Paediatric and Teenage Nutrition

food, feeding and nutrition

Tag: food refusal

make mealtimes better

Make Mealtimes Better: Structure, Nurture & Boundaries

This accessible on-line workshop series is designed for parents/carers of older infants, toddlers and pre-school children. It provides a space alongside others to listen, learn, share, practice and develop tools and strategies to make mealtimes better.


Who should attend?

For infants and young children with, and for families seeking support with

  • food refusal/aversion, feeding anxieties/previous adverse experience
  • helping your child/family to eat well
  • prolonged difficulty with texture
  • excessive gagging or vomiting
  • limited feeding skills, experience and range of foods eaten
  • prolonged illness or hospital admissions
  • sensory difficulties and highly selective eating
  • tantrums at the table, difficult feeding behaviours

Young children and parents/carers can get stuck in selective eating/food refusal for many different reasons. And although it’s helpful to unpick those reasons, it’s good to explore ways of bridging gaps, whether that’s nutrition, tools and strategies or managing the moment. There are no single magic answers, but there are some very useful ideas, tools and strategies you can learn, and which do help. Take control, give yourself some agency, share your experience and come and take part!  Make Mealtimes Better Workshop Overview gives you a flavour of the key themes of structure, nurture and boundaries.

Workshop Dates for 2023

3 x 60-minute sessions, fortnightly on Tuesdays at 1.30 – 2.30pm, Cost £60

  • May 2023:  2nd, 16th, 30th
  • June 2023: 6th, 20th June and 4th July
  • September/October 2023:   12th, 26th September and 10th October
  • November/December 2023: 7th, 21st November and 5th December

Express your interest here.

diet related conditions in childhood

Diet related conditions in childhood benefit from the skilled help of a Paediatric Dietitian, especially when foods are affecting a child’s eating, sleeping, playing or growing.  Do browse this section or get in touch with a question or to make an appointment.  Does you child have adverse reactions to foods or a diet-related medical condition?  Perhaps you have concerns that your child is not eating or growing well enough?  Are you concerned that your child has lost weight recently? Whatever their age, a child’s diet makes a huge contribution to their wellbeing. This website, and the service I offer, help to provide you with an understanding about, and treatment for, some common diet related conditions in childhood. To use the Paediatric Nutrition website, navigate age-related issues using the top bar and condition-specific ones using tabs on the side bar. A quick overview then:

The Infant feeding matters section contains information about diet related conditions in infancy such as cow’s milk allergy, and also gives an overview of an infant’s nutritional needs.

Food refusalCommon feeding difficulties in childhood that affect toddlers and pre-school children include behavioural issues such as food refusal and functional problems like constipation.  As needed, I work with other colleagues including paediatricians and speech and language therapists at Cambridge Paediatric Practice.

Food allergies and intolerance can affect all age groups, although food allergies do more commonly affect younger children.  Most early food allergies are outgrown by puberty, but those that persist or are diagnosed later in childhood are often life-long, requiring an epipen and careful dietary management.

gastrointestinal problems in teenagersGastrointestinal difficulties are often associated with stress or anxiety, illustrating the link between mind and body, and specifically the gut.  Abdominal pain, reflux or diarrhoea that become persistent can be successfully treated by diet. Teenagers can be affected by emotional problems and may experience restricted or disordered eating at some point. I offer specific dietary assessment and link with other paediatric colleagues including family therapists or psychologists when there is concern about an eating disorder.

Questions are welcome by contacting me directly, or of course to provide any feedback about this website.

identifying the symptoms of cow’s milk allergy

Identifying the symptoms of Cow’s Milk Allergy is the 1st part in this 5-part blog series about Cow’s Milk Allergy in Infancy.

Cow’s Milk Allergy (CMA) is an immune reaction to the proteins found in cow’s milk affecting 1 in 20 infants in the UK.  There are two distinct types of cow’s milk allergy: IgE reactions with immediate onset of symptoms and non IgE reactions with delayed onset.  In both types, symptoms range from mild-moderate to severe and persisting with potentially life-threatening reactions such as anaphylaxis. The following table will help you in identifying the symptoms of Cow’s Milk Allergy.

Delayed Onset Symptoms

Non-IgE Cow’s Milk Allergy

2 – 72 hours after milk intake

Immediate Onset Reactions

IgE Cow’s Milk Allergy

Minutes after milk intake

Affecting formula-fed, exclusively breast fed infants or at the onset of mixed feeding/solids Affecting formula-fed infants or at the onset of mixed feeding
Gastrointestinal symptoms may be mild-moderate or severe and persisting
colic, reflux, loose, frequent stools, soft stool constipation, painful wind,  blood or mucous in nappy, food refusal, feeding aversion, poor growth vomiting, diarrhoea, colic
Skin symptoms can be mild-moderate or severe and persisting
itchy, raised red rash, atopic eczema intense itching, erythema (raised red rash), urticaria (flushing, spreading rash), flare up of atopic eczema, angioedema (facial swelling)
Respiratory symptoms are confined to IgE reactions
acute rhinitis (hayfever), conjunctivitis (swelling in and around the eyes) ANAPHYLAXIS

This blog series will focus on non-IgE CMA with delayed onset, which although less severe can be more complex and difficult to diagnose.  This is due to a number of issues: the similarity to other common conditions during infancy such as colic, reflux or loose stools and also the symptoms being mistakenly treated as lactose intolerance. Again this is due to the similarity in gut symptoms such as colic, bloating, discomfort and diarrhoea.  Unlike IgE CMA, there is no diagnostic allergy test for non IgE CMA and because reactions are delayed up to 72 hours after intake, cause and effect is not quite so clear. Lactose intolerance does not involve immune reactions, but results from lack of the digestive enzyme lactase, with malabsorption of the “milk sugar” lactose  causing discomfort and diarrhoea. A lactose free formula (which normally contains cow’ s milk protein) will resolve lactose intolerance but not Cow’s Milk Allergy,

Non IgE Cow’s Milk Allergy in infancy responds extremely well to prompt dietary treatment, with the majority of infants outgrowing their allergy within 6-12 months.  Delays in diagnosis and treatment lead to symptoms becoming severe and persistent, with feeding difficulties and growth faltering more evident.  Identifying the symptoms of Cow’s Milk Allergy early and discussing an allergy focused history with a trained GP or Paediatric Dietitian will assist making a diagnosis and accessing prompt appropriate treatment.

Next Confirming a diagnosis of Cow’s Milk Allergy.

portion sizes for your toddler

How confident do you feel about portion sizes for your toddler?  In a recent survey from the Infant & Toddler Form, 73% of mums felt that they their toddlers were not eating enough.  Toddlers appetites vary depending on how they feel, what’s on offer, how tired they are  Some days there is no feeding them.  Fussy eating and food refusal during the toddler years is a great cause for concern with parents, but it is a normal part of childhood development. Toddlers can be be tricky feeders at mealtimes, with food refusal gaining attention and often resulting in a battle of wills.  Use this portion size guide to help guide you.

Can giving toddlers large portions cause excess weight gain and obesity?
Large portion sizes for toddler meals are linked to obesity development says another recent survey.  There is however no single cause for obesity, just as there is no single correct portion size for toddler. Meal times are good opportunities to eat nutritious food, and portion sizes of nutritious food should not be limited.  Foods high in fats and sugars, deep fried and battered should be kept to a minimum, as these are very high in calories and do contribute to obesity if eaten regularly. But, it’s often the food eaten outside of mealtimes that is high in calories with low nutritional value.  For all you worried mum’s out there, its good to know that nutrient deficiencies are rare in the UK, and children who are eating a variety of foods from the 5 food groups will not need a vitamin supplement.

Need further advice?  Contact Carine to book an appointment.