The Childrens Clinic

It is easy to blame the mother

CC-Admin — Sun, 12 Feb 2012 22:39:08 +0000

In clinic. Just seen a distressed mum and a distressed baby boy, 10-month old. He is not sleeping, crying, screaming and waking every hour or so. Also, not eating and will only suckle from the breast. He’s not growing, he’s losing weight. Mother has sought help from a lot of different doctors and a paediatrician – she says she feels blamed for her child illness.

“Every time I go along to the doctors, I feel bashed down. It’s like hitting my head against a brick wall. I began to think that I must be going insane. I became suspicious that it was all in my head.”

Yes. It is all so easy to blame the mother … or blame the child for bad behavior.

But this baby has gastro-oesophageal reflux disease. He screams with food. He had colic and reflux early on. He needs medication to treat his heartburn. I expect him to be better very soon. We need to treat children seriously … it is not okay to blame the mothers.

The Childrens Clinic helps lots of these misunderstood families

Dr Rodney Ford

Next best after breast milk – what formula?

CC-Admin — Thu, 09 Feb 2012 21:06:58 +0000

What Formula should my baby have? This is the desperate question that many mothers ask me. They know that cow’s milk is making their baby sick, and now they are searching for the best alternative. They are ready to wean, but they are unaware of the various choices and what will best suit their baby.

Correct formula feeding is very important

There is no question that “breast is best”. However, it is important that a “next-best” option is available. This is otherwise known as artificial or formula feeding. The decision of how to feed a new baby is not a menu choice. Formula feeding is not equivalent to breast feeding. But it is an important strategy in some food allergy children.

What is a “Formula”?

A formula is a combination of food components that are manufactured to be as close as possible to the food value of breastmilk. At this stage these formulas do not have the same biological advantages of breastmilk and will never capture to depth of breast feeding. However, they are an important part of nourishing children.

Possible food and nutritional components in formula

Protein: Cow’s milk casein & whey (standard cow’s milk formulas).
Goat milk casein & whey. (Karicare Goat)
Cow’s milk hydrolysates. (Pepti-Junior)
Amino acids (Neocate, Elecare)
Soy protein (Karicare soy, Infasoy S26)
Carbohydrates: Lactose, Glucose, Corn starch
Fats: Polyunsaturated fatty acids (PUFA)
Minerals (calcium, iron) and vitamins
Fibre and prebiotics.
Added thickeners (the AR anti-reflux milks)
Water

Some concerns of formula feeding

Infection: sterilization of bottles, teats, storage of made up milk.

Cow’s Milk Intolerance: 5% of infants develop cow’s milk intolerance. As up to 40% of infants with gastro-oesophageal reflux have been shown to have cow’s milk intolerance.

Anaemia: unmodified cows milk feeding is associated with iron deficiency anaemia.

Obesity: growth rates of formula fed babies is faster. Feeding may not be well regulated.

Intestinal flora: lactobacillus, acidophilus growth is important.

What Formula are available for my baby?

Breastfeed for as long as you can. Breast milk exclusively to 4-5 months and then add solids from 5 months – keep breastfeeding to 12 months if possible. But there comes a time when formula feeding is a good for your baby. What are your options?

Cow’s milk

Standard cows milk formulas are based combinations of casein whey proteins.
Whey-based formula are usually recommended for a start.
Follow-on formulas have a little more iron and are for babies over 6-months old.
Anti-reflux (AR) formulas have added thickeners to help reduce vomiting.
Lactose-free formulas are for lactose intolerance but not for babies allergic to cow milk

Other formulas (see dairy free formula)

Goat milk (can have similar problems to cow’s milk)
Soy milk (needs to be fortified – some concerns with phyto-oestrogens)
Rice “milk” (lacks adequate proteins)
Special milks (see Special milk formula):
Partial cow’s milk hydrolysates (known as HA hypo-allergenic formula).
Extensive cow’s milk hydrolysates (such as Pepti-Junior)
Amino acids based formula (such as Neocate and Elecare).

We can help you work out the best formula for your child at the Childrens Clinic | Allergy Centre

Unsettled baby syndrome! Rubbish

CC-Admin — Tue, 20 Dec 2011 18:46:12 +0000

Lilly, by four days old, she was constantly screaming, distressed, and hard to feed. She was going rigid and vomiting. She developed eczema and had intermittent blotchy red rashes.

Her local paediatrican gave her an odd diagnosis of the “unsettled baby syndrome” – he said that there was nothing wrong, and that she was a “normal’ baby. Lilly’s mother was amazed and felt frustrated.

At the Childrens Clinic, we made the diagnosis of gastric reflux from a cow’s milk allergy. We put this poor Lilly on a special dairy-free formula (Neocate).

She is now “a different baby”. She is smiling, gaining weight, and her rashes have gone.

“Unsettled baby syndrome” was a ridiculous diagnostic label. It means nothing and was of no comfort or use to her parents.

Who needs a gluten test?

CC-Admin — Tue, 13 Dec 2011 00:35:10 +0000

“What a great video. This is so helpful and I will be going for a blood test shortly.” – says a grateful viewer.

This YouTube has over 18,000 views – so happily it must be helping a lot of people understand who needs testing and what test to get.

Gluten sensitivity and coeliac disease are such common problems, but often not tested for.

Who needs a gluten test? Dr Rodney Ford

Food colours/additive hyperactive worry

CC-Admin — Thu, 08 Dec 2011 22:14:13 +0000

At least 60 food additives used in our foods which are questionable in terms of safety, or at worse, known to be harmful.

This has been highlighted by this campaign: http://www.additivealert.com.au/

Food additive colours on to-be-banned list are:
102, 104, 110, 122, 124, 129

Five years ago, studies from the University of Southampton UK (2007) confirmed that these 6 colours could cause hyperactivity in children. http://www.thelancet.com/journals/lancet/article/PIIS0140673607613063/abstract

As a result of this research, these 6 colours are being removed from ALL foods in the UK. But they a still in many of the coloured food in New Zealand.
For your children’s sake, please keep these harmful food additives out of their diet.

GORD (Gastro-Oesophageal Reflux Disease) caused by milk allergy

CC-Admin — Wed, 07 Dec 2011 23:50:48 +0000

Cows Milk Protein Allergy (CMPA) is the underlying cause in up to 40% of infants suffering from gastric reflux.

A recent review of GORD and treatment with acid suppression stresses that Cows Milk Protein Allergy (CMPA) is the underlying cause in up to 40% of infants referred for specialist management of GORD (Gastro-Oesophageal Reflux Disease) – yes, this is more evidence that gastric reflux is often caused by a food allergy/intolerance. Check this out. Special infant formulas are often needed. If your child has continuing gastric reflux symptoms, then a CMPA or a gluten sensitivity could be the problem. Get tested.

http://www.bpac.org.nz/magazine/2011/november/infant_reflux.asp

Oats – can they be part of a gluten-free diet?

CC-Admin — Thu, 01 Dec 2011 21:30:47 +0000

There has been controversy for years as to whether it is okay, or not okay, to eat oats if you are gluten-sensitive.

Clinical studies have now provided very good evidence that oats do not damage the gut mucosa in most people who have coeliac disease. Following this, guidelines from some Coeliac Societies now accept that moderate amounts of oats can be consumed by most coeliacs without risk.

Many experts concerned with coeliac disease have now concluded that oats are safe for coeliacs, as long as they limit their consumption to amounts “found to be safe” in these research studies. This quantity is up to one-half cup of dry whole-grain rolled oats per day. Of course, any oats that are consumed need to be free of any contamination from other grains.

Half a cup of oats each day is usually okay

Here is some of the information that this opinion is based on:

A study in Finland looked at 52 coeliacs who were in remission and who had been on a gluten-free diet for more than a year. They all had a duodenal-biopsy, then they ate about 50 grams of oats (half a cup) per day over the next six months. Finally, they had a second biopsy. None of the people had any villus damage.

Your gut can heal whilst eating oats

Another group studied 40 newly diagnosed coeliacs in the same way. As expected, their initial biopsy showed significant villus damage (this was of course because they were still on a gluten-containing diet until they began the study). These people started on their gluten-free diet as well as eating their 50 grams of oats each day for 12 months. At the end of the year, their biopsies showed no damage to their villi. The meaning of this study was that their damaged villi were able to heal while eating oats.

A few people get unwell eating oats

However, other studies have found that not all people with coeliac disease are able to tolerate oats. Especially, those who also have dermatitis herpetiformis. Researchers report that although oats are well tolerated by most coeliacs, they did find a few exceptions. Several people recounted initial abdominal discomfort and bloating. A few patients have been found to eventually develop total villous atrophy during an oat challenge.

Yet another study has investigated 20 adult coeliacs who were in remission, to see if they could eat even larger amounts of oats in their daily gluten-free diet. They consumed about 100 grams (one cup) of uncontaminated rolled oats in their daily diet for over a year. They were tested four times during the study period. This included small bowel endoscopy and blood samples. They experienced no gut symptoms. Also, there were no adverse effects seen in small bowel histology or in their blood test results. The conclusion was that the vast majority of adults with coeliac disease could include large amounts of rolled oats in their diet without problems.

Oats have also been studied in children. A group of ten children with coeliac disease were investigated at the time of their diagnosis. They were put on a gluten-free diet but they were also eating about 25 grams (quarter of a cup) of rolled oats each day. After six months they were tested again. There was improvement in both their small bowel histology and their tissue transglutaminase antibody results.

Children tolerate oats well

However, there is still a word of caution. Oat proteins have been shown to trigger the immune response of cells taken from coeliac people. Therefore, the long-term effects of oat cereal added to a gluten-free diet in children still need to be determined.

Oats are useful fibre

The ability to use oats in your diet gives an important source of fibre as well as other important nutrients. This is very important in children who have other food allergies. If you are also allergic to cow’s milk and eggs, then going gluten-free is a big task. Therefore, if oats can be tolerated, this makes food planning just a little bit easier.

Each person will have to work out whether or not they can tolerate oats for themselves. This needs to be determined both clinically and with follow-up blood tests.

Finally, some gluten experts have expressed some further concerns about oats. These are:

Some food chemistry research studies suggest that avenin protein in oats does have toxic properties.
The purity of oat products in some countries is suspect. Oats and oat products can inadvertently be contaminated with wheat. This can occur during harvesting, milling and processing.
There is a possibility that gut damage from oats takes longer than six to twelve months to show up. Also, symptoms might not be readily apparent to the person.
The possibility that young children might have a higher cross-sensitivity to oats because of their relatively immature immune system.

These are real concerns. It is important that gluten-sensitive people know about the oats story. Whether or not they choose to eat oats, they should be under some sort of regular medical evaluation and supervision. However, the common opinion is that the long-time consumption of oats as part of the gluten-free diet is well tolerated among the vast majority of those with coeliac disease.

Dr Rodney Ford
Food allergy and Gluten expert

He will just grow out of it!

CC-Admin — Mon, 28 Nov 2011 18:50:47 +0000

How many times have a heard this. I have just seen a boy with severe eczema, food allergies, who is quite miserable. His mother is doing the best that she can and each time she takes him to her doctors they say “he will just grow out of it”. How irritating for the parents to hear this each time. This means that his doctor does not know how to manage allergies and is just fobbing these parents off.

The same doctor is unlikely to say “just get over it” to an adult with Rheumatoid Arthritis or Heart Disease. In my opinion, established disease which causes symptoms should be managed – not ignored! Children with eczema and other allergies can very much be helped. Start to think about food allergy/ intolerance.

In our allergy clinic (the Childrens Clinic | Allergy centre, Christchurch), every day I see children who have been suffering with allergies for years but without anyone really getting to the bottom of the problem. These children need investigation (usually skin tests or blood tests). Their allergies need to be clearly documented and a management plan implemented. This is what we do in The Children’s Clinic: where we take allergies seriously.

New to food allergy – what to do next?

CC-Admin — Mon, 28 Nov 2011 00:49:17 +0000

When your child has just been diagnosed with food allergy, you probably will want some help as to what to next.

We interviewed a group of mothers who had recently attended their appointment at the Childrens Clinic | Allergy Centre. Their children had been diagnosed with food allergy. We asked them how we could help them more. They said that they would like to know:

What to do first, when feeling so overwhelmed.
How strict does an elimination diet have to be.
Advice on what children can eat once they have finished formula: a list of practical allergen free foods, especially breakfast and snacks.
A phone number of the support group: many mothers said that it would be good to talk with other mothers who have gone through similar experiences.

The shops in Christchurch that supply dairy- egg- free foods.
About egg replacer, where to get it and how to use it.
The alternative foods that supply calcium to their child’s diet.
When their child comes off the formula, how do they know that they are getting all the nutrients they need.
What are the alternative sources high nutrient foods that can replace dairy, egg and nuts.
Practical recipes that are egg-free, dairy-free and nut-free.

A detailed list of what foods their child can have, and must avoid (for example: soy sauce, sesame seeds, dressings, preservatives, colourings, gluten-free products).
More ideas of how to cook with Neocate/ Elecare / Pepti-Junior special infant formulas.
More information about anti-histamines, when they sould be used, as well as side effects.
More about the progression of food allergy, when might the child outgrow the problem.
When is it a good time to see a dietitian? Is their child is getting all the nutrients he needs.
Is it safe to completely eliminate all dairy and/or egg from the diet.
More help in reading food labels.

These are the questions that you are asking for more help. So we have answered all of these in detail. We have also produced you a practical and easy-to-use set of recipes so that you can feel confident your giving your child a fully nutritious diet that avoids milk, egg and nuts.

We have also gathered a list of useful websites related to buying safe foods for your child (we have asked these firms to check through and make sure that this information is correct).

If we haven’t been able to answer your questions, please let us know and we will help you even more.

Gluten tummy now better

CC-Admin — Thu, 10 Nov 2011 00:38:01 +0000

Just seen another gluten sensitive boy in the Childrens Clinic (Christchurch). I saw Julian who is 7 years old. He came for his follow-up appointment.

His main symptoms had been: recurrent abdominal pain (’my tummy aches’), feeling ‘yucky’ and looking pale. His blood tests showed up: a high IgG-gliadin (this is a positive gluten test) but normal tTG (this is a negative coeliac disease test). He does not carry the celiac gene.

Because of the high gluten blood tests, he went onto a gluten-free diet 3 months ago. Mum says:

“He is a different child, Julian no longer has any of his tummy aches, his colour is so much better, he has energy again and he got his spark back. Also his appetite has picked up … he is eating just so much better. And yes … his poos are now normal again … no longer runny. I have noticed that if he eats even a small amount of gluten food he complains to me ‘I feel sick’. He is so much better gluten-free. Thank you.”

__________________________________________

He is a typical gluten sensitive child. This is a common diagnosis for the children who a “sick, tired and grumpy”. We test all children for gluten sensitivity/ intolerance /coeliac before suggesting a gluten-free diet.