The American Academy of Pediatrics (AAP) doesn’t recommend the use of multivitamins for all children because eating a balanced diet (with iron-fortified foods) is usually sufficient to meet a child’s vitamin and mineral requirements. However, for a child with a restricted diet, a multivitamin may be necessary. We’ve been getting a lot of inquiries about Phlexy Vits, our powdered micronutrient supplement, so I wanted to use this blog post to provide some more information on it.

Phlexy Vits are a powdered micronutrient supplement containing vitamins, minerals and trace elements. They were designed to meet the nutritional needs of older children (11+) and adults. Occasionally Phlexy Vits are used in children but the dosage must be adjusted and this should only be done under the direction and supervision of a healthcare professional.

Phlexy Vits were actually originally developed for patients with Phenylketonuria or PKU, who require a restrictive, low protein diet. However, they may be useful for anybody with a medical condition that requires them to follow a restrictive diet. We have received inquiries about the use of Phlexy Vits for patients with multiple food allergies because many popular multivitamin brands contain hidden allergens.

Hidden Allergens in Children’s Vitamins

Below is a list of popular children’s multivitamins and the food allergens that they contain:

• Centrum Children’s: contains milk, soy and wheat (as well as lactose)
• Flintstones Complete and Flintstones Plus Immunity: contain soy
• Flintstones Gummies: contains wheat and tree nuts
• One-A-Day Scooby Doo Gummies: contains wheat and tree nuts

Vitamins for Children 11 and Older with Food Allergies

For older children (11+) with food allergies, Phlexy Vits may be a great option because they are free of milk and soy proteins, gluten and the sugars lactose, sucrose and fructose. There are no corn proteins in Phlexy Vits; however, certain nutrients are derived from corn so discuss this with your health care provider if your child is very sensitive to corn derivatives. Keep in mind that Phlexy Vits were developed for individuals over 11 years of age so do not use for younger children unless advised by your health care professional. The daily intake will have to be adjusted for a younger child.

For those of you with children on Neocate products, a multivitamin probably isn’t necessary. Neocate products are nutritionally-complete and were designed to meet all nutrient needs: protein, fat, carbohydrates, vitamins and minerals.

- Mallory

We’ve talked about EpiPens before on Food Allergy Living, including how to travel with them and what to do in case of an accidental injection of epinephrine. With the new school year upon us, many parents of children with food allergies are faced with the dilemma of where to store their child’s EpiPen at school. Should they carry it with them at all times? Should it be stored in the nurse’s office? What happens on the playground or on a field trip?

Carrying an EpiPen at School

If your child is old enough, some schools will allow them to carry the EpiPen with them at school or on a field trip and self-administer in the case of a reaction. While many states have passed legislation to allow this, New York, Pennsylvania, Rhode Island and Wisconsin have not. To find out specific details about what the legislation mandates in your state, you can visit the Allergy & Asthma Network website which provides links to each state’s current law regarding anaphylaxis medications.

EpiPens in the Classroom as well as the Nurse’s Office

If your child is not old enough to carry their own EpiPen, or their school will not allow it, you will want to determine whether or not one can be stored in their classroom (in addition to the nurse’s office). If they are in multiple classrooms each day, you may want to store one EpiPen in each room to be safe. You will also want to make sure that all of your children’s teachers are properly trained in how to administer the EpiPen.

Planning for EpiPen Use When Outside the Classroom

One thing that can help you address where your child’s EpiPen or other medications are stored at school is a 504 plan. A 504 plan refers to Section 504 of the Americans with Disabilities Act, which ensures that children with special needs get a level playing field from government services like public school. Depending on the details of your child’s food allergy, he or she may qualify for a 504 plan for the school to follow. The plan will outline not only where their EpiPen is stored, but also where they will eat, what allergens are permitted on school grounds, and how teachers and other personnel are trained to react in the event of an anaphylactic reaction.

Planning ahead is key to ensuring that your child will be safe at school in the event of an allergic reaction. What plans do you have in place for your children?

- Sarah

Brain development is most sensitive to a baby’s nutrition between the last trimester of pregnancy and the first two years life. The brain is rapidly growing during this period; in fact, an infant’s brain increases in size by 175% during the first year of life and by another 18% during the second year[1] Children who are malnourished during this period do not grow and develop properly so adequate nutrition is of utmost importance[2]. Although all nutrients are important for health and development, certain nutrients play especially important roles.  If your LO has food allergies, his/her limited diet can make it more difficult to get enough of these nutrients. Therefore, it is important to understand which nutrients are key so that you can make sure your LO’s needs are met.

• Protein and Calories

  True malnourishment occurs when there is a prolonged inadequate intake of protein and calories. Studies show that grossly malnourished infants and toddlers suffer both short and long-term consequences, which may include delayed motor and language development, as well as poorer intelligence schools and school performance[3].

• Fat

  Myelin is a fatty substance that covers and protects nerves. Myelination (the development of myelin around nerve fibers) occurs at a very rapid rate during the first 2 years of life and this is a key part of brain growth and development.  Because myelin is composed mostly of fat, fat is an important component of nutrition for infants and toddlers and fat intake should not be restricted during this period.

  • DHA and ARA:

    DHA and ARA are fatty acids found in breast milk. Research shows that DHA and ARA are important for brain and eye development, especially during the first year of life. The levels of DHA and ARA in breast milk and formula has been linked to better visual acuity and cognitive performance1.

• Iron

  Iron deficiency during the first 2 years of life can result in irreversible cognitive deficits[4]. Bottle-fed babies should receive formula that contains iron and breast-fed infants should receive some form of iron supplementation at around 6 months of age. Most infant starter foods (such as rice cereal and Neocate Nutra) are fortified with iron to meet these needs.

• Other Nutrients

  Like iron, iodine deficiency during infancy and toddlerhood can have long-term cognitive consequences. Fortunately, iodine deficiency is very rare is developed countries. Research also shows that zinc, choline, Vitamin B12 and Vitamin D play important roles in brain development but there is less concrete knowledge about the specific roles they play.

Nutrition and Brain Development for Children with Food Allergies

For most children, milk and milk products are key sources of calories, protein and fats, all of which are critical for proper brain development. For infants and children with milk allergies, its critical that they receive alternate sources of nutrition so that their brains have all the ingredients necessary for proper brain growth and development. This is why its so important to work with a health care provider to develop an allergy-safe, nutritionally-adequate diet.

• Breast milk or a nutritionally-complete infant formula provides a full range of nutrition for infants
• If your LO is formula fed, consider a formula supplemented with DHA and ARA to support brain and eye development
• If your LO is breast-fed, be sure to supplement iron after 6 months of age and if formula-fed, be sure to choose a formula with iron. Starter foods like rice cereal or Neocate Nutra are fortified with iron to meet these needs
• Once children transition to solids, be sure to provide a balanced diet to ensure all nutrient needs are met. For children with a restricted diet, a wide variety of foods may not be possible so talk with your health care provider about appropriate medical foods or supplements, which can be helpful for filling in the blanks

-Mallory

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[1] Abad-Jorge, A. “The Role of DHA and ARA in Infant Nutrition and Neurodevelopmental Outcomes”. Today’s Dietitian Vol. 10 No. 10 P. 66.
[2] Zero to Three: The National Center for Infants, Toddlers and Families. http://www.main.zerotothree.org.
[3] Benton, D. The Influence of Dietary Status on the Cognitive Performance of Children. Mol. Nutr. Food Res. 2010, 54, 457-470.
[4] Beard J. Iron deficiency alters brain development and functioning. J Nutr. 2003 May;133(5 Suppl 1):1468S-72S.

We had such a great time last year attending the FAAN Walk for Food Allergy in different cities around the country, that we are doing it again!  These walks are organized by the Food Allergy and Anaphylaxis Network to raise public awareness, to provide advocacy and education, and to advance research on behalf of all those affected by food allergies (such as peanut, egg, soy & dairy) and anaphylaxis.

Here is a list of the FAAN Walks Neocate will be participating in:

• Houston, TX – September 11
• Philadelphia, PA – September 12
• Baltimore, MD – October 2
• Charlotte, NC – October 2
• Long Island, NY – October 10
• Tampa Bay, FL – November 13

For a complete list of cities and to register for a walk in your area or donate money, visit the FAAN website.  Are any of your families attending a walk in your city or organizing a team?  We’d love to hear about your plans!  And if you are going to be attending any of the walks mentioned above, make sure you stop by the Neocate booth and say hi!

- Sarah

Back to School with Food Allergies

Back to school is near. This is the perfect time to prepare if your little one has food allergies. Last year Nita provided some great tips to help you prepare for the first day of school.  In addition to those, I wanted to share a great article I came across on www.FoodAllergy.org .   It discusses how to best handle the education of food allergies for teachers and other school mates. The article talks about an educational awareness program called PAL: Protect a Life from the Food Allergy and Anaphylaxis Network. The PAL program provides educational brochures, posters, and even certificates to give out to other children who have shown they are a PAL.

Communication and education is the most important aspect for a child going back to school with food allergies. Hopefully this will provide you with some ideas on how to best educate your little ones new classroom on living with food allergies.  If you  have any creative strategies to help prepare for a safe school year, we’d love to hear about them in the comments!

- Christine