Author: Carine Henry (Page 1 of 3)

making mealtimes better

8th March 2023 / Carine Henry / 0 Comments

Making Mealtimes Better : Structure, Nurture & Boundaries

Accessible and full of sensible evidence-based information to support feeding young children well, Making Mealtimes Better is on-line workshop series is designed for parents/carers of young children with a variety of food-related behaviours. Delivered by Carine Henry RD, paediatric specialist dietitian, with 30 years of practical working with children and families, in areas of feeding difficulties, growth faltering and tummy troubles.

Making Mealtimes Better provides a space alongside others to listen, learn, share, practice and develop tools and select strategies to make every mealtime better. Carine uses themes of Structure, Nurture and Boundaries to guide topics including:

meeting your child’s nutritional needs : key nutrients and food groups
expanding food experience : where you are now, next steps and forward planning
giving right attention to food and feeding
learning to enjoy food and feeding : agency and satisfaction
awareness of how emotions impact food, feeding and nutrition, for both parents and child

Making Mealtimes Better is intended for children aged 18 months to 5 years whose nutritional wellbeing and growth may be compromised and/or where food-related behaviours are challenging eg.

food refusal, feeding aversion, food fears, feeding anxieties
prolonged difficulty with expanding to mixed textures of food
difficulty introducing new foods and & limited experience of a range of foods
highly selective eating and sensory difficulties
tantrums at the table, difficult feeding behaviours, battlegrounds with food

Mindful parenting is skill that can be developed through practice, and impacts both parents and children positively. Carine will be exploring themes with you around mindful approaches as they relates food, feeding, eating and nutrition.

Iron Deficiency Anaemia in infancy

5th July 2021 / Carine Henry / 0 Comments

Iron deficiency anaemia (IDA) is the most common nutritional problem affecting infants with 60% of 6-12 month old babies in the UK having low dietary iron intake, a key risk factor for developing IDA. Early childhood is a time of vulnerability as iron deficiency anaemia in this period is associated with brain development. It’s a time of rapid physical growth, and a time when dietary iron needs are at their highest. Various risk factors are known to contribute to IDA: particularly premature birth, very low birth weight and maternal iron deficiency. Infant feeding practices including the introduction of solids are important considerations. Iron absorption is limited (by the gut) to around 15-20% and this becomes relevant when thinking about choosing iron-rich foods to offer. Iron contained within plant and animal foods differ, with absorption being higher from animal foods, which can be improved in the presence of Vitamin C. Here I provide some information about nutritional needs, dietary sources and infant feeding practices.

Infants’ Nutritional needs and Dietary sources of iron

An essential micronutrient, iron is required to make haemoglobin, the red pigment in haemoglobin, which carries oxygen around the body within the red blood cells. IDA means that the blood carries less oxygen than the body needs. Infants with IDA will be pale and tired, have poor resistance to infection and their general health, appetite and vitality is limited. Typically, infants don’t show any signs in the early stages of IDA, and it commonly goes undiagnosed until they become symptomatic. Iron needs are highest at 6-12 months, when term babies will have used up all their body’s stores of iron, which built up during the last trimester of pregnancy. Dietary iron needs rapidly increase then. Introducing iron-rich foods is critical at this age: to provide essential dietary iron, and to introduce and establish the familiar tastes, smells and textures of iron-rich foods. Red meat, liver, egg yolk apricots, dried fruits, green vegetables, lentils, avocado, oily fish, seed and nut butters are all food rich in iron. The required daily intake of iron for a healthy, term baby is 7.8mg, half of that needed by a women of child bearing age.

Infant Feeding practices and the Introduction of Iron-rich foods

Breast-fed infants need iron-rich foods on a daily basis from the weaning period, as breast milk contains very little iron. Drinking iron-fortified formula does protect against IDA, but formula-fed infants also need to become familiar with iron-rich foods to broaden their diet. Becoming familiar iron-rich foods at an early age improves acceptance and continual consumption of these foods, throughout toddlerhood. This applies to other food too, that have been eaten regualrly during the sensitive period at 6-12 month, and infants are more familiar with those foods and have practiced eating them. First formula milks, those with a higher ratio of whey, are best suited for all babies until 1 year for many reasons, with improved absorption of nutrients including iron; there is none for follow-on formulas, as all formulas comply with standardised contents for key nutrients.

portions of calcium rich foods

21st June 2021 / Carine Henry / 0 Comments

Portions of Calcium rich foods

Portion	Food	Calcium (mg)
200mls	cow’s milk	230
200mls	soya milk	240
150g	natural yoghurt	300
150g	fruit yoghurt	240
30g	cheddar cheese	200
30g	soya cheese	125
2	tinned pilchards	330
4	tinned sardines	460
120g	tinned salmon	105
1 tsp	tahini (sesame seeds)	135
30g	almonds	65
10	apricots	75
1	dried fig	50
90g	spinach	145
3 tbls	baked beans	70
portion	broccoli	35
portion	spring greens	65
1 slice	white bread	30
1 slice	wholemeal bread	20

Source “The Composition of Foods” 5th Ed; McCance & Widdowson; Royal Society of Chemistry

Izzy’s Overnight Almond Oats

9th January 2020 / Carine Henry / 1 Comment

I really do get it – it’s hard to make time on a school morning to prepare a nutritious breakfast. My teenage daughter Izzy and I teamed up to produce this blog, after she developed this yummy recipe. Izzy doing the creative part – great instagram photos and actual recipe development, and me doing the nutrient analysis with my dietetic book “The RSC Composition of Foods“. Overnight Almond Oats are vegan, milk free, wheat free and positively bursting with health giving nutrition.

It all started when we both decided to moooove away from cow’s milk for 2020. We’re experimenting at the moment, trying various milk alternatives: oat, almond and soya are our favourites. We haven’t yet tried the many different yoghurts like oat and coconut, but soya based yogurt with toasted almond tastes really great. So, look out for more delicious and nutritious recipes! If you are developing your own recipe ideas and selecting more vegan and milk/wheat free choices, don’t forget about calcium. It an absolute must! Read the label of the milk or yoghurt you are buying, and if it doesn’t have calcium, then find one that does. You bones will thanks you when you get to my age! Or quite a bit before!!

Recipe for Overnight Almond Oats		Calories	Protein	Calcium	Magnesium
150g 1 oz 1 teaspoon 1 handful 1 spoonful Drizzle Big pinch	Almond Yoghurt Porridge Oats Ground almonds Frozen raspberries Almond Butter Honey Flaked toasted almonds	81 112 35 12 97 14 10	5.8 3.4 2 0.7 3.8 – –	180 15 15 12 36 – 4	20 33 16 10 40 – 5
Totals		368kcals	15.7g	262mg	124mg
Method
Place all the ingredients into the cup, to create the layers of colour and yumminess, seal and refrigerate overnight. Enjoy in the morning with no fuss, no rush and fantastic, fresh, energising nutrition for the whole morning.
Nutrition Notes
Dairy free, wheat free, vegan Low in sugars, high in plant-based fats but moderate in overall calories Keeps blood sugar levels steady with energy release from digesting complex carbohydrates in the oats and nuts, providing energy and focus throughout the morning 33% daily needs for calcium, essential for bone strength and muscle function 60% daily needs for magnesium, essential for energy metabolism and nervous system Protein, potassium, vitamin C, and the B vitamin Folic Acid for getting your brain in gear Last but not least, a good source of soluble and structural fibre @ 7.6g to keep your gut microbiome bugs happy and digestive system fighting fit

what’s the difference between lactose intolerance and cow’s milk allergy?

26th November 2019 / Carine Henry / 1 Comment

Many people are confused about the difference between lactose intolerance and cow’s milk allergy. Misunderstood as same condition; the terms lactose intolerance and cow’s milk allergy are used interchangeably and incorrectly. Most likely due to the similarity of symptoms such as bloating, wind and diarrhoea; both being related to drinking milk and alleviated by avoiding it. When I say milk – I mean mammalian milks such as cow’s (including infant formula) goats, sheep and human milk. So, here is the main difference: Cow’s Milk Allergy is an immune system response to milk protein, which drives a spectrum of symptoms affecting the skin as well as the tummy. In the more severe IgE allergic reactions, the mouth, throat and breathing are affected. Lactose intolerance is not an allergy but a physical response due to lack of digestive enzyme lactase required to digest the milk sugar lactose. This blog will give an overview of symptoms, causes and dietary management of lactose intolerance providing further links on products and nutritional information.

Lactose Intolerance
Is a normal response to the presence of undigested lactose (milk sugar) in the large intestine. When lactose digestion fails in the small intestine the lactose sugar travels onto the large intestine where bacterial fermentation, responsible for the characteristic bloating, discomfort and wind, takes place. In the presence of large amounts of lactose, water and salts are drawn into the large bowel (by osmosis) causing increased water volume, urgency to go to the toilet and explosive stools. Lactose is found in milk and dairy products like soft cheese and yoghurts. Hard cheeses have naturally low levels of lactose, as do products like butter, margarine and double cream. Adults and older children with established lactose intolerance can typically eat these foods without any problem. Those small amounts of lactose provide food for the friendly lactobacillus bacteria which normal live in the large bowel.

What are the causes of lactose intolerance?
Lactose intolerance itself does not cause damage to the small intestine; rather it’s the result of tissue damage to the intestinal lining which affects lactase enzyme production. A temporary condition in infants and young children, it will resolve as the gut cells turnover and repair themselves. Lactase enzyme decreases progressively with age with around 70% of the world’s population with limited lactase activity. Persistent lactose intolerance is uncommon in infants and young children, due to their high milk intake, which maintains enzyme production. Teenagers however may not regain their lactase activity following small intestinal damage or serious infection. The most common causes of lactose intolerance include:

Gastro-intestinal infection with characteristic diarrhoea and vomiting
Allergic inflammation, especially with unresolved non-IgE Cow’s Milk Allergy
Small bowel bacterial overgrowth eg. in older children, teens

Products and differences in dietary management
It’s important to understand that the nutritional composition of milk alternatives make them unsuitable as drinks for infants and toddlers, but can be a useful addition to solids, when a nutritious fluid is needed to blend or mix. When selecting a milk alternative, always choose one fortified with calcium. Lactose free milks and cheeses made from cow’s milk contain cow’s milk protein, making them unsuitable for those with cow’s milk allergy. Vegan cheeses, whilst lactose and cow’s milk protein free have poor nutritional value and are not fortified with any calcium. A low lactose diet to treat lactose intolerance is usually followed for between 2 and 6 weeks (depending on severity of symptoms) and a cow’s milk protein exclusion for CMA for at least 6 months. Use this guidance on reintroducing lactose back into the diet if you had lactose intolerance but do seek further guidance for Cow’s Milk Allergy in Infancy if feeding is difficult and you are unsure about next steps.

reintroducing lactose back into the diet

30th October 2019 / Carine Henry / 0 Comments

Following a 2 – 6 week low lactose diet to treat lactose intolerance, your child should now be well on their way to recovery from symptoms. Reintroducing lactose back into the diet in a controlled way is the next step. Starting with low lactose foods, then adding in medium and, once you’re satisfied all is being tolerated, finally adding in high lactose-containing foods. Use the guidance below on lactose content of dairy foods to assist you, taking about 2-4 weeks, gradually increasing, will do several things:

stimulate production of lactase, the small intestinal digestive enzyme that digests lactose
help establish and then increase the amount of dietary lactose that is tolerated
assist in the build up and return of normal lactase production in the small intestine

Re-establishing tolerance to lactose
Re-establishing tolerance to lactose varies from child-to-child, depending on age, habitual diet and degree of severity. Because infants and young children are more dependent on a high milk diet, the lactase enzyme returns more readily and lactose intolerance is usually temporary. Resumption of a normal diet is somewhere between 2-6 weeks for most infants and children. Referred to as secondary lactose intolerance this is often the result of nasty gut bugs like rotavirus, or can be secondary to small intestinal damage caused by untreated cow’s milk protein allergy or coeliac disease. Individuals including older children and teens may develop primary lactose intolerance or a permanent reduction in lactase enzyme, more typically affecting non-caucasian children and those with a habitually low milk/no milk intake following a similar route via infection of small intestinal irritation. Amounts of 2 – 4g lactose per day are usually well tolerated despite the lack of lactase enzyme. Instead lactose is digested by the lactobacillus bacteria, naturally residing in the large intestine.

Other points worth noting about lactose intolerance and reintroduction

lactase enzyme production returns with exposure to lactose from the diet
lactose reintroduction can be tried again and again every 2-4 weeks, depending on response
lactose itself does not cause damage to the small intestine
a tolerance threshold may be reached at a certain level of lactose intake
tolerance may be improved by spreading lactose intake over the day, or eating with other foods
the difference between lactose intolerance and cow’s milk allergy
the nutritional composition of milk alternatives

Special care with infants
Formula fed babies with lactose intolerance, need a lactose free formula. Lactose intolerance may also occur in breast-fed babies but is less common; only in very rare congenital primary lactase deficiency would there be a need to stop breast feeding and use a lactose free formula. What is important, is to correctly identify if cow’s milk allergy are the cause of the symptoms, to ensure that infants get the right dietary treatment. Products in the shops vary enormously in nutritional composition, and are not suitable to drink because of poor nutritional quality.

Lactose content of dairy foods

Very Low Lactose

< 2g per portion

Medium Lactose

2-4g per portion

High Lactose

4-6g per portion

The foods in this group contain very low amounts of lactose and are tolerated by most people with lactose intolerance. If consuming these foods does not give any symptoms, try medium lactose foods per portion.

Continue to introduce lactose containing foods, including foods with medium lactose. If symptoms return, go back to the previous tolerated stage for 2 weeks and try again.

In addition to very low and medium lactose content foods, continue to introduce lactose-containing foods, including one portion from the high lactose category.

Cheese 1oz

Most hard cheeses have very small amounts of lactose and are unusually well tolerated. Eg. cheddar, red leicester, caerphilly, stilton, parmasan

Cheese spread, cottage cheese, soft cheeses eg. ricotta, marscapone, dolchelate

Cheese spread, quark

Yoghurts & fromage-frais 60g	125g	Larger portion
Greek yoghurt, Goat’s yogurt, all yoghurts and fromage-frais	Yoghurts and fromage-frais, Low fat fruit yoghurts, Organic whole milk yoghurt	Natural whole or fruit yoghurt, Low fat natural yoghurt, Diet/low calorie yoghurts
Dairy desserts & creams 2oz	4 – 6oz	Larger portion
Half fat cream, Single, Double, Whipping, Clotted cream, UHT Spray Cream, Fresh Cheese Cake	1 scoop ice cream, Frozen cheesecake, Trifle with cream, 1 chocolate mousse	2 scoops ice cream, 10mls Angel Delight, 150g tinned rice pudding, 100mls Custard
Hidden milk
1 x small slice cake, 4 chocolate digestives, 1 chocolate coated biscuit eg. 2 finger kit-kat, 100g egg custard tart		1 milk chocolate bar, 125mls whole milk, 70mls evaporated milk, 1 tblsp skimmed milk powder, 40mls condensed milk

risk of iodine deficiency during pregnancy

17th October 2019 / Carine Henry / 0 Comments

The nutrient iodine has been under scrutiny over recent years, due to public health concern that 50% of UK women are at risk of iodine deficiency. Health consequences include thyroid dysfunction, goitre and poor mental function. Pregnant women are particularly at risk of iodine deficiency, and their unborn babies at increased risk of brain damage. The purpose of this blog is to highlight iodine deficiency as a real problem for pregnant women, provide guidance on dietary sources of iodine, suitable iodine supplementation and links to expert information via The UK Iodine Group.

Why is iodine deficiency so important?
Iodine is a constituent of thyroid hormones, essential for thyroid function and optimum functioning of the nervous system. Importantly, during early pregnancy iodine is essential for the healthy brain development of the foetus, and later in pregnancy provides iodine directly to the baby for maturation of the thyroid gland. Iodine deficiency during pregnancy is linked to brain damage; the more profound the deficiency, the more severe the health consequences for the developing foetus. This is a world-wide longstanding problem, and you can see a UK perspective the SACN statement on Iodine and Health published in 2014.

Dietary sources of iodine
Iodine comes from the soil, leaches into water and is naturally found in fish, shellfish and other seafood. Iodisation of salt was not adopted in the UK, as it was across the US, China, Asia and Europe throughout the 1920’s. In the UK it enters our food chain via dairy farming practice, as a constituent of sterilisers used in milking and of winter cattle feed. Together with encouraging children to drink more milk after WW2, cow’s milk is now the main dietary source of iodine in the UK. However our dietary practices are changing – we drink less cow’s milk, eat less fish and consume a more plant-based diet. As a result we are becoming iodine deficient. There are calls for iodisation, but as we have no consensus. Do have look at other dietary sources of iodine to check on your own intake.

Increased needs for iodine during pregnancy and breastfeeding

Needs for iodine are 40% higher during pregnancy and breast-feeding
There is a 50% surge of thyroid hormone production during the early part of pregnancy, mainly to supply iodine to the developing foetus. Mum’s daily needs for iodine are 200-250ug
There are increased urinary losses during pregnancy
Iodine is required by the unborn baby from around 20 weeks gestation, to support the start of thyroid function; drawing this from maternal iodine supplies
Once born babies daily needs for iodine throughout the first year are 50-60ug and breast milk contains around 7ug/100mls (formula contains 12-14ug/100mls)

Taking an iodine supplement
Breast feeding mums are at further risk of iodine deficiency if following a milk free diet for their cow’s milk allergy baby. It is important to be aware that the nutritional composition of milk alternatives is poor, usually without iodine and sometimes even without calcium! Do take a supplement if you cannot get enough iodine from dietary sources, bearing in mind that single supplements of iodine are not routinely available (partly because too much is dangerous). Pregnant women should not take kelp or seaweed supplements for this reason. Multivitamin & mineral supplements now routinely contain iodine, providing around 150ug, which is the usual daily adult need. The rest can more easily be found in the diet.

good sources of calcium

2nd October 2019 / Carine Henry / 1 Comment

Infants and children need good sources of calcium in their diets on a daily basis. Calcium absorption in the gut is variable and ranges from 25-50%, increasing when intake is low and reducing when intake is high. Plenty of foods rich in calcium are especially important throughout infancy to support the rapid bone growth and bone mineralisation that occurs at this time. The uptake of calcium by bones is then regulated by Vitamin D, with Vitamin D deficiency limiting bone mineralisation even in the presence of adequate calcium. Growth spurts during infancy and childhood, from a surge in growth hormone provides a boost to calcium absorption, which further strengthens bone mineralisation. Absorption of calcium from breast milk is very efficient at around 66% and from formula milk around 40%. For all infants and young children offer them calcium rich foods every day.

Dairy products like milk, cheese and yoghurt are the UK’s best sources of calcium for infants and young children
Calcium is also found in tinned fish, nut butters, tahini or sesame seed pulp, hummus, figs, dates, and green vegetables
White wheat flour is fortified in the UK with 120mg Calcium per 100g
Water in areas of hard water like Cambridge contains 120mg calcium per litre
For all children with cow’s milk allergy, take care to offer calcium enriched products, checking sources of other valuable nutrients such as protein, iodine, Vitamin D as well as overall calories
Prolonged poor calcium intake will lead to brittle bones that break more easily, both in childhood and in later adulthood
Exercise and weight bearing activity will also strengthen bone
Have a quick check on recommended intakes to check if your child is getting enough calcium
Download the portions of calcium rich foods below
Infants and young children need a Vitamin D supplement containing a minimum of 10ug daily until 5 years and thereafter for a minimum of the 6 Winter/Spring months to maintain good levels

Recommended Intakes

Daily calcium needs during infancy are 525mg
5-600mls formula provides the majority of calcium during infancy
Breast fed infants depend on mum’s diet, and a calcium and vitamin D is advisable for mum
Daily calcium needs during early years are 350-450mg; provided by 3-4 portions of calcium rich foods
Daily calcium needs during primary school are 450-700mg; provided by 4-5 portions of calcium rich foods
For all children with cow’s milk allergy, take care to offer calcium enriched products, checking sources of other valuable nutrients such as protein, iodine, Vitamin D as well as overall calories.

nutritional composition of milk alternatives

25th September 2019 / Carine Henry / 0 Comments

If you have a child who has lactose intolerance or cow’s milk allergy, chances are you need to think about the nutritional composition of milk alternatives. Cow’s milk and its products are good sources of calcium and trace elements like iodine in the UK diet. As someone who takes nutrition seriously, a Paediatric Dietitian and mother of 3 growing teenagers, I would like to point out that the nutritional composition of milk alternatives available in our shops is shockingly poor. It does not serve consumers well, has insufficient nutrition for infants, children or teens, and for those who depend on the nutrients milk would normally provide. The missing nutrients and their physiological roles are as follows:

calcium – for growth and maintenance of strong bones, blood clotting
iodine – for neurological development during pregnancy, control of metabolism, thyroid function
Vitamin B2 – for healthy skin, eyes and nervous system, releasing energy from food
protein – for growth and repair of all body tissues, immune function
Vitamin B12 – assists in maturing red blood cells, absorption of iron
lactose – the milk sugar – food for the beneficial lactobacillus genus of bacteria, maintenance of a healthy intestinal microbiota

Exciting range of nut milks
I was quite excited to see such an explosion of nut milks now routinely available; and on researching this recently, felt somewhat aggrieved to see such poor nutritional composition. Nuts are one of nature’s most incredibly nutritious foods – high in calories, protein, essential fats, minerals like zinc, calcium, iron and magnesium as well as B vitamins. They are also (currently) fairly conflict-free and sustainable. There are not many foods you can say that about! Unfortunately none – and yes I do actually mean NONE – of that goodness is retained in the resultant, washed out and expensive product marketed as milk. Some have no calcium, no protein, no minerals no vitamins, and poor calories. Mil for mil they are 7 times the price.

Compare the nutritional composition of milk alternatives in the chart below, and take care to ensure that you choose ones with higher calories and protein for young children, ensuring they are fortified with calcium, and where possible Vitamin D and other vitamins.

Type of Milk	Calories	Protein	Calcium	Vitamin D	Extras
Whole Cow’s Milk	69	3.3	120	Low	Wide range of nutrients
Cow’s Milk formula	66	1.3	65	1.2	Full range of nutrients
Mature Breast Milk	67	1.3	35*	Varies	Wide range of nutrients
Goats Milk	70	2.8	120	Low	Wide range of nutrients
Arla Lactose Free Milk	56	3.3	120	Low	Wide range of nutrients
KoKo unsweetened	16	0.2	120	0.75	Nothing
Oatly Original	46	1.0	120	1.5	Vitamins
Innocent Hazelnut Milk	72	1.0	0	0	Nothing
Innocent Almond Milk	37	1.4	0	0	Nothing
Alpro Soya Original	42	3.3	120	0.75	Vitamins
Alpro Cashew Milk	23	0.5	120	0.75	Vitamins
Alpro Soya Growing-Up 1-3	64	2.5	120	1.5	Iodine, Vitamins
Rice Dream plus calcium	50	0.1	120	0.75	Not for <5years

absorption of calcium from breast milk is extremely efficient, but infants needs for calcium from 6-12 months through are high. Check out good sources of calcium if weaning your cow’s milk allergic infant.

innovative treatments in cow’s milk allergy

8th November 2018 / Carine Henry / 0 Comments

Innovative treatments in cow’s milk allergy is the last in this 5-part blog series on Cow’s Milk Allergy in Infancy and is best read following positive outcomes for cows milk allergy.

Infants who develop Cows Milk Allergy (CMA) usually outgrow it before they start school. Until recently, dietary treatment was based on strict cow’s milk avoidance for long periods; typically 1-2 years. Introduction is now advised at an earlier age, especially for those with delayed reactions affecting the gut. Starting with tiny amounts of baked milk as early at 9 months, identifies those infants who are ready to start building tolerance. It is now believed that strict avoidance for long periods is unhelpful in promoting tolerance.¹ Infants with more severe (IgE) reactions do take longer to outgrow their allergy, and care needs to be taken to make introductions safely for those infants.

Active Allergy Management
Active Allergy Management is one of today’s most innovative treatments in cow’s milk allergy. It can be described as the deliberate, early introduction of tiny amounts of milk proteins in a controlled way. Effective and safe for the majority of infants with CMA, the timing of this introduction depends upon age and the type and severity of previous reactions. See my blog identifying symptoms of cow’s milk allergy for more information. Tolerance to baked milk is now used as a marker of readiness for the next steps of cows milk reintroduction.² This step-wise approach is known as the Milk Ladder, the earliest introduction of which can begin for non-IgE CMA around 9 months. Actively exposing an infant and educating the immune system in this way, enables young children to eat a normal diet at any earlier age.

The Infant Microbiota
The infant microbiota describes the total number of microbes living in an infants gut. Recent research shows earlier tolerance to cow’s milk using CMA treatment formulas with the added probiotic microbe strains Lactobacillus rhamnosus or Bifidobacteria breve . Other treatment formulas with added prebiotic co-factors (specialised sugars called oligosaccharides) may also be helpful, by providing food for these beneficial microbes. Breast feeding is known to be protective for food allergy. Although the mechanisms are not entirely understood, the higher numbers of lactobacillus and bifidobacteria which dominate the microbiota of breast fed babies are likely to be involved. Intimately involved with educating the immune system, the infant microbiota has a key role to play in allergy development and management. Specialised formulas are now available (on GP prescription) which mimic the breast milk provision of those beneficial microbe species alongside prebiotic co-factors that help colonise the infant microbiota, with earlier resolution for children with Cow’s Milk Allergy.

Dietary baked milk accelerates the resolution of cow’s milk allergy in children, Kim JS et al 2011
Tolerance to baked and fermented cow’s milk in children with IgE mediated and non IgE mediated CMA in patients under 2 years, Uncuoglu A et al, 2017

Next An introduction to the Infant Microbiome

Paediatric and Teenage Nutrition

food, feeding and nutrition