Allergy and Asthma: About Children
The nutritional goal for infants and young children with asthma and allergies is to support normal growth and development. As for all children, adequate calories, protein and other key nutrients must be provided. Youngsters who are not properly nourished have the potential for growth problems, increased susceptibility to infection, poor appetite, excessive fatigue, and an inability to keep up mentally and physically with peers.
Infants have the highest risk for food allergy. This is because their digestive tract (intestines) are immature, allowing more allergenic proteins to pass from the intestines into the blood. Once in, the immune system identifies these proteins as foreign intruders and an immune response is activated. This process initiates a food allergy. As the child matures, however, the fine lining of the intestines becomes less permeable to the large protein particles, thus older children and adults are better protected.
In recognition of this high risk time, infant feeding practices are recommended to minimize the dietary introduction of highly allergenic proteins. Following these guidelines is encouraged for all parents but, for those with a strong family history of food allergies, delaying introduction of solids and certain highly allergenic foods is especially important.
Obtaining adequate calories is more of a challenge for a child with severe dietary restrictions, a child who is frequently ill, or a child who is on medications that can interfere with appetite and food intake. Regular monitoring of weight gain progress, appropriate diagnostic studies, and evaluation of dietary intake is important. Children have specific nutritional needs during their various stages of growth and development.
Medications and diets used in treatment of allergies and asthma may interfere with adequate nutrition. Special attention needs to be given to the side effects and drug-nutrient interactions of prescription and over-the-counter medications used. Nutrients effected by eliminating foods from the diet need to be obtained from alternative nutrient rich foods or vitamin-mineral supplements. Caloric intake should be monitored on a regular basis, especially if the child's weight or weight gain pattern is effected.
When a child has asthma, parents often want to protect the child as much as possible. Sometimes this means the child is kept indoors frequently, which limits physical activity and increase sedentary time. Children who experience symptoms with increased physical activity or exercise may choose more sedentary ways to occupy their time. The limitation of activity, combined with medications such as oral corticosteroids that can increase appetite and food intake can result in excess weight gain or obesity.
A child with asthma who becomes obese often has more difficulty breathing. The higher the weight climbs, the less active the child will become. This pattern quickly escalates, with weight gain, breathing difficulty and inactivity each contributing to the obesity spiral. To interrupt the cycle, children who are gaining excessive weight should be promptly evaluated and monitored regularly. Working with the health care team, a dietitian can help the family plan an appropriate diet to limit empty calorie foods, excess sugar and fat and discuss options for increasing physical activity.
Children with food allergies follow restrictive diets. For some, this requires the elimination of a major food group or a combination of several important foods. Children for whom this is true may not get enough calories or key nutrients, and are at risk for growth delays. All children on restricted diets need to be evaluated and monitored regularly for adequate growth and development. Supplementation may be necessary if nutrient needs can not be met with appropriate dietary substitutions for the avoided allergens.
The child's diet should be monitored on a consistent basis. If the diet is restricted for milk and/or meat, poultry, fish, eggs, soy, or nuts, special attention needs to be given to protein intake. Diets restricted in these foods may also be inadequate in iron, calcium, vitamin D, riboflavin, zinc, and B12. Diets restricting grains may be inadequate in calories, B vitamins, as well as certain minerals. Those restricting fruits and vegetables may be inadequate in the antioxidant nutrients, primarily beta-carotene and vitamin C.
Careful planning of the daily diet is important and most parents need at least some assistance from a dietitian in doing so. Special supplements may be necessary when needs cannot be met using appropriate substitutes.
It is also true that children with asthma and allergies tend to be very thirsty. Water is the best beverage to include regularly. Unsweetened fruit and vegetable juices in moderation are also a good choice. Sweetened flavored drinks usually provide calories and minimal nutrients unless fortified.
Children with asthma and food allergies often feel they are different and cannot do the things children do. Birthday parties and sleepovers can be difficult, especially when food is served. Parents can plan ahead and discuss food restrictions with the host parents in advance. If necessary, send along an appropriate substitute to help the child participate in important social activities. There is no reason these children can't if their asthma or allergy is managed properly and under control. This will enable them to miss less time at school or other organized activities, and keep up with their friends.
As they grow older and with proper education, children can play a major role in controlling their condition. Teach them about their triggers, how to avoid triggers and how to use their prescribed treatment appropriately. There are a number of organizations which help parents and children learn to manage these conditions, and support children's need to live socially active lives.
While growth and development of older children and adolescents are still concerns, the focus of their nutritional well being includes desirable healthy weight patterns and optimal level of physically energy. Adolescents tend to be less careful with food choices due to their daily schedule of school, sports activities and social activities, therefore may benefit from vitamin-mineral supplementation. Another line of concern is that food choices are increasingly influenced by peers who may not have allergies and asthma.
Adolescents involved in sports programs are susceptible to 'fad' diets and dietary supplements that tout greater performance with their use. Teens may not realize the presence of food allergens in these products. While the incidence of food allergy is not as high in adolescents as in younger children, it may exist. Teens often fail to follow dietary restrictions related to food allergies and asthma when away from home with their friends. Educating adolescents regarding their responsibility for diet and health is an important part of their treatment plan.