By Marion Groetch, MS, RD, CDN
Feeding an infant or young child can be confusing even without the complicating factor of a food allergy diagnosis. Having a food allergy means adapting your child’s diet to ensure the identified allergen is eliminated. Sometimes the task of providing a safe, allergen-free diet can be so overwhelming that mealtime conventional wisdom gets lost altogether. One of the common problems I encounter in my work with families is the child who is a picky eater or just plain “difficult to feed”. Indeed, children with food allergies may actually have more feeding problems than their peers without allergies. Because these children already have restrictions in their diet, a picky eater limits his diet further and may add to the nutritional and social burden. Although there are times when a feeding problem may need to be professionally addressed, many problems are simply a matter of inexperience with foods or even a normal part of childhood development.
Many parents ask me if a picky eater is born or made. Clearly some children are more adventurous eaters than others. Some may be inherently cautious, but whether this leads to a future “picky eater” may be, in part, how we handle feeding. Children with food allergies may also be more cautious due to previous unpleasant experiences with a food. Cautious eaters actually need more support to try new foods but what they often get are the same meals over and over because they seem less willing to try new ingredients and recipes. This unfortunately amounts to less support to learn about and feel comfortable with more variety in their diet.
Early childhood is the optimal time to expose your child to a wide variety of flavors and textures to encourage acceptance of a variety of foods. When a food allergy limits a child’s diet, we have to make sure we don’t limit that diet beyond what is necessary. Research shows that school-aged children are significantly less interested in tasting new foods than younger children. For children with food allergies, it is important to focus on the “positive”, meaning all the foods that are safe and delicious to try. For instance a child who is allergic even to multiple foods such as milk, egg, peanut and tree nut will still have plenty of foods of varying flavors and textures to master such as meats, poultry, fruits, vegetables and safe grains. If you are unsure which foods are safe for your child, discuss this with your allergist.
Here are some tips to remember when feeding your child:
• Ask your allergist specifically what foods or food groups need to be avoided. Many parents are concerned their child may have an allergic reaction to another food and so are afraid to introduce foods that have not been eaten and tolerated in the past. If you have these concerns, please discuss them with your allergist and ask what foods need to be avoided so you don’t limit your child’s diet beyond what is necessary. Remember to introduce new foods one at a time – a recommendation for all children, not just those who already have a diagnosed food allergy.
• Eat together as a family. This is especially important for children with food allergies who may end up separated and isolated from their peers at mealtime. Children who eat in isolation may have less opportunity to observe others eating and enjoying a variety of foods. Mealtime is the time for busy families to come together so the atmosphere should always be pleasant and relaxed. Children need role models with eating and the family meal is the ideal place to model appropriate meal time behaviors and enjoyment of a variety of foods in a safe environment. Take care to adapt the meal or at least parts of the meal to be allergen-free so your child with food allergies will feel included in one of the most practiced social traditions in our culture – the family meal.
• Serve balanced meals and snacks. Variety in the diet will help ensure that nutritional needs are being met. Offer a variety of tolerated foods and serve meals that are balanced, including a food from each food group. For instance, dinner should include a meat or substitute, grain, vegetable, fruit and milk or milk substitute. If your child is too young to eat all of these foods in one sitting, then save a portion of the meal (maybe the milk or milk substitute and fruit) for snack time. Equally important as serving balanced meals is serving one or two foods with each meal that you know your child is willing to eat and enjoys eating. I call these foods the “mastered foods.” In addition to one or two “mastered foods”, include with each meal a new food or a food that is not yet readily accepted. I don’t use the term “dislikes” because it implies a permanent state, which, I promise, it is not. Children need time to get to know new foods. A child who is served a limited variety of foods over and over again will learn to accept only those foods and will not be happy to have new foods served instead. Offering a new food alongside favored foods together is a good plan.
• Offer regularly scheduled meals and snacks.
Most young children require three meals and two to three snacks per day – generally spaced about 2 1/2-3 hours apart. There should be specified times when foods are served and just as important, times when foods are not available. If the consequence of not eating a meal or snack is feeling hungry, then your child will be more responsible about eating the next time foods are provided. There is no need to pressure your child to eat. Children who are forced to eat a food generally get less pleasure than children who are allowed to approach new foods at their own pace. Remember the cautious eater may have more fear of new foods, so be patient. If the consequence of not eating a meal is getting a snack – either food or beverage – a few minutes later, then there is no motivation to eat the meals and snacks you have presented. So if your child is grazing on foods and drinks between meals and snacks, he may not have enough appetite at mealtime or snack time to eat the foods presented. Remember, foods taste better when we have an appetite.
The home environment will play a major role in your child’s food acceptance and overall nutrient intake so take time to plan for healthy, balanced meals and snacks served regularly and consistently. Discuss your child’s food allergy with his allergist and be aware of the foods that need to be avoided and those you can safely introduce. The Consortium of Food Allergy Research has an extensive food allergy education program with handouts on numerous topics including How to Introduce New Foods to your child with food allergy. Please take advantage of this free educational resource.
Lastly, if feeding your child has become stressful or if you are concerned about your child’s nutrient intake or growth, consider making an appointment with a registered dietitian who can help you develop a stress-free, tailored feeding plan that includes a variety of safe, healthy and delicious foods.
Marion Groetch has been working in the field of nutrition for over 20 years, focusing exclusively on pediatric nutrition for the last 15 years. She holds a Bachelors degree in Dietetics and a Masters degree in Clinical Nutrition. After completing a post-graduate UAP Nutrition Fellowship through New York Medical College, Ms. Groetch began a private practice in Westchester County, serving the needs of children with feeding difficulties. In 2005 she joined the staff as Senior Dietitian at the Jaffe Food Allergy Institute, at Mount Sinai School of Medicine where she is involved in patient care, research and education. Ms. Groetch is a recognized nutrition authority in the field of food allergies and is a frequent guest speaker both locally and nationally for the American Academy of Allergy, Asthma and Immunology, the Food Allergy Anaphylaxis Network and the American Dietetic Association.