Nutrition and Dietetics
At the Paediatric Gut Investigation Clinic we know that proper nutrition is an essential element in the growth of children and young adults. A healthy diet should include a wide variety of food from all of the food groups in order for the body to function correctly. However a gastrointestinal disorder can limit your child’s ability to have this variety. This can be caused by a poor appetite, food intolerances, allergies, food sensitivities, and others. If this happens our team will provide you with a variety of ways to ensure that your child has a well balanced diet. Below are the frequently asked questions about nutrition and the role of a dietitian.
What is a dietitian?
“Dietitians are the only qualified health professionals that assess, diagnose and treat dietary and nutritional problems at an individual and wider public-health level. They work with both healthy and sick people. Uniquely, dietitians use the most up-to-date public health and scientific research on food, health and disease which they translate into practical guidance to enable people to make appropriate lifestyle and food choices.
Dietitians are the only nutrition professionals to be regulated by law, and are governed by an ethical code to ensure that they always work to the highest standard.”
British Dietetic Association https://www.bda.uk.com/improvinghealth/yourhealth/dietitians
Why is nutrition important in children?
Nutrition is a vital component to supporting the growth and development of all children. Achieving the correct nutritional intake ensures children meet their full potential which is the target for parents and health professionals alike.
An increasing body of international evidence supports the theory that what and how much we feed our children not only effects their current health but has the potential to profoundly impact on their long term health as adults. Because of this increasing attention is being paid to the nutrition of both and well and unwell children to ensure we provide the correct balance of nutrients (i.e. avoiding excess and insufficient intakes).
Some conditions such as food allergy and GI conditions can have a significant impact on the foods and diets of children and therefore the involvement of a dietitian is key.
What can your dietitian provide / how can we help?
Assessment of growth
Assessment of current intake
Practical advice on special diets
Practical advice on feeding behavioural modification
Provision of reliable and trustworthy written literature
On going support and reviews
Why monitor growth?
Growth is a vital and very reliable overall marker of health in infants and children. This is why we always start our appointments with an assessment of growth and address this first. Infants and children seen in our clinic will always have their weight and height checked (other anthropometric measurements such as head circumference, mid arm circumference, BMI etc. as clinically indicated) as an essential part of their review.
Just as important as accurate measurements is ensuring the correct interpretation of these in the context of growth and development. We have significant experience and expertise in this area and we will take the time to review growth and nutritional status carefully and thoroughly.
If concerns around growth exist or become apparent there are a variety of interventions we can advise to successful and safely correct this.
What areas do we specialise in?
Food allergy appears to be on the increase in the UK. Management is often simply avoidance of the foods or food groups that have been identified as causing an issue. However balancing the diet within these restrictions and practically ensuring the intake is free from necessary allergens is not always so simple. Food allergies have a considerable impact on the life of the child and their parents/caregivers and have shown to be associated with high levels of anxiety in affected individuals
Children seen in our clinic will have their diets assessed to ensure they are adequate and well balanced. We might suggest alterations within the diet, use of specialist supplement products and use of specialist infant formulas. We will also advise on the timings and practical aspects of safe and appropriate challenges to ensure restrictions are regularly reviewed and practical advice like how to read and interpret food labels. Food allergy is a fast evolving area. We follow the most recent European recommendations as well as keeping a close eye on the latest research to ensure the advice and support we give is the most up to date.
Below are the most common foods to cause allergic reactions or hypersensitivity.
Cows milk protein allergy
Cows’ milk protein allergy (CMPA) is an immune-mediated allergic response to proteins in milk. It is one of the most common childhood food allergies in the developed world, with the highest prevalence during the first year of life. Strict exclusion of cows’ milk protein from the child’s diet (or maternal diet for exclusively breastfed babies) is currently the safest strategy for managing confirmed cows’ milk protein allergy (Ref 1). CMPA commonly resolves by age 6 years but due to the significance of this food group for calories and nutrients it is essential to involve a dietitian in the management. As well as the restrictions, the timings and types of milk protein challenge are important to re assess tolerance with time.
There are two types of soya allergy: ‘IgE mediated’ (where the allergic reaction is immediate) and ‘non-IgE mediated’ (where the allergic reaction is delayed). It is much rarer than milk allergy but often co exists if the child also has a milk allergy. Strict avoidance is again necessary with a planned systemic re introduction in a timely way to review status and possible tolerance development. Practically one of the biggest hurdles with soya exclusion is the sheer number of basic foods that contain soya as an ingredient such as bread, pasta and many commercially processed foods.
Primary nut allergy affects over 2% of children and 0.5% of adults in the UK (Ref 2) It often presents in the first 5 years of life and infants with other allergic conditions such as severe eczema and/or egg allergy have a higher risk of peanut allergy. Nut allergy is likely to be long-lived and nut avoidance advice is the cornerstone of management. Ensuring parents understand labelling if key to education to ensure reduced risk of a reaction. Nuts are good sources of several minerals so having knowledge of alternative sources is important.
Wheat allergy/ sensitivity/ coeliac disease
True wheat allergy is thought to be very rare (estimated 0.4%) but hypersensitivity leading to symptoms is quite commonly reported and seen in clinical practice. For information about coeliac disease please see separate section. It is important to distinguish between wheat allergy, coeliac disease and non-allergic hypersensitivity for your child and your gastroenterologist can clarify this for you. Depending on the condition the severity of the restriction will be different with most care required for those with a coeliac diagnosis.
Wheat restriction limits major staple carbohydrate sources which in turn can limited a selection of nutrient dense fortified foods like breakfast cereals.
Prevalence of hen’s egg allergies is thought to be about 2% (Ref 3,4). Management again centres around education of avoidance and replacement options. Most children outgrow their egg allergy but prevalence data is variable. Eggs are nutrient dense foods and alternative foods to ensure a complete diet are important to include.
Difficult feeding behaviours
Recurrent abdominal pain
- Nice guidance Milk allergy 2014
- Stiefel1, K. Anagnostou, R. J. Boyle, N. Brathwaite4, P. Ewan, A. T. Fox, P. Huber , D. Luyt, S. J. Till4, C. Venter and A. T. Clark. BSACI guideline for the diagnosis and management of peanut and tree nut allergy 2017
- Nwaru BI, Hickstein L, Panesar SS, Roberts G, Muraro A, Sheikh A, On behalf of The EAACI Food Allergy &Anaphylaxis Guidelines Group. Prevalence of common food allergies in Europe: a systematic review and metaanalysis. Allergy 2014; 69:992-1007.
- Xepapadaki P, Fiocchi A, Grabenhenrich L et al. Incidence and natural history of hen’s egg allergy in the first 2 years of life – the EuroPrevall birth cohort study. Allergy 2016; 71:350-7.