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Tackling food intolerence

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Special diets
If your baby has special dietary needs, ask for your health visitor or doctor for a referral to a dietician with a special interest in infant feeding. If your baby has already been diagnosed with a metabolic problem, you will need some help in devising a healthy diet for him.
If your family has a history of allergies, it is sensible to take care when moving your baby on to new foods, and to be even more careful about avoiding known allergens such as gluten (in wheat and wheat products) until your baby is at least six months old.

Food intolerance and food allergy
Food allergy occurs when the immune system responds to a food by releasing antibodies, causing allergic symptoms such as a rash, bloating, wheezing, runny nose and sometimes sudden and dramatic swelling of parts of the body. He is likely to show an obvious reaction soon after eating the offending food. The only way to avoid any reaction is to avoid that particular food totally. Talk to your doctor if there is a history of serious allergy in your family, especially to peanuts.

Food intolerance may occur when your child has an ongoing problem such as ear ache or diarrhoea. The only way to determine whether or not a suspected food is the culprit is to give that food to the child, in small quantity, when he is well again. If this does produce adverse symptoms, the reason will probably be a true allergy to that particular food.

If you are concerned about the possibility of allergies you may like to think about:

• Breastfeeding your baby for as long as possible as this seems to help protect against some allergies
• Avoiding introducing solids until your baby is at least four months old
• Taking extra care to avoid common allergens in your baby's diet
• Introducing foods one at a time, with several days between them, so that you can more easily identify the food causing the reaction
  

True food allergy is not common, but it does exist. You should get a proper diagnosis if you suspect your child reacts abnormally to the same food each time. Your health visitor will be able to advise you and your doctor can refer you to a dietician.

The most common foods to which people are allergic are:

• Wheat, rye, oats and barley
• Eggs
• Sesame seeds
• Nuts including peanuts
• Citrus fruits like oranges and grapefruit
• Cow's milk and cow's milk products
• Fish and shell fish

Serious reactions are thankfully very rare, but they do need emergency medical treatment. So if there is a history of food allergy in your family, ask your health visitor for advice as to how to recognise potential reactions.

One of the best ways to prevent the development of allergies in children is to introduce solid foods according to a schedule which corresponds with the ability of the digestive system to fully digest and tolerate them.The purpose of digestion is to break foods down into simple sugars, amino acids and fatty acids. Babies are unable to do this efficiently until the age of six months or so, and the notion that solids help them sleep better at night is just a myth. They will sleep well when their digestive system is healthy.

The more mature the infant's digestive system is at the time of introduction of solid foods, the more likely they will be able to tolerate them. It is now well established that breast feeding is the best food for infants and should be continued until either the mother or infant wants to wean. The introduction of solid foods, especially those which have been shown to create many food reactions, should be delayed as long as possible. Foods should be introduced in small amounts, one at a time.

New foods should be given not more than once every four days, while observing for any reactions such as sneezing, rashes, a change in stool, or a behavioral change. Give only a bite the first time, increasing the amount with each feeding if no adverse effects are observed.

Further research needs to be conducted to determine the best schedule for the introduction of solids, but until this is available it would be prudent to go by the following guidelines which are based on the collective experience of professionals who work extensively with infants and children.

• Carrots, poi, yams, squash, and zucchini are vegetables which are generally well tolerated. Beans, spinach, and peas should not be given before 12 months of age. Tomato and corn should be withheld until 24 months.
  

• Raw fruit, other than very ripe bananas, should not be introduced before 12 months of age. Apples, peaches, and citrus fruits should be the last fruits introduced. Pears, plums and apricots are believed to be among the least sensitizing and best tolerated.
  

• Rice or oats cereal, mixed with water or breast milk, may be the best grain to start the infant at about nine months of age. Wheat, eggs and cow's milk should not be given to an infant before 21 months of age.

A Schedule for some healthy foods and their approximate time of introduction.
Time					Foods
	6 months				Hypoallergenic, pureed, mashed foods containing iron. 1-2 tablespoons per day of: carrots, poi, squash, yam, broccoli, cauliflower, zucchini, Jerusalem artichoke, sprouts (blended in water).
	7 1/2 months				Cooked fruits. 2-3 tablespoons per day of: kiwi, pears, prunes, cherries , banana blackberries, grapes, applesauce.
	9 months				Foods high in zinc and good for the immune system. 2-4 tablespoons per day of: sweet potato, cabbage, oatmeal, papaya, potato, blueberries, lima beans, string beans, nectarine, peach, black strap molasses, split pea soup, millet, plum, rice cereal, beets.
	12 months				Foods high in zinc and bulk. 4-10 tablespoons per day of: acorn squash, barley, chard, tofu, yogurt, parsnips, asparagus, avocado, egg yolk, rice, goat's milk, quinoa (a grain), barley, buckwheat, spinach, spelt & teff (grains).
	18 months				Foods high in B vitamins and calcium Tahini, lamb, greens, kelp, eggplant, rye, beet greens, chicken, rutabaga, beans, fish, buckwheat, spinach, spelt & teff (grains).
	21 months				Foods high in protein. Almond butter, egg, turkey, walnuts, wheat, cornish hen, beef liver, cashew butter, pineapple, orange, brewer's yeast, cow's milk.
	2 - 3 years				Sunflower seeds, corn, peanut butter, clams, soy, cottage cheese, lentils, tomato, cheese, beef.

	Sources:
	The Complete Guide to Food Allergy and Intolerance by Professor Jonathan Brostoff and Linda Gamlin, Bloomsbury, £6.99. Food Allergy Prevention: Introduction of Solid Food for Infants Michael Traub, N.D. Association of Naturopathic Physicians

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