aversions, hugely impacting mealtime and feeding development. Those toddlers in particular do not have a normalized response to various sensory stimuli. This could be observed in a child who does not tolerate walking barefoot on grass or sand, does not enjoy the feel of playing in rice or bean boxes, tags on the back of shirt, and who may experience gagging on all food textures with the exception of smooth foods or very crunchy, etc. Those are just a few examples. Imagine how it feels for a child to be uncomfortable with certain textures and input on hands and feet, the thought of exploring such textures in their mouth is less than appealing to them.

I mention this topic so families can be aware of these 'red flags' which may indicate a food sensitivity to milk. A child who has congestion, history of ear infections, history of diaper rashes often needing anti-fungal cream (Indicating presence of yeast)...these are all indicators of a possible food intolerance or allergy that often go overlooked as some symptoms are not typical of a classic IgE mediated response. Symptoms may not appear immediately after the food consumption and the only indication may be the history of ear infections or the thought that your child "always has a cold". Immediate reactions are often taken more seriously than these delayed reactions, as there could be anaphylactic reactions leading to life threatening circumstances.

From the feeding standpoint I feel it is very important to rule out the presence of these food intolerances. A child's battle with food, his finicky eating, his anxiety increasing at the very thought of being in front of a food he is expected to eat, despite a known underlying diagnosis such as sensory processing dysfunction or Autism, Asperger's, developmental delay, etc and despite an immediate allergic reaction---All may be related to a food offender. Treatment is available, but I encourage you to do you research before randomly choosing a feeding therapist or a program. Some intensive feeding programs take a very different approach than mine or other therapy clinics.

We must look at the big picture, the whole child and all factors involved, not just medications to help with the possible reflux, the eczema, the constipation, etc. Although these may be warranted in time, I feel it is important to really look into these food intolerance possibilities as well. We have many success stories, or should I say these families I have worked with have many success stories and wish they would have looked into the possibilites of food allergies sooner than later. I suggest taking a detailed food journal for 3 days and be sure to list any and all changes in any physical changes (bowel, appearance of eyes, rash, etc) behavior, sleep patterns, eating (new foods tried?) and anything else worth noting.

It is a little overwhelming how often I and other therapists working with feeding have seen this connection to delayed food allergy/intolerance and the sensory component. Perhaps the elimination of the food reduces or eliminates silent reflux that had been occuring unknowingly. Symptoms of Reflux can be found in this article Gastroesophageal reflux and Childhood Feeding Disorders and http://reflux.org/. We know that with sensory integration therapy, as the child progresses with various sensory goals, there is often an increase in eating. I strongly encourage looking at all modalities and to not rule out possibilities of underlying GI discomfort such as food intolerance as a strong culprit to the feeding aversions. When I had morning sickness with my daughter I did Not want to smell coffee (which i loved before) I could not pick up my dog's waste from the yard (intense smell made me gag). I compare those changes in sensory experiences to the changes these kids must be feeling! They know what feels best to them and they know what sets them off. There is help for these children and so many ways to build on their current accepted foods. I just wanted to take this long post and highlight the need for a wholistic treatment approach for these kids. Do you have a child craving their milk or pediasure in addition to the little voice inside of your head saying "Something he is eating is making him sick or making him have a very difficult time in a lot of areas" At least worth looking into! Email me for further information re: Milk Allergies and Elimination trials.

Suggested Reading:

http://www.nutramed.com/children/kidsmilk.htm
http://www.askdrsears.com/html/4/t041800.asp
http://www.nutramed.com/Foodallergy/fachildren.htm