By Carol Patton
Do you know the difference between a food allergy and a food reaction in children?
Not every RD does, especially since food sensitivities can be masked by childhood illnesses such as ear infections and rashes, says Kelly Dorfman, MS, LDN, author of What’s Eating Your Child?
“Allergies are narrowly defined as histamine reactions, which cause symptoms associated with irritation and itching—hives, rashes, or throat closing,” she explains. “Food reactions and sensitivities [cause] all kinds of reactions that may not have a histamine base. The problem is there’s no slam-dunk testing.”
Dorfman says it’s important for RDs to play the role of detective and identify foods that may not appear on allergy tests but still cause reactions. Her book addresses food sensitivities that act as behind-the-scenes culprits of common childhood ailments or behaviors. Here are several examples:
• Chronic ear infections: Dorfman says roughly 90% of recurring ear infections are linked to food sensitivities or allergies, according to a study conducted in the 1990s by Talal Nsouli, MD, director of the Watergate and Burke Allergy and Asthma Centers in the Washington, D.C., area. Milk and other dairy products were the worst offenders when it came to causing chronic ear infections, followed by wheat. Seventy of 81 children who reacted to both dairy and wheat improved when avoiding foods without these ingredients.
Dorfman says RDs can add soy products to the list of offenders. In fact, she suggests eliminating both dairy and soy from a child’s diet if he or she is prone to ear infections. Studies have shown older children can take calcium supplements, she says, adding that this approach can be effective for preventing ear infections in most children.
• Frequent upper respiratory infections: Other than geography, Dorfman says respiratory infections are similar to ear infections, so RDs can apply the same approach mentioned above. However, some children may develop seasonal allergies, which are often exacerbated by food reactions. If patients are sick year-round, focus on food. If they’re sick only in the spring, target allergies.
• Stomachaches and reflux: If your car engine started sputtering, you’d question the type of gas you used. The same holds true with your stomach, Dorfman says. If your stomach doesn’t like a particular food or food ingredient, she says it can lead to pain, reflux, diarrhea, cramps, gas, or bloating.
“If patients have stomachaches every day, it has to be something they’re eating every day,” she says.
The two most common causes of stomachaches are gluten and lactose. However, drinking milk also can cause constipation in children who are sensitive to casein, a milk protein. To further complicate matters, Dorfman says children may react to casein but not lactose or vice versa. However, many people who experience trouble with gluten are also lactose intolerant.
The most common cause of reflux in babies under the age of 2 is their formula or a breast-feeding mother’s diet. Dorfman says changing the formula or the mother’s diet usually eliminates the reflux.
• Rashes: Kids often eat too much processed foods and not enough nuts, seeds, olive oil, or other basic essential fats. Poor fat consumption can cause a wide variety of symptoms, including “chicken skin,” Dorfman says. Unfortunately, this condition is often misdiagnosed as keratosis pilaris, a skin condition in which red bumps appear on the upper arms, thighs, and cheeks.
If patients have bumpy skin and their diet reflects a lack of essential fatty acids, suggest they change their diet to include essential fats found in foods such as walnuts or olive or flaxseed oils and take fish oil capsules, a quick fix that provides the proper fats and will clear up this type of rash.
• Picky eating: Not all children who are picky eaters suffer from behavioral issues. Sometimes, the problem can be physiological, Dorfman says.
“You should know the common symptoms, like excessive drooling, eating tiny bites, taking an hour to eat, preferring to drink rather than eat, or eating only foods with similar textures,” Dorfman says, adding that such children may have a sensitive gag reflex that can lead to choking and the fear of trying new foods. She tells the story of one child with a history of food allergies and sensitivities that has never been resolved, so his stomach never feels well. Since eating isn’t fun, he routinely skips meals and is underweight. While extensive allergy tests are planned, she suspects he’s allergic to eggs and nuts since they’re a big part of his daily diet.
Dorfman believes many doctors don’t suspect food as the source of childhood illnesses, so it’s up to RDs to fill in this nutritional gap.
— Carol Patton is a freelance journalist in Las Vegas who covers health-related topics for various publications.
