We hear from a lot of parents who are dealing with feeding difficulties. Often, feeding difficulties can be a symptom or side effect of food allergy related conditions such as Eosinophilic Esophagitis and other GI conditions. This can occur because eating is a learned developmental skill, and one of the few activites of daily life that a child can completely control. If a child experiences discomfort associated with food they can learn to avoid this discomfort by developing food selectivity, difficult mealtime behaviors, or food aversions. Even after your child’s condition has been treated and they are no longer in pain, they still may have lingering issues at mealtimes due to learned associations with food and discomfort. For others, they may simply not like the taste of their new formula and need some help adjusting to it.

Below are some tips that we hope can help make mealtime a little less stressful for both you and your child. As always, be sure to consult with your doctor and/or feeding therapist before trying anything new.

• Transition to new formula gradually. If your child is refusing Neocate when you first switch, try mixing a small amount of it with a large amount of another beverage that they will drink. Then you can increase the concentration of Neocate gradually, until your child will accept a bottle of 100% Neocate.
• Plan predictable and routine mealtimes. Sometimes when a child is on a diet consisting mainly of formula, they will “graze” throughout the day, drinking a small amount of formula here and there. Maintaining a predictable mealtime schedule, seated in a highchair or at the table can help increase their appetite, leading to an increased intake of formula. Predictability can also help decrease anxiety about eating, and promote optimal learning about the routines, customs and social richness of mealtimes.
• Try “repackaging” their formula. If your child doesn’t like to drink their formula from an open cup, try introducing it in a sippy cup or with a straw cup with a lid (or even better, a flavor straw!) to help decrease the smell and intensity of the flavor.
• Offer choices, when possible. For example, if your child brings his or her formula to school for lunch, let them choose which flavor they want each day. This will allow them to feel more in control of their mealtimes.

Have any of you dealt with a feeding difficulty? What tips have you found helpful?

Angela Haas MA, CCC-SLP

Pediatric Feeding and Swallowing Specialist

This month we are doing a series of blog posts on hidden food allergens. So far we have discussed hidden sources of the allergens dairy and soy, and this week we will discuss hidden sources of gluten.

If your little one has a gluten allergy or intolerance, you are quite aware of the many challenges it causes. Gluten is a protein commonly found in all forms of wheat and related grains like rye, barley and possibly oats. It is also in many other foods consumed daily, such as cereal, breads and pasta. Depending on the severity of the intolerance to gluten, different side effects may occur. They may be limited to GI discomfort, such as diarrhea, gas and bloating.  A more severe intolerance would be classified as celiac disease (CD), a lifelong digestive disorder that causes damage to the small intestine and prevents absorption.

Gluten-Free Diets

If you or a loved one is following a gluten-free diet, it is important to be aware of where gluten may be hidden. Luckily, a gluten-free diet is not as limiting as it used to be. Now, gluten-free breads, pastas and prepared foods are available, which really aid compliance on a tricky diet!  You can purchase these gluten-free foods from most grocery stores or online.

As a general rule of thumb, if following a gluten-free diet, you should avoid the following ^1,2 :

Wheat and Gluten Ingredients:

• Anything which contains: wheat, rye, barley, spelt and millet
• Hydrolyzed wheat protein, sprouted wheat or barley malt
• Anything with the term “gluten”
• Words that refer to the specific kind of grain or wheat
  • Ex: bulgar, durum, farina, macha, matzo or matza, kamut, graham, semolina, seitan, fu, udon, couscous, tabbouleh

Generalized terms which should be avoided with gluten allergies:

• Malt/Malted milk/malt extract/malt syrup
• Soy sauce/Teriyaki sauce
• Flour
• Beer (most contain barley or wheat)
• Bran
• Germ
• Orzo (pasta)
• Cookie crumbs/cookie dough
• Bread crumbs
• Gravy
• Seafood analogs (imitation crab contains wheat)
• Bouillon or broth

Everyday products which may contain hidden sources of gluten:

• Lip balm
• Sunscreen
• Children’s stickers
• Stamps and envelopes
• Soaps and shampoos
• Washing machine detergent
• Toothpaste and mouthwash
• Medicine and antibiotics
• Ground spices

For a complete list of foods to avoid and other resources about celiac disease, visit www.celiac.com

Can you think of any other hidden sources of gluten that weren’t mentioned?

-Nita

Sources:

1. Hidden Ingredients Containing Wheat or Gluten: Tips and Tricks on How to Discern Gluten Ingredients http://food-allergies.suite101.com/article.cfm/hidden_ingredients_containing_wheat_or_gluten#ixzz0oD3Qh3V2

2. http://gfcf-diet.talkaboutcuringautism.org/hidden-sources-of-gluten.htm

We’re excited to introduce you to our newest product — Neocate Junior with Prebiotics. As many as 55 percent of children don’t get enough fiber and for those on a restricted diet, it can be even more difficult! For that reason, we have added prebiotic fiber to our Neocate Junior formula.

Why is prebiotic fiber important? Prebiotics promote digestive health by supporting healthy bacteria in the gut and inhibiting bad bacteria. Studies have shown that prebiotics can help decrease constipation, diarrhea, gas and vomiting.

If you want to learn more about how prebiotics work and the importance of fiber in your children’s diet, check out this blog entry.

This blog is a follow-up to Nita’s informative blog “Fats 101”. If you haven’t already, I encourage you to read it first to gain a better understanding of all the different types of fats out there.

When reading the ingredient label, you may notice all the different types of oils used in Neocate. Why are there so many types? Each one is a source of a different type of fat, and a variety of fats are needed to maintain a balanced blend of fatty acids to help your baby develop and grow properly.

Sources of fat found in Neocate products include:

• Refined Vegetable Oil made up of:
  • Palm Kernel and/or Coconut Oil (source of Medium Chain Triglycerides)
  • High Oleic Sunflower Oil
• Soy Oil
• Canola Oil
• M. Alpina Oil (source of ARA)
• C. Cohnii Oil (source of DHA)

*Keep in mind that all of the proteins from these ingredients have been extracted. Since proteins are generally what cause an allergic reaction, Neocate should still be an appropriate choice for your little one – even if they have a soy, coconut or sunflower allergy.

Take a look at this very helpful chart which compares different sources of fat:

Source: www.canola.okstate.edu/nutrition/index.htm

I have this chart near me at all times to help me understand what exactly each fat ingredient contains.

You will notice how some ingredients have a very specific ratio of polyunsaturated, monounsaturated, and saturated fats. Each fat found in Neocate was specifically chosen to ensure there is a balanced blend in order for your child to get the right amounts of essential fats needed to grow and thrive.

You may also notice that Neocate Infant, Neocate Junior and Neocate One+ all have different percentages of fat. This is because children need different amounts of fat depending on their age and medical conditions. For this reason, it is important to pick a formula that is tailored to your child’s specific needs.

Infants need plenty of fat for proper growth and development, so Neocate Infant contains 41percent fat. Once children get to be a little bit older, fat should be taken in moderation, so Neocate One+ has 32 percent fat. If your child has a GI or allergy disease, they might have issues with malabsorption of certain nutrients. Neocate Junior is specially formulated to account for this with 45 percent fat and higher amounts of other important vitamins and minerals.

Mallory will be diving deeper into the fatty acids DHA and ARA at the end of the month, so be on the lookout for that blog!

I hope this helps a bit with understanding the ingredients in the Neocate Infant formula. If you still have questions about these or any other ingredients, ask away!

- Christine

A group of families is working to get legislation passed in South Dakota that would require insurance companies to cover elemental formulas like Neocate. With help from State Representative Todd Schlekeway, an act to provide health insurance coverage for elemental formulas was recently introduced in the state legislature.

The Kurtz family is one of many who would benefit from the economic relief the bill would bring. They have two children, Annie and Quincy, who both suffer from milk protein allergies. Keloland Television in Sioux Falls, South Dakota recently did a story on the parents’ legislative fight.

If the South Dakota legislature passes the bill, it will join other states like Arizona, Connecticut, Illinois, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Oregon, Rhode Island and most recently Texas, which have similar elemental formula legislation.

Effective January 1, a new bill requires insurance companies in Texas to reimburse families for amino acid-based formulas. Check out this news story about the new law from CBS 11 in Dallas, Texas: http://cli.gs/aG8z6E. It profiles the Stewart family whose son, Marcus, was born with Smith-Lemli-Opitz syndrome and relies on Neocate formula for his nutrition needs.

If you want to introduce reimbursement legislation in your state, you can visit the Children’s MAGIC Web site and download the “Guidebook to Enacting Legislation,” which has everything you need to get started.

Be sure to keep us up-to-date on your efforts by posting a comment below, emailing us at foodallergyliving@shsna.com or connecting with us on Facebook.