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Thursday, May 13, 2010

Thursday Table Talk: Living and Working with Children with Food Allergies

Living and Working with Children with Food Allergies

By Tonya Sakowicz

Living and working with children with food allergies can be a challenging task, but also one that you can turn into something fun!

There is still a fair amount of misinformation circulating around the internet and even within the medical community about food allergies, so I am going to share the basics first, some tips, tricks and ‘rules’ about working with food allergic children and finally some easy substitutions for common allergy items.

Many doctors, midwives and lactation specialists will tell moms that allergens cannot pass through the breast milk (or, if a baby is having an allergic reaction, that they are allergic to breast milk itself which is actually quite rare), but that is not true. Allergens can and do pass through breast milk so moms do need to be aware of what they are eating to try and narrow down what is causing an allergic reaction if they notice one. One of the most common ones seen that passes through breast milk is dairy proteins and it is one of the first items I recommend moms eliminate from their diet if it appears their baby is having an allergic reaction. In my personal experience, my children also reacted to wheat, peanuts and fish/seafood in my diet.

Another common mistake often passed on, even by doctors, is that children do not/cannot have food allergies. This is also not true. This misconception comes from the fact that children often outgrow allergies as they get older so it is assumed that their reaction to the food (or even on an allergy test) must not have been a true allergy. It is also possible for children to test negative on an allergy test and yet still have an allergic reaction to certain foods. And in fact, it is most likely a true allergy but they simply outgrew it. My son was allergic to wheat, dairy and peanuts and by age 5, had outgrown all 3. His dairy allergy was considered a level 4 allergy (the most severe reaction on a test) and we were told it was likely he might never outgrow it, but we were vigilant and fortunately he did. The fact that he outgrew his peanut allergy is nearly miraculous as it is incredibly rare to outgrow a peanut allergy.

Although children can be allergic to anything, the most common allergens are often referred to as “the Big Eight” and are as follows: Dairy, Wheat, Peanuts, Soy, Eggs, Corn, Tree Nuts, Fish and Shellfish. The FDA now requires that all 8 of these are listed on packaging by food manufacturers ( This helps you identify which manufactured foods have the allergen you are trying to avoid and not avoid. Fresh foods such as meats, fruits and vegetables, etc are not usually labeled in this manner, even if they are prepared or marinated in the store.

A common mistake many people make is assuming because a food was safe when purchased before, it still is safe. In fact, manufacturers often change their inert ingredients or the sourcing of their ingredients based on cost and so something that was allergen-free last time you purchased it may not be this time. You have to read labels every time to ensure the safety of the children in your care.

It is also important to know all the ‘hidden’ forms of the allergen you are trying to avoid. For example, if a child has a dairy allergy, there are many, many food items that need to be avoided that do not seem obvious: Coke and other dark colored sodas is a good example. Aside from the obvious negative health implications of these drinks, dark colored sodas contain ‘caramel coloring’. Caramel is dairy-based and while not all caramel colorings contain dairy, you have no way of knowing which does and does not, so all dark colored sodas need to be avoided. Another one is Vitamin Water and many other (not all) waters with electrolytes. Electrolytes are often made from dairy-based products (although Pedialyte is dairy-free) and so their labels need to be read carefully. Do your research, talk to the child’s doctor and make sure you keep a list of hidden allergens with you when you are shopping or choosing a food item for an allergic child.

Going out to eat can be a nightmare with children who have food allergies. Think those Mc Donald’s French fries are just potatoes cooked in vegetable oil with salt? Think again. Not only does Mc Donald’s ‘doctor’ up their oil to make it taste more like the lard they used to use to fry their foods, but they also use a special coating on their fries to make them taste so good. Mc Donald’s fries actually have both dairy and gluten (wheat protein) in them. And that chicken breast you bought because nuggets obviously have breading on them? Yep, that too! It is marinated in a solution that has dairy, gluten and soy. And don’t assume that because a restaurant makes their French fries from a fresh potato they are safe either. You have to know what else they cook in their oil (fish anyone?), what kind of oil they are frying with (Peanut oil?) what is in the seasoning they put on their fries (Red Robin uses their proprietary seasoning blend—dairy, soy and gluten at last check), if they coat them prior to frying (corn flour to crisp them up) and you have to request they use all new utensils, bowls, strainers, cutting boards, etc… when they are handling the food to prevent cross-contamination with allergens. Depending on the level of severity of the child’s allergies, going out to eat may just have to be crossed off your list unless you live in a large city where you can find a Vegan (different than Vegetarian!) restaurant, but even then you have to deal with corn, wheat, nut and soy possibilities. However, this at least minimizes the number of possibly allergens you will be exposed to and gives you a few more options. I have simply found it is easier to get the kids involved in finding and making their own foods and going out for picnics and as long as the kids are part of the process, they don’t seem to mind.

One thing I always do is carry Benadryl with me at all times for the milder but instant reactions such as itching and swelling and in cases where it has been deemed medically necessary (including for my daughter); I carry an Epi-pen. It is important to know the correct dosing based on weight for Benadryl, especially for smaller children since it will not have that information on the box. Ask the child’s pediatrician or allergist to be sure—what they will tell you is often different than a pharmacist because the medication is being used differently than the typically prescribed use. And if a child in your care requires an Epi-pen, it is important that you get a hold of an Epi-pen trainer and learn how to use it properly. Educate yourself on the signs of an anaphylactic reaction and how to care for it. I also always carry the phone number of the pediatrician and the child’s allergist.

As my son got older, we began to make a game out of finding foods that were safe for him to eat and exploring new recipes. It became our own personal scavenger hunt and he did not feel so ‘different’ from the other children. We made gluten-free pizza crusts together and put them in the freezer so when he was invited to a pizza party, we could make his pizza and take it with us. We experimented with gluten, nut and dairy-free cake and muffin recipes and once we found some he liked, we made those and put them in the freezer so he had treats to eat/share also when school had parties or when he was invited to a birthday party. We learned together that sunflower nut butter (not a nut at all) tastes JUST LIKE peanut butter and makes great cookies. We learned that not only does olive oil and garlic salt taste great on quinoa (gluten-free) pasta, but that it makes a super-healthy alternative to the traditional kids favorite of noodles and butter. We learned early-on that if you expose a child to healthy alternatives to ‘traditional’ foods, not only does that child develop a taste for them, but he/she actually becomes a healthier child and finding yummy foods to eat can actually be a lot of fun!

Some great allergen-free food items and ingredients are being made these days and more and more hit the market every year as the prevalence of food allergies becomes more obvious. It used to be that you could only find these items by mail order or through specialty stores. Now most mainstream grocery stores carry many, many items that are allergen-free.

Some commonly available substitutions:

For Dairy: Soy based products, Coconut (not an actual nut) based products, rice based products, hemp based products, nut based products and for those with mild dairy allergies or intolerances, goat’s milk based products. It is also being discovered that many people with dairy allergies can tolerate raw cow’s milk products, but do not give these to the children in your care without parental/doctor’s permission since they are not pasteurized. Many of these products are so good you cannot tell the difference in taste or texture.

For Peanuts: If the child is not also allergic to Tree nuts, then there are a multitude of options available that are almond and cashew based. There are also soy and sunflower based products for those who cannot have any nuts at all.

For Eggs: There are egg-free baking substitutes and in some cases, applesauce will work.

For Fish/Seafood: There are no great substitutes, but I have found canned chicken works quite well in some recipes.

For Soy: This is probably one of the hardest because in and of itself since soy is not often consumed in its natural state except for edamame, but it is a common ingredient in a huge number of foods, so it is important to find those which are soy-free.

For Corn: Like edamame, there is no real great substitute for the raw product, but most grains will substitute quite nicely for corn-based flours and meals for baking.

For Wheat: Quinoa, Amaranth, Rice, Soy and a multitude of other flours and baked products, pastas, etc… are available to substitute for wheat (important note: wheat-free and gluten-free are two different things. Gluten-free will always be wheat-free, but wheat-free is not always gluten-free.).

Life with a child who has food allergies is not always easy and can sometimes be downright scary, but if you try to take an attitude of it as an adventure and are willing to put in the time and effort, you can make it less difficult and even outright fun and tasty for the special child in your life.

Tonya Sakowicz is a INA credentialed nanny with over 20 years of nanny experience. During that time, she worked with several children with food intolerance or allergies. 5 1/2 years ago she became a mom to a little boy who had severe allergies to wheat and dairy and and a mild peanut allergy. Her little girl, now age 2, has dairy intolerance and severe fish and seafood allergies. Tonya has served on the board of NAN, as a special committee head for INA in their Nanny to Nanny Mentor Program for several years and has taught at many of their National Conferences. Tonya was voted the Professional Childcare Provider of the Year in 2003 and nominated for the International Nanny Association Nanny of the Year in 2004. In addition, that same year, she was deeply honored with a nomination by her peers for the National Association of Nannies Harriette Grant Memorial Award. Tonya currently works as a Newborn Care Specialist, primarly doing consultations on sleep issues, reflux and food allergies.
Tonya Sakowicz, Nanny Answers


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