It is known that young children with food allergies often exhibit ‘faddy’ or picking eating behaviour. In some presentations of food allergies, such as Eosinophilic Esophagitis, this may even present as a more severe form of faddy eating, referred to as feeding dysfunction.
I have often wondered if food exclusion diets during infancy still affect food intake years later, even into later childhood or adulthood. In 2012, I obtained UK funding for a PhD student to research the effect of cow’s milk avoidance in the first year of life on food choices up to a decade after any possible signs of cow’s milk allergy have resolved. The Food Allergy and Intolerance Research (FAIR) Cohort on the Isle of Wight were nearing 10/11 years of age and were ideal to perform such a study.
Kate Maslin RD led this research as part of her PhD and published the results earlier this year: Cows’ milk exclusion diet during infancy: Is there a long-term effect on children’s eating behaviour and food preferences? She also set up collaborations with the team across the waters in Southampton who recruited a birth cohort (Prevalence in Food Allergy – PIFA) as part of the Europrevall study, and these children were nearing 5/6 years of age.
Kate showed that children who avoided cow’s milk for more than 4 months in the first year of life, rated their “liking” for dairy foods such as butter, cream, chocolate, full-fat milk and ice cream significantly lower than those who never avoided milk products. This was nearly a decade after the FAIR children outgrew any possible signs of milk allergy and up to 5 years after the PIFA children outgrew signs of a milk allergy.
What have I learned from this paper?
This paper has emphasised the importance of a dietetic consultation, focussing beyond just which foods should be avoided. Furthermore, I have realized that during dietary consultation the importance of focusing on suitable alternatives as well as what can be eaten is extremely important.
Looking at the particular foods the children did not “like” according the paper – butter, cream, chocolate, full-fat milk and ice cream – one cannot help question how often children ate any of the suitable milk-free alternatives based on soy, coconut, hemp, small amounts of rice and nut beverages (if tolerated) during the period of milk avoidance. If so, whether using these products would have prevented this long-term effect of less “liking”.
I therefore now spend significantly more time during consultations discussing suitable alternatives and ensuring the client’s diet is varied in terms of tastes and textures. Once the child outgrows their milk allergy, I stress the importance of introducing milk-containing foods as much as possible. This requires, in my opinion, very clear practical advice and at least one-two follow-up appointments with in RD.
Which questions still needs to be answered?
One of the questions our research team on the Isle of Wight particularly wanted to answer was if any particular formula(s) used for the diagnosis and management of cow’s milk allergy had a more profound effect on food intake than others. We unfortunately did not have the statistical power in each group to fully address this question.
Carina Venter PhD RD
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Dear Dr Venter
Thank you for publishing this very important easily accessible piece to such a large potential audience. RDs, SpRs, Allergists, parents and patient Allergy charities need to think about the results of the Maslin research and consider putting it into practice. Those that lead and manage services too have to understand why consultations may be taking longer.
I look forward to more!
Thank you Andrew! This week I address “Is taking a fish oil supplement safe for those with fish allergies?” I am sure you deal many many of these in your Adult Allergy Service.
Can I ask why you think it is so important for a child to have such foods in their diet? Is it not true a child can have a perfectly healthy and sustainable diet omitting dairy products entirely? I understand it is important to introduce a varied diet to decrease the likely good of fussy eating later on, but I fail to understand the need for cream and Icecream in anyone’s diet?! My daughter is four and has a dairy and nut allergy, she eats a healthy variety of foods including milk free alternatives. She takes a calcium supliment but eats a variety of foods containing naturally occurring calcium. I wonder if you could enlighten me? Many thanks
Dear Emma Apologies about the slow reply. I agree with you that there is no need for children/adults to eat any particular food (including cream and ice cream). The point we were trying to make was that avoidance of a food in early life (in this case milk), could lead to a less varied diet in later life. As you rightly say, many people have to avoid foods life-long due to food allergies. Avoidance of these foods is therefore required but with good planning and choosing a variety of alternative food, the diet can still be healthy and varied. Many parents/adults manage to do this very well, but in some cases, dietetic guidance is required to ensure that the diet is varied and nutritionally sound. I hope that clarifies it for you.