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Posts for category: Food and Nutrition

By Diji Vaughan, MD
February 11, 2013
Category: Food and Nutrition

 

Diverse symptoms ranging from an infant “spitting up” to overt vomiting or diarrhea or colic are very common in newborn infants. Abdominal pain, flatulence and constipation tend to be more common in older children. All these symptoms often bear a timed relation to the ingestion of the suspected food item when parents notice them and the perception of a probable allergy or food intolerance is made as a result. The diagnosis of food allergy is beyond the scope of this article, however once the diagnosis is established, strict avoidance and elimination of the culprit food item becomes medically necessary. The Food Allergen Labeling and Consumer Protection Act of 2004 mandates food packaging companies to identify products containing milk, egg, soy, wheat, peanut, tree nut, fish and shellfish on the packaging label. This allows parents to make an informed choice to avoid known allergens and exclude these from the diet of their children.

Do allergies last a lifetime once established?

Food allergies as with other disease processes affecting the immune system can vary widely in their clinical courses over time. Most studies however posit that 70%-80% of patients outgrow milk and egg allergy, 60% to 70% outgrow soy and wheat allergy, and 10% to 20% outgrow peanut and tree nut allergy. Repeat assessment by your physician or allergy and Immunology specialist may be necessary with an updated patient history before conclusions about ‘outgrowing” a specific allergy can be made with certainty. These can be done yearly, but it is noteworthy even from above numbers that peanut, tree nut and fish along with shellfish are less amenable to “outgrowing” and repeat testing may need to be less frequent in these cases.

What do I do, if I’m accidentally exposed to a known food allergen?

The approach to care would depend on the appearance and severity of symptoms. Immediate reactions or those that occur within a few minutes or delayed reactions occurring many hours later are both common. They may be mild and benefit from comfort measures that often include anti-histamines. Anaphylaxis is a medical term used when severe allergic reactions involve multiple body systems after exposure to a known or unknown allergen. These reactions may affect, the skin, the gastrointestinal or respiratory systems commonly. Indeed any body system of tissues and organs can be involved in a severe allergic reaction like anaphylaxis. They are life-threatening emergencies. The epinephrine auto-injector comes in two strengths for different patients depending on their weight. These are administered via injection into the muscle through clothing in an emergency. Every child or adult with a known food allergy should carry one or have immediate access to one at all times. Observation in a medical facility after use of epinephrine is necessary and activation of the emergency medical service afterwards is recommended in our practice.

By Diji Vaughan, MD.,FAAP
February 02, 2013
Category: Food and Nutrition
Tags: food allergy   IgE testing   allergic  

 

Food allergies have become extremely common in our collective daily experiences. I recently got my turn to buy snacks for my daughter’s kindergarten class and was impressed by the lengthy allergy list, as I kept glancing at it furtively for compliance while I raced through the snack aisle at the store.

8% of US children are currently affected by food allergies and recent epidemiologic trends reveal a progressive rise. In keeping with this quasi rule of 8’s, largely just 8 food groups cause this rather impressive prevalence of food allergies. These are milk, egg, peanut, tree nuts, wheat, soy, fish and shellfish. There has always been a hasty approach by parents to designating children as having food allergies. We need to remember that allergy have a very specific immune mechanism and that not all adverse food events are truly allergic. Some are more appropriately food intolerances. The distinction is important because it’ll help our understanding of the intriguing world of immunology and how diagnostic testing for immune mediated (allergy) diseases however enchanting can fall short of correctly identifying true allergies. The quality of life issues and fall out that follow an incorrect food allergy designation can last a lifetime and affect socialization and frankly gustatory delights that’ll make the Travel Channel’s, Anthony Bourdain jealous.

How are food allergies diagnosed?

The medical history is very important and providing your healthcare provider with a good run of events preceding and surrounding the sentinel allergy event is a great start. We encourage the use of a diary and conscientious documentation of food items ingested. The importance of this chronicle of foods eaten, was it cooked? baked or eaten raw? and reactions observed cannot be overstated. How soon after exposure did the symptoms occur? What symptoms were observed? Because often, the careful identification and informed elimination of the likely culprit(s) may be all that’s necessary. Diagnoses of food allergies or intolerance can be made this way and when done appropriately fall into the very high pedigree of statistical accuracy called “ a trial of 1”. Specific blood testing looking for presence of antibodies to food allergens by measuring the levels of the antibody most commonly associated with allergies, called IgE are common in everyday clinical practice. When this is combined with a skin-prick test, the diagnostic accuracy improves. It would be fine if the immune system were as simplistic as that. A system that’s so uniquely adapted and continually evolving to memorize every invader that’s ever breached its defenses and program itself to make antibodies or get cells battle ready to stop that invader or others related to it next time they get lucky enough to get inside while maintaining surveillance for cancer cells and preventing the body from turning its own more than a billion troop of soldiers on itself surely would be more complicated. It is! There are food allergy mechanisms that by-pass the process above, termed non- IgE mediated or use some combination of it with other mechanisms. Blood or skin-prick testing would not readily detect these. It is also possible to find a positive test as described above to food a child is eating presently without any difficulty. This is where a careful patient exposure and observed reaction history is truly worth its weight in gold. This eliminates indiscriminate testing and optimizes the physician’s chances of correctly making the food allergy diagnosis.

To be continued next week…

By Springfield Pediatrics- Dr. Diji Vaughan
June 30, 2012
Category: Food and Nutrition

 

Humans are the only species that routinely ingest the milk from other species, our hierarchy on the food chain confers that ability to all of us and there are distinct nutritional advantages and health benefits to that. Our newborn infants, time and again have been shown to fare better when nourished with human milk. The inherent advantages apparent in any infant fed human milk are legion and won’t be exhausted in this post today.

With about seven billion of us on God’s good green planet today, racial and ethnic diversity the world over would be instinctively expected to lead to different growth patterns in our newborns respectively along these lines - aaah!, Not so, if they are all breastfed newborns. Scientific data drawn between 1997 and 2003 from six different geographic sites across the world by the World Health Organization showed this to be the fact. The sites were, Pelotas, Brazil; Accra, Ghana; Delhi, India; Oslo, Norway; Muscat, Oman; and California, USA.

The researchers generated a question, that infants and young children have the potential to grow similarly, regardless of their race/ethnicity and place of birth, if they are breastfed, living in a safe healthy environment, and have adequate nutrition. This study answered the question in mathematical certainty with the answer, yes. The average growth measurements from birth up to 24 months in the 6 country sites were virtually identical.

The new standard for tracking growth parameters in the first 2-years of life has now changed to the growth curves generated from the above study sponsored by the World Health Organization as it more accurately reflects what the ideal growth pattern should be for a given newborn. All newborns will now be compared to this standard and the use of the new WHO growth curves is now recommended in the USA.

Join us in our advocacy for breastfeeding and feeding of human milk exclusively in the first 6-months of life followed by continued breastfeeding as complementary foods are introduced, and the continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. The medical contraindications to breastfeeding are uncommon and concerns along these lines should be discussed with your physician before deciding to discontinue breastfeeding your newborn as result of a medical condition. 

 

Breast milk really is best! and the way to go through the first year of life. As the number of mothers who want to breast feed their newborns continues to increase in our experience, we’ve decided to address the issue of Vitamin supplementation for exclusively breastfed and formula supplemented newborns in this post. The recommendations addressed here apply to full-term healthy newborns between birth and 12-months of life only. Additional considerations would apply for newborns who do not fit into this category. The element, Iron and Vitamin D will be discussed.

Iron is a key element in body cells and for biochemical processes. It’s many benefits and need to maintain adequacy of intake are protean and will not be discussed in great detail here.

Term, healthy newborns have sufficient iron in the blood cells and in storage forms in the body for at least the first 4 months of life.  Breast milk contains iron that despite it’s low quantity has been shown to be more efficiently available for absorption by the body. This goes a long way in offsetting the impact of its relatively low quantity. Recognition of the effects of insufficient iron for use by the body on blood formation, a condition called anemia which may be evident on a blood test. The body could also be dealing with insufficient iron levels without any abnormalities evident on a blood test. Their is evidence that developing nervous system is also affected by insufficient iron which can manifest as poor cognitive abilities in later life.

Newborns who are exclusively breastfed are at an increased risk of having insufficient iron available for use in the body after 4 months of life. Therefore, at 4 months of life exclusively breastfed infants should be supplemented with oral iron at this age until appropriate iron-containing complementary foods (including iron-fortified cereals) are introduced into their diet. For partially breastfed infants, the same risk above is often applicable once intake of the formula ingested in less than 500ml in a day. Therefore, beginning at 4 months of age, partially breastfed infants (more than half of their daily feedings as human milk) who are not receiving iron containing complementary foods should also receive supplemental iron at a dose determined by your physician.

Vitamin D is essential for good bone health and insufficient levels have been linked to a condition called rickets in infants and children. Bone maturation and formation does not progress as expected in children with Vitamin D deficiency.  Scientific research has in addition found an expanded role for Vitamin D in the body and conditions like type 1 diabetes mellitus as well as inflammatory diseases are being more readily identified in individuals with Vitamin D deficiency. There are limited natural sources of vitamin D in a typical diet. Nature makes up for this lapse with sunlight converting some chemicals in the skin into Vitamin D forms. Clothing and lifestyle choices in the outdoors and ethnic skin pigmentation and geographic location are some of the factors that do not easily allow for clear recommendations on what amount of sunshine is adequate for a given mother who is breastfeeding her newborn exclusively. Mother’s with insufficient Vitamin D levels will not have adequate Vitamin D in breast milk as well and will therefore, put their exclusively breast fed infant at risk for Vitamin D deficiency.

Current recommendations to ensure adequate vitamin D status have been revised to cover all infants, including those who are exclusively breastfed. These infants need to have a supplemental dose of 400 IU of Vitamin D orally daily.

There are many formulations for administering recommended doses of vitamins in eligible infants, discuss vitamin supplementation options with you doctor before administration.

 

 

 

By Nutrition
April 24, 2012
Category: Food and Nutrition
Tags: Breastfeeding  

 

My baby is crying, can I use a pacifier?

Many mothers find themselves seeking answers to this question especially in the breast feeding mothers, who often have been schooled pre-discharge not to administer anything other than the breast when a desire to breast feed is expressed. The 1998, 10 steps to successful breast-feeding issued by the World Health Organization was very clear on the recommendation not to use pacifiers or artificial nipple devices.

Will pacifier use disturb successful breast-feeding?

Breast-feeding on demand is ideal and depends on many steps some of which need to be identified in the prenatal  period during counseling and too many problems with successful breastfeeding later may have been excessively attributed to the pacifier .  This question was generated by medical researchers recently and their results were published in March 2001  in the Cochrane Database of  Systemic Reviews. They set out to assess the effects of pacifier use compared to a no pacifier use in healthy full-term newborns whose mothers initiated breast-feeding and the intend to exclusively breast-feed.

Does the scientific evidence suggest harm?

They pooled prior studies addressing this problem using rigid criteria. Cumulatively their efforts involved studying about 1900 infants. Rigorous scientific and statistical methods were applied and the results show that  the use of pacifier in healthy full-term breast-feeding infants either at birth or after successful lactation is established did not significantly affect the regularity or duration of exclusive and partial breast-feeding up to 4 months of age. The data reviewed here does not answer short term breast-feeding difficulties faced by mothers and the long term effects of pacifier use on infant health, considering that breast-feeding is often encouraged through the first 6 months of life and beyond.

Pacifier use is not in encouraged in our practice in the first 2 weeks of life. In this situation, we believe it may actually point to hidden problems with the feeding process which may later on hamper successful breast-feeding. Pacifier use may also increase the likelihood of nipple contamination and diarrhea illnesses. Some of the benefits identified in clinical practice with pacifier use however include reducing the chances of the dreaded sudden infant death syndrome since it obligates the newborn to breathe while sucking.

Mothers who are breast-feeding can use the pacifier appropriately, without feeling guilty but need to remain conscious of the fact that each mother-infant unit is peculiar and the goal of breast-feeding on demand remains key. Breast feeding on demand requires frequent feeding sessions anywhere between 8 to 25 feeds in the 24-hour cycle on the average with attendant age appropriate number of stools and voids. Prolonged use of the pacifier can significantly interfere with this process and compromise newborn nutrition and hydration especially in a hot climate like Arizona where frequent nursing helps to offset increased evaporative moisture losses through the breath and skin by the environment in exclusively breast fed newborns.