27 Oct 2008
Allergy and Intolerance in Babies and Young Children:
A Tool Box of Strategies for Managing Day-to-Day
Kay Winters, Occupational Therapist (BOccThy)
October 2008
For many parents the presentation of allergies and intolerances in their infant or young child can lead to more questions than answers. The identification of the specific allergens alone can be a time consuming (and emotional) process in children so young. Not only do certain traditional medical tests such as skin tests and blood tests not work as well for the very young, but the baby or child is unable to give feedback about what they are feeling and where they are feeling it.
Identification of allergens aside, the managing on a day-to-day basis can be an even more challenging. It is common that a parent is told what to avoid, but many are told very little about what they can have or use. Or if they are told this, they may not be told how to use it.
The aim of this article is to summarise some of the key issues associated with managing, and managing with confidence, a baby or child with allergies and/or intolerances.
Signs and Symptoms of Allergies and Intolerances
In short, the difference between allergy and intolerance is that allergic reaction involves the immune system and intolerance does not (but may involve other systems of the body).
Many true allergies involve excess amounts of immunoglobulin E (IgE), an antigen that will react with an allergen that is introduced to the body. A quick example is that of a child with an egg allergy who eats something containing egg. The IgE reacts with the egg which causes mast cells (tissue cells) and basophils (blood cells) to release substances such as histamine. In essence, the body views the egg as a foreign substance and reacts accordingly.
It must be noted that allergies can involve other immunoglobulin reactions such as IgA’s, IgM’s and IgG’s. Parents should seek professional advice for more information on this.
Intolerance is the body’s inability to properly deal with something and is more common than true allergy. For example, someone with lactose intolerance doesn’t have enough of the required enzyme for the breakdown of the lactose.
Table 1: Signs of allergy and intolerance
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Skin
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hives, eczema, dermatitis, swollen hands and feet, frequent nappy rash, red rash around the mouth
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Ears
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recurrent ear infections
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Nose
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runny nose, sneezing, itchy nose, hay fever symptoms, nasal congestion
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Mouth
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excess saliva, excessive dribbling, frequent mouth ulcers, sore tongue,
coated tongue, cracks on tongue
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Eyes
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puffy eyes, red eyes, red rims, dark circles under eyes, watery or “leaky”
eyes, conjunctivitis
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Respiratory
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congestion, “rattling”, persistent cough, asthma-like symptoms
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Limbs/Joints
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leg aches, restless legs, sore muscles and joints
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Gastro-Intestinal
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stomach cramps, stomach pain or discomfort, distended stomach, vomiting, reflux, bloating, flatulence, rash around the anus (very red on the anus itself), diarrhea, constipation, bed wetting
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Head
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head ache, migraine
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Behaviour
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night waking, fatigue, frequent crying, behavioural problems or behavioural changes, hyperactivity, irritability, colic, screaming
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Growth
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“failure to thrive”, poor weight gain, poor growth, loss of appetite, excessive appetite (eating to try to stop the stomach ache)
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Anaphylaxis
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breathing difficulties, faintness, unconsciousness, severe asthma-like symptoms, rapid heartbeat, irregular heartbeat, heart failure, low blood pressure, throat tightness or swelling, tingling feeling in lips or mouth, vomiting, cramping stomach pains, nausea, diarrhea, flushed skin, sweating, facial swelling, severe itchiness of skin, hives
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Obviously many of these symptoms could indicate other health conditions, so consider two rules of thumb. Firstly, the more of these symptoms in place at the same time then the higher the chance that there may be allergies or intolerances present. Secondly, seek professional advice before self-diagnosing.
Adjustment of Perceptions and Expectations
When a new baby arrives things such as getting enough sleep can be challenging at the best of times. The addition of allergies or intolerances adds a whole new dimension. There is a choice in the way this is viewed however. A parent can choose the “poor me” and “it’s too hard” approaches which will lead to further frustrations and emotional upheaval. An alternative approach is to accept the situation, look at what is to be gained out of it and to expect that suitable strategies for managing will be found.
It is easy for a parent in this situation to focus so much on allergy issues that little time is spent simply enjoying their child. Another common focus is on the “can’t have” or “can’t be exposed to” rather than the “can have” and “can enjoy doing”. Think about these things!
The reality is that a shift in the way you manage day to day tasks is often necessary to help you cope. Take a good look at your current expectations about issues such as where you shop, what you buy, how long you expect to spend in the kitchen and how hard you consider cooking to be. The difficulty level is only as hard as you make it. Alter your perceptions and all of a sudden the way you manage can change.
Making An Informed Choice About Investigation and Treatment Options
The investigation types that are considered orthodox include skin testing, patch testing, blood testing and a controlled elimination diet. There are however restrictions in using some of these tests including limited application with very young children and the ability of some of the tests to pick up true allergies only. A controlled elimination diet process remains the most effective orthodox method of identifying individual allergies and intolerances in this age group.
There is a range of what are considered unorthodox investigation methods touted as helpful to the identification of allergies and intolerances. The authors personal viewpoint on these is that some are useful as tools if the right practitioner is found and if used in combination with an elimination diet process. There is no substitute for careful observation! Some examples are:
§ Kinesiology involves the use of muscle testing to identify imbalances within the body. It can help to identify “where to start” when working out exactly what to eliminate out of the diet. It can also be helpful to identify what supplements (eg. for gut function repair) that are more likely to be suitable for an individual. A Kinesiologist with nutritional qualifications is recommended in this instance.
§ Live Blood Analysis is where a drop of blood is taken and observed through a microscope. Information is then gained about nutritional deficiencies, organ-system dysfunctions, gut permeability, digestive health, antioxidant levels, free-radical load, certain biochemical imbalances and immune activity. Whilst this technique cannot identify specific allergens, it has great merit as a tool for identifying certain deficiencies and dysfunctions that may be impacting on allergy or intolerance levels, as well as providing a visual on improvements that are made.
§ Iridology involves study of the coloured part of the eye to determine potential health problems and provides information about the state of body organs and systems. This technique also has merit as a tool for identifying certain deficiencies and dysfunctions that may be impacting on allergy or intolerance levels. Iridology can establish if a persons system is having an abnormal reaction to food, however it cannot distinguish which food.
§ Hair Analysis is used to give an indication of mineral levels, nutrient levels and toxic metal levels. This can therefore be used to identify supplements to assist with issues including gut function and nutrition, factors which are known to impact on levels of allergy and intolerance.
Other alternatives for allergy identification include:
· Bio-Dermal Screening, a procedure used by some medical practitioners and other health care professionals. A double blind study of this safe and non-invasive technique against other forms of allergy and sensitivity testing was performed in the United States, and it was shown that it is as good as and in most cases better than blood and scratch testing and only marginally less effective than food re-challenge tests.
· Bio-Resonance Therapy (or BICOM Therapy). This is also a safe and non-invasive procedure.
Treatment options are another area of potential controversy. There are a range of interventions available, with variable results reported. The author recommends that parents speak with a range of practitioners to gain an understanding of what is involved, the cost and the potential outcome of each treatment type. An informed decision can then be made regarding treatment. Options to consider include:
§ Medications
§ Desensitisation / Immunotherapy
§ Chinese Medicine / Acupuncture
§ Nutritional therapy (eg. calcium to decrease histamine levels)
§ Various allergy elimination clinics
§ Bio Resonance
Finding Out What Your Child CAN Have, Not Just What They Can’t Have
A common scenario is that of a parent being told that their child should avoid things such as wheat, dairy and egg. The question for many who have been accustomed to a “standard” diet is of course “how?”. Becoming familiar with the range of alternatives in the early stages enables parents to incorporate these alternatives into the investigation process and thereby identify what their child is able to have.
This process is not limited to foods. Becoming familiar with potential allergens in areas such as personal care products, environmental factors, animals, cleaning products, chemicals, pollens, synthetic materials and fragrances is essential if an holistic understanding of a child’s allergens is to be gained. Similar to foods, working out what that child can be exposed to is important. This has a great impact on lifestyle factors. For example, if your child does not have any reaction to chlorine then they will be able to participate in swimming lessons held in swim schools.
Working On Efficient Gut Function
The efficiency of our gut function and digestive processes can have an impact on how we tolerate food. A child who has been consuming foods over a period of time that their body doesn’t tolerate well may experience reduced gut function. This may then lead to a seemingly increased number of food intolerances that aren’t actually related to intolerance at all. It can simply be that the body is not able to efficiently digest a food type that would otherwise be tolerated, because the gut is not functioning as well as it should be.
Another scenario is that of a baby or young child who does have allergies and intolerances to certain foods but who also doesn’t seem to be showing any improvement over a period of time. Whilst there are potentially a variety of reasons for this, one is that no action had been taken to improve the function of the gut, and therefore improve the digestive processes. Improved digestion can lead to less intolerance.
A range of supplements are available that can aid gut function, probiotics probably being the main one that many would have heard of. The specific ingredients of each supplement considered should be taken into account to ensure that each is suitable. For example, some probiotics contain dairy, an allergen in itself for some children. Parents should seek the advice of a qualified health professional to discuss their child’s individual needs relating to this issue.
Alternative Food Options
There is a growing range of off-the-shelf food products now available. These are particularly suited to those without complex allergies or intolerances to consider. A visit to your local health food store or to the natural section of a large supermarket is recommended.
Baking and cooking is of course greatly changed when the standard ingredients such as wheat, dairy and eggs need to be avoided….. but change doesn’t have to equate with “boring” when it comes to everyday eating. It is very possible for someone with allergy and/or intolerance to enjoy a variety of tasty meals and snacks from breakfast through to dinner.
There are many flour and grain alternatives to consider, remembering that gluten and wheat are not the same. Gluten is a component of wheat, but it is also contained in some other grains.
Gluten-free grains and flour include:
§ Amaranth
§ Arrowroot
§ Besan / chickpea flour
§ Buckwheat
§ Corn
§ Millet
§ Potato flour / starch
§ Quinoa
§ Rice
§ Sago
§ Sorghum
§ Wild rice
Wheat-free grains and flours include:
§ Barley
§ Kamut
§ Oats
§ Rye
§ Spelt
§ Triticale
A variety of sweetener options are available for use, some refined and others not.
§ Agave syrup
§ Beet sugar
§ Cane sugar (various styles)
§ Demerara sugar
§ Fruit juice concentrate
§ Fruit puree
§ Glucose
§ Honey
§ Molasses
§ Muscovado sugar
§ Rapadura sugar
§ Rice syrup
§ Palm sugar
§ Xylitol
There are also a range of methods of adding sweetness without a sugar or sugar-alternative. Two examples are replacing some of the flour with desiccated coconut and/or almond meal, given of course that these food types are not an allergen themselves.
If cow milk and cow milk products including yoghurt and cream are not an option for your child, there are a range of alternatives. For some babies and young children an Elemental formula may be necessary, which can be organised through a medical practitioner.
Dairy and dairy alternatives include:
§ Coconut milk
§ Goat milk, yoghurt & cheese
§ Grain milk (various)
§ Nut & seed milk (various)
§ Nuttlex margarine
§ Oat milk
§ Rice bran margarine
§ Sheep cheese & yoghurt
§ Soy milk, yoghurt & cheese
The calcium debate is worth mentioning here. There’s a school of thought that is in disagreement with current official dietary guidelines recommending milk and dairy products as the best source of calcium. The body is able to digest the calcium from other food sources more easily than from dairy sources. This is because vegetarian forms of calcium have a higher phosphorus ratio than animal sources, which aids absorption. With enough care and knowledge, it’s possible to obtain a lot of calcium from non-dairy sources. Good sources include green leafy vegetables, salmon, sardines, soy, tofu, nuts and seeds (especially sesame seeds). Of course, seek professional advice about how to make sure that you have an adequate intake of calcium.
Surprisingly for most, there are many types of egg substitutes readily available. Once you know how to use them you have a wide range of alternatives to choose from:
§ Agar agar
§ Arrowroot flour
§ Baking powder & oil
§ Baking powder & vinegar
§ Bean flour
§ Carbonated water
§ Corn flour
§ Flaxseed meal
§ Guar gum
§ Lecithin
§ Orgran No-Egg (a shop-bought product)
§ Pureed fruit or vegetable
§ Soy milk & yoghurt
§ Tofu
§ Xantham Gum
§ Yeast
Avoid a Boring Diet and Provide Food Similar to Other Children
A baby or child with allergies/intolerances does not have to be limited to what others would consider a boring diet, and their food can look the same or similar to that of other children. As discussed above, there are a wide range of potential alternatives to consider. Off-the-shelf food products are great but the cost can add up, and for some children with more complex allergies/intolerances many of these items may still not be an option. In these situations home-baking is essential.
By becoming familiar with what your child can eat, and how to effectively use the alternative ingredients as well as how to substitute one food type for another, a range of “normal” and “fun” foods can be made. Seeking out suitable recipes helps this process.
Breastfeeding and Allergies
There is plenty of evidence to suggest that breastfeeding is best for babies, especially those with allergies. The associated dilemma for the mother is of course that their diet is limited to only those foods suitable for their baby. There are situations where a mother struggles to provide adequate milk and/or a baby continues to have ongoing allergic reactions despite a mother’s diet limitations. An example of a strategy to manage this is to increase the mother’s protein and decrease her carbohydrates. This can change the structure of the breast milk so it is lower in lactose, which may limit reactions.
Some mothers in these circumstances may choose to consider elemental formulas, a script for which must be obtained through a medical practitioner. However those who wish to continue feeding their baby should be encouraged to do so. There may be some foods that a baby cannot consume directly but can tolerate through breast milk, but otherwise the mother may need to avoid the identified allergens. By applying the strategies discussed in the food-related sections above, a variety of meals and snacks will be able to be consumed.
Dietitian support during this process may be necessary to ensure that the correct amount of nutrients is obtained.
Consider Possible Changes to Clothing, Bedding, Toys and Other Items
Materials: Synthetic materials such as polyester, rayon and acrylic can cause skin reactions. Look for cotton and hemp instead, with tolerance for wool depending upon the individual. Take into consideration the fabric for clothes, bed sheets, doona covers, pillow slips, blankets, play mats and anything else that a child is playing or lying on.
Nappies: Disposable nappies can cause rash for some babies. In circumstances where even the eco-friendly disposables are not able to be used, cloth nappies will be necessary. Parents are no longer limited to the old style square nappies, as there are a number of easy-to-use types of shaped cloth nappies available that use clip or Velcro systems. These nappies seem expensive to start with, however over the long term the cost is minimal, especially if they are used by younger siblings down the track.
Baby Wipes: Baby wipes can easily cause a skin reaction in sensitive babies and children. If the chemical-free, more natural wipes now available still cause a reaction, a large store of washers is a must. They can be thrown in with the nappies for washing.
Nappy Liners: Nappy liners are the next problem. The throw-away one’s are great except for the associated skin reactions for some. An easy option is to purchase bulk packs of cotton men’s hankies and wash these with the nappies and washers. All you need to do is fold them in half or thirds to line the nappy, depending on the width of the nappy. Alternatively you could make your own or purchase organic cotton liners.
Pilchers: Apart from the traditional plastic pilcher there is now a variety of polyester fleece, wool and polyurethane laminated (PUL) polyester pilchers on the market. Trial and error is recommended in finding one that does not cause reaction.
Items Containing Latex: Allergy in this circumstance can either be to the latex itself or to the chemicals used in manufacturing the latex. Items that contain latex that are commonly used for children include cot mattress protectors, dummies and some bottle teats. Author suggestions include use of a thick cotton baby blanket instead of a standard mattress protector if in a cot, using either a woollen underlay or a cotton blanket as a mattress protector if in a bed, silicon bottle teats or the newer more natural bottle teats rather than latex teats and avoiding a dummy.
Dribble: Some babies or young children may wake up with a rash on their face, and in extreme cases it could be due to lying in their own dribble, a reaction to the toxins coming out in the dribble. Frequent changing of sheets (and possibly cot liners) may be required to reduce the reaction to this.
Sterilisation: Consider boiling bottles for sterilising rather than using chemical solutions.
Toys: A child sucking on or playing with plastic toys may cause a reaction. Ensure that at least some of the toys are made of materials such as wood (but watch the paint and resin issue!).
Pillows: For those children old enough for a pillow and who are sensitive to dust mites, get into the habit of putting the pillow out in the sun each day, whether or not you are washing the pillow case.
Consider Your Cleaning Products, Fragrances and Personal Care Products
Chemicals in cleaners are widely acknowledged as causing a range of health conditions. A read of the Material Safety Data Sheet (MSDS) on many of the commonly-used cleaning products is a big eye opener for most people. The author’s challenge to the reader is to do an internet search for the MSDS on three of the cleaners in their house (or call the manufacturer and request a copy).
There is a growing market of chemical-free cleaners which work well for many. Caution is advised however for children with sensitivities to natural chemicals such as salicylates, as smells such as eucalyptus and sage can lead to signs of allergy and intolerance. Read the side of the packaging well to ensure that the product is suitable.
Fragrances including incense also need to be considered. Some will be synthetically manufactured and others may contain smells that someone with a natural chemical sensitivity will react to.
Parents of very sensitive children are recommended to be on the look-out for signs and symptoms that may be related to those discussed above. Situations to consider include shopping centres, other peoples’ houses and childcare.
There are a range of ingredients in personal care products such as shampoo, conditioner, baby care items, soap and toothpaste that could well impact on the health of a baby or young child, especially one with sensitivities. Some of the ingredients used in many personal care products include: Sodium Lauryl Sulphate, Propylene Glycol, Polyethylene Glycol, Sodium Hydroxide, Alpha Hydroxy Acid, Aluminium and Sodium Fluoride. The other uses for some of these ingredients are commercial degreasing (floors, machinery), brake fluid, anti-freeze, paint, varnishes, oven cleaners and pipeline cleaning. One is a known toxin and carcinogen and has links to cancer, arthritis and allergic reactions.
There are a wide range of personal care products now available that do not contain these ingredients. When considering these products parents are still recommended to check the ingredients carefully to ensure that individual needs are met.
Associations and Support Networks that Provide Relevant Support
Appropriate support from others is a key coping strategy for parents with children who have an allergy or intolerance. In the words of many parents who have been here before, being able to talk with someone else who understands the language, the issues and the frustrations associated with managing allergies and intolerances can mean “sanity”. Another important role of a support network is the opportunity to gain ideas and to share ideas.
Here are a selection of networks and associations to consider:
§Food Intolerance Network. See www.fedup.com.au for resources and email support groups.
§Allergy and Environmental Sensitivity Support and Research Association Inc. See www.aessra.org .
§Local support networks. Ask around in your local area to find out if there are any available.
Allergy Alert Systems
Alert systems are in important consideration for babies or children with anaphylaxis, especially if that baby or child is attending playgroup or childcare. There are a variety of allergy alert systems available for babies and children, and can include badges, stickers, t-shirts, bibs, hats, ID tags. Suppliers include:
Managing With Childcare
There are a range of resources available to assist parents with sending a child with allergies or intolerances to childcare. Some of the strategies are also relevant for those attending playgroup. The scope of the childcare issue is large so for the purposes of this article the following resources and links are recommended.
The Australasian Society of Clinical Immunology and Allergy (ASCIA).
Telephone (within Australia): 02 9907 9773
Anaphylaxis Australia
Telephone (within Australia): 1300 728 000
Food Intolerance Network – factsheet “Playgroups and Food Sharing”
Managing Other Peoples’ Reactions
The reaction of other people to finding out that a baby or young child has allergy or intolerance can be varied. Common concerns raised include comments such as “It must be so hard for you”, “Can’t they just have a little bit”, “Oh the poor thing” and “Will they grow out of it”. An unfortunate scenario for many is the situation where a child is exposed to an allergen or given food that is an allergen by friends or family members. There is no one easy solution to ensuring that (a) other people accept the restrictions and (b) that a child is not exposed to an allergen either on purpose or by accident, however by using some of the following strategies scenarios such as these may be avoided.
§ Be very clear about what your child cannot have or be exposed to, and give examples of what could happen if they are.
§ Provide specific ideas about what your child can have or be exposed to. For example, in the case where you are going to a grandparents house provide a list of specific foods that can be given to them. You may need to go into as much detail as the exact product name and where to get it.
§ Act and feel confident about what you are doing for your child. Any ambivalence that you may have is likely to be felt by others.
§ Where possible focus on the positives, or what your child can have or be exposed to.
§ Be consistent in your approach.
Putting It All Together
Finding out that your child has allergy or intolerance can come as a shock to the parent, especially if there has been no knowledge of or exposure to allergies prior to that. It is natural that a grief process may be necessary initially, particularly if severe allergies involving anaphylaxis is involved. A parent is best to allow this process to happen and then move on to considering a variety of strategies for (a) managing the child’s needs and (b) managing their own needs.
A builder doesn’t rely on just a hammer and nail to build a house: a full toolbox and a wide range of other products and resources are necessary. The same analogy should be applied to managing allergy and intolerance. Find the tools that work for you, be familiar with a selection of additional tools to call upon as required, be aware of the resources available to you and use the products that are appropriate to your child’s needs.
References
1. The Australasian Society of Clinical Immunology and Allergy (ASCIA): www.allergy.org.au
2. Anaphylaxis Australia: www.allergyfacts.org.au
4. Cutler, E. The Food Allergy Cure. New York: Three River Press. 2003.
10. Bio-Dermal Screening: www.biomeridian.com
Author Details
Kay Winters is an Occupational Therapist with extensive personal experience in dealing with allergy and intolerance. As a result of this Kay started a business aimed at helping people with the practical management of allergy and intolerance, from babies through to adutls. Kay also coordinates a support network for parents of children with allergy or intolerance in her local area.
Mailing address: Indigo Peak, PO Box 298, Palmwoods Qld 4555 (Australia)
Kay Winters
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