Absorption Problems

Absorption Disorders Absorption disorders, also sometimes called malabsorption syndromes, are characterized by problems digesting or absorbing substances (called nutrients) in the diet. Nutrients include vitamins, minerals, carbohydrates (e.g., sugars, starches), fats, and proteins. The term, "absorption disorder," does not refer to a specific disease—in most cases, the disorders are related to another medical condition. - See more at: http://www.healthcommunities.com/absorption-disorders/index.shtml#sthash...

Active Athlete

Nutrition is important part of the extra attention that young athletes need for several reasons:

  • Sports increase energy, nutrient and fluid demands on children and teens.
  • They need to have the energy and stamina to play and stay healthy.
  • The energy and protein needs depend on the level and type of physical activity they engage in, as well as their physical development.
  • The timing and content of meals before and after participation can help or hinder players' health on and off the field.
  • Sports and energy drinks are not well understood by those who use them.

Athletes do need

  • Extra protein, even when restricting calories. Too much, however, can lead to dehydration or weight gain.
  • Increased sugar (glucose) for heavy training, long contests and to refuel afterwards.
  • Healthy fats (avoiding saturated fats, trans fat, and fried foods).
  • Adequate calcium, iron, zinc, folate and vitamin B6. Without enough of these in particular, athletes can develop fatigue, muscle soreness, increased injury, decreased metabolism and slower recovery from injury.
  • Adequate hydration during and after events and practice.

But families and coaches must be aware that with more and more children participating in sports, the competition has increased. And those trying to become or remain elite athletes, sometimes seek an advantage so that they can rise to the next level of competition.

  • Nutrition is often seen as a way to improve performance.
  • In some sports, weight classes lead to efforts to control or manipulate weight.
  • Dietary supplements often carry claims that appeal to young athletes.
  • Medications used to enhance performance or control weight may impact the child or teen's nutrition.

Anemia

The body's red blood cells carry oxygen from the lungs to all the other tissues in the body. When there aren't enough red cells or when they're small or misshaped and can't function fully, that's anemia. And when the body can't get the oxygen it needs, symptoms develop.

  • Looking pale
  • Tiredness
  • Feeling weak
  • Easily out of breath
  • Poor concentration
  • Increased infections (later)
  • Changes in the tongue and fingernails (later)

Causes

Nutritional Deficiencies

Iron :Needed for the structure of the Hemoglobin that actually holds the oxygen within the red cells. When iron is low, the red cells are small and their oxygen carrying capacity is reduced. Growing infants, children and teens need to build the amount of iron in their blood cells and are often low in iron when they don't get red meat and other sources in their diets. Women need to compensate for their monthly losses, and pregnant women need to recognize that some of their accumulated iron will be transferred to their infants and they need to replenish their stores.

Vitamin B12 and Folic Acid: These two B vitamins are involved in forming the red cells themselves. When either is reduced, the cells balloon to a larger size. These cells too have difficulty transporting oxygen. B12 is present in animal meats, fish, and is primarily absorbed in the lower intestine, as long a substance from the stomach, Intrinsic Factor is present to assist the absorption. If the lower intestine  has been removed (in Crohn's disease and other conditions) or B12 is not supplemented when on a strict vegetarian diet, deficiency can arise. Folic acid is found in numerous foods, especially green leafy vegetables, but also many other vegetables and fruits,  but extra is needed when taking certain medications.

Vitamin E: An antioxidant, Vitamin E protects the red cell from being destroyed. When there's more poly-unsaturated fats (like vegetable oils) in the diet, the need for Vitamin E increases, but that's also where Vitamin E comes from, so this is rarely a problem except in premature infants and those who don't absorb fats well.

Vitamin B6: Needed to create hemoglobin and the cell itself. But because so many foods are good sources of B6 and it is often stored in the body, this is a rare problem that mainly occurs with certain genetic diseases. Babies who have the anemia also usually have prolonged diarrhea, distension and even seizures.

Copper, Vitamins A, C  (much less common): Vitamins A and C both seem to increase the effectiveness of iron either by increasing its absorption (C) or working with the iron to increase the hemoglobin levels. Long term copper deficiency can result in anemia, but this is rare in the developed world now unless a child has chronic diarrhea.

Non-Nutritional Anemia

Other causes for anemia include genetic disorders that affect the hemoglobin (Sickle cell anemia, for example); intestinal or internal bleeding; heavy menstrual bleeding; poor nutrient absorption; bone marrow problems with production; cancer and certain chronic illnesses and conditions. 

Testing

Hemoglobin and the hematocrit measure the amount and size of the red blood cell population.

A blood smear shows the size of the red cells. when iron is low, the cells are small. They enlarge with B12 or folate deficiency.

The reticulocyte count measures how frequently red blood cells are being pumped into the blood stream from the bone marrow.

Serum iron measures the amount of iron in the bloodstream.

The iron binding capacity measures how much of the iron is bound to proteins, though the amount of the protein (transferrin) that's being manufactured influences the results.

Ferritin reflects the body's iron stores. The result is decreased when there's a deficiency but goes up when there's too much iron, which can be a sign of potential liver and heart damage. However, inflammation (in rheumatoid arthritis and IBD) can cause an increase as well.

Vitamins A, B6, B12 and folate levels can be measured in the blood.

While Vitamin E can be measured, it sometimes has to be compared to certain fat levels in order to be interpreted correctly.

Copper can be measured in the blood.

Various tests are needed to determine whether B12 deficiency is due to its lack in the diet, a problem with absorption, or a decrease in Intrinsic factor, which is needed to assist with B12 absorption.

Stool test for blood (guaiac, hemoccult, others) can indicate whether blood is being lost.

Treatment

Treatment for anemia depends on how severe the situation is, the cause and whether ongoing problems are suspected. When the situation is dire, blood cell transfusions or intravenous iron may be needed. With mild anemias,  patients may need to be placed on iron or a vitamin with iron and monitored.

Iron is available without prescription. However, it should not be routinely taken without being monitored because the iron can overload the heart and liver beyond their storage capacity. B12 and folic acid can also be given as part of a routine vitamin or as a separate prescription (though folic acid has to be in chewable or pill form). When B12 can't be absorbed, a monthly shot can be given. The other vitamins and minerals are also included as part of routine vitamins or they can be given separately, but if deficiencies are present, their use should be guided by a knowledgeable physician or pediatric dietitian.

Asthma and Respiratory Problems

Asthma is a common, chronic respiratory disease Asthma has two main components that make it tough to breathe: inflammation (swelling and excess mucus build-up in the airways) and airway constriction (tightening of the muscles surrounding the airways). Treating both components of the disease is necessary for many patients to achieve optimal asthma control and to help prevent symptoms, including coughing, wheezing, shortness of breath, and chest tightness. Whether mild or life-threatening, these symptoms can interfere with sleeping and disrupt daily life.

Autism Spectrum Disorder

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Blood Disorders

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Bone Disorder or Low Bone Density

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Breastfeeding Mother

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Cancer

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Caretaker Problems

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Celiac Disease

Celiac disease and (non-celiac) sensitivity to gluten are so common now that some groceries have entire gluten-free sections.But few people understand the difference or even what gluten is. So let's start there.  Gluten is a small part of the protein in certain grains, most notably wheat, but also rye, barley and spelt.It's not in oats, but because oats are often milled on the same equipment that is used for wheat, there can easily be some gluten with the oats (that's cross-contamination).

Bakers often add extra gluten to help dough hold its shape when it rises.Not a problem for most people, but for those with celiac disease, gluten triggers an auto-immune reaction, damaging the intestinal surface.That damage interferes with nutrient absorption.The auto-immune reaction can also cause other problems,including a skin rash and decreased fertility in women.The additional problem is that celiac disease (or celiac sprue, or in Europe, coeliac disease) is lifelong, meaning that,at least for the present,those with the condition have to follow a gluten-free diet.

Celiac Symptoms

These may not all be present (in fact, some children and adults won't show up with the usual symptoms, but will instead go to the doctor for one of the consequences of celiac disease listed here (and see the “Further Reading”):

  • Abdominal pain
  • Bloating and/or gassiness
  • Diarrhea, bulky stools or constipation
  • Poor weight gain or growth
  • Decreased appetite
  • Irritability
  • Fatigue

Consequences of Celiac Disease

  • Anemia
  • Osteoporosis
  • Dermatitis herpetiformis (itchy rash)
  • Infertility, shorter periods  
  • Intestinal cancers  
  • Migraines
  • Depression or Anxiety

Associated Autoimmune Disorders

Celiac disease is increased in these conditions. As many as 3-8% of these individuals will also have celiac disease

  • Diabetes, Type 1
  • Thyroid disease (especially Hashimoto's thyroid inflammation)
  • Juvenile arthritis
  • Lupus and Sjogren's Syndrome   
  • Liver diseases, especially autoimmune hepatitis.
  • Down, Turner and Williams Syndromes

Blood Test For Gluten Sensitivity

Genetics / Auto-immune

The gene responsible for celiac disease is actually present in 1/3 of the world's population, going from at least one parent to a child, but the disease doesn't actually develop until something turns it on. It might be a virus that, in part, has a similar structure to gluten. The body develops an immune reaction to the virus and that carries over so that it also reacts to gluten. So instead, only 1 out of a 100 individuals has celiac disease, but among those with the gene that can range all the way up to 1 in 7.

Enormous Confusion

Celiac disease can appear similar to a number of similar conditions.

  • Wheat allergy
  • Non-celiac gluten sensitivity
  • Irritable Bowel Syndrome
  • Crohn's disease
  • Lactose Intolerance

Chronic Infections

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Colic (Infant Colic)

Colic in a baby can be distressing for the entire family.It's defined by

  • Inconsolable crying and irritability
  • Gas-filled abdomen
  • Usually the same time each day (often afternoons or evening)
  • Between 3 weeks to 4 months of age

The Causes

Colic can be the result of (or confused with) a number of causes:
  • Overfeeding
  • Underfeeding
  • Reflux
  • Milk allergy / Formula intolerance
  • Unrecognized infection (rarely)
  • Intestinal problems (rarely)
  • Fussy baby

No matter how the problem starts, the baby's crying results in swallowed air.That air expands the stomach and is uncomfortable and causes the baby to cry more, repeating the cycle.

Nutrition for Colic

  • Breastfeeding can continue.  Babies are not allergic to breastmilk, though sometimes they are sensitive to a food the mother is eating.  Gassy vegetables and foods can be stopped.  Spices can be lessened.
  • Probiotics may be helpful, particularly Biogaia drops (Lactobacillus reuteri).
  • If you are using formula, you may need to try a different formula or cut down the amount you are feeding.
  • The most cost-sensitive partial hydrolysates are Gerber Good Start or Gentlease, depending on pricing (Good Start Soothe also includes Lactobacillus reuteri).
  • Soy formula or complete hydrolysates become a real alternative if milk allergy is suspected and the partial hydrolysates do not reduce symptoms.
  • Medications may be necessary—but beyond gripe water, simethicone to diminish gas, or an antacid, they may merely create a drowsy baby instead of a well one.
  • Learn how to take care of yourself.You need to relax.  Guard your health, energy, and emotions so that you can be at your best in order to take care of your baby during this frustrating period.

Constipation

Constipation can vary between monstrous toilet-clogging rocks that some children only pass every few days (or longer) to tiny rabbit pellets that they struggle to produce-but they do so daily. And some children are mistaken to have uncontrolled loose stools or accidents in their pants, because they are having seepage around a large load that they can't pass (or don't want to because of the pain they fear they might have).

The Symptoms

  • Hard stools (Large or small)
  • Infrequent stools
  • Long time on toilet
  • Refusal or reluctance to use bathroom
  • Stool leakage into underwear
  • Urine leakage
  • Abdominal pain, better after bowel movement (usually low or left sided, occasionally higher)
  • Decreased appetite until bowel movement
  • Reflux or vomiting (rare, and often lessens after bowel movement)

The Cause

You can think of the small intestine's job as absorbing the nutrients from what we eat and the large intestine's job as absorbing the fluids that are coming downstream (though it does scavenge the residue and absorb some nutrients too). It then eliminates what hasn't been absorbed.

When the large intestine, also known as the colon, doesn't absorb the water, we have diarrhea. When it pulls more water out (because the residue sits in there longer), the stool becomes harder. So anything that slows the intestine down, gives us a tendency towards constipation.

  • Low fiber diet
  • Dehydration
  • Holding back
  • Medications (cold medications, pain killers)
  • Nerve or muscle problems of the spine or colon
  • Narrowed intestine or problem at anus or rectum
  • Low thyroid
  • Celiac disease
  • Low calcium, potassium (rare)

In my experience with children and teens, a low fiber diet and holding back are more common than all of the other conditions combined. And the problem is that when this starts early in childhood, the toddler or young child falls into a cycle of withholding, which makes the stool larger and harder when he finally does go, which then causes more pain and gives the child more reason to hold back.

It may have begun when the child didn't want to interrupt an activity or go at school--or unintentionally, when he didn't eat well for a short while or when he first began taking milk at a year and didn't balance the dairy with enough fruits and vegetables. The stool then got firmer, and the child wasn't used to evacuating that somewhat harder stool.

Instead of pushing it out, the rectal muscles resisted. It's an automatic response. The rectal muscles tighten when there's pain--even though the real need is to let those muscles relax and let the intestine pass the stool.

Correcting the Problem

Sometimes a laxative can be used and that's the end of the problem, but often constipation returns because the real problem hasn't been corrected. T hat takes some investigation to find the root cause and then a 3-Step Solution to resolve the problem.

  • Remove the blockage
  • Lessen the tendency to withhold
  • Address the root causes

The Role of Good Nutrition

Having enough dietary fiber and fluids is essential. The fiber holds water and makes the stool soft (so it's important that the fiber is accompanied by fluids as well). Together, the fiber and fluid soften the stool and build up the bulk so your child also will have more sensation of needing to go without the pain of a hard evacuation. But there's also the potential for too much fiber, which can cause gas and pain.

Fiber can present a problem for infants, causing more discomfort. Often a milk laxative works better. And better yet is making sure that they are well hydrated, with enough breast milk or formula and not getting too much cereal. Water or a small amount of juice in the water (1-2 tablespoons in 3-4 oz of water), particularly pear or prune, may help as well. If that doesn't work, you'll want to see the baby's doctor.

Crohn's Disease

Crohn's disease is a type of inflammation that occurs anywhere (and sometimes multiple places) in the intestinal tract. The inflammation often shows up as ulcers. The ulcers seem to start as small mouth ulcer-like sores on the intestinal surface. They can become larger with swelling surrounding them, and deeper, indicating a more severe disease course. If the disease progresses, the swelling can become so tight, the inside of the bowel (another name for the intestine) narrows. The narrowed area is called a stenosis, and when it is there for a long time, it can form a scar (called a stricture).

These narrowings can block (obstruct) the flow. And then, as if the intestinal contents are trying to find another way out, they burrow through and penetrate the bowel, forming tracts, or fistulas, that go the skin or other tissues. When they can't exit to the skin, infections can develop and fester into an abscess.

Several classifications have helped us to understand the disease patterns in different age groups. They break out Crohn's disease by its location and behavior (stricturing, penetrating or just inflammatory) as well as by the patient's age and whether they've had growth problems. While that has not yet been linked to evidence on how each group will do with certain treatment regimens or with the genetics and triggers leading to each form of the disease, one day soon, it should.

Crohn's Disease And Other Issues

Crohn's disease can interfere with growth and / or puberty in as many as 25% of the kids who have it. They can also have problems develop in association with their bowel disease. These extra-intestinal manifestations can include the joints, the skin, the liver, and other tissues. Sometimes, they can even occur before intestinal symptoms develop.   

Symptoms of Crohn’s Disease

  • Abdominal pain
  • Diarrhea
  • Intestinal bleeding
  • Anemia or fatigue
  • Weight loss
  • Decreased growth
  • Delayed puberty
  • Sores or tissue thickening near or at the anus
  • Joint swelling or long-term pain
  • Particular rashes

The symptoms of Crohn's disease are similar to those of ulcerative colitis as well. Together, they are the two most common forms of Inflammatory Bowel Disease (IBD). Diarrhea and abdominal pain are also common symptoms of infections and Irritable Bowel Syndrome (IBS). Not all of the symptoms are present in all patients. Some will even have just growth problems or joint or skin complaints before they ever have any intestinal complaints.

Treatment For Crohn's Disease

Treatment is not just focused on relieving the complaints (clinical remission), but on trying to heal or improve the intestine itself. At the present time, there is no cure for Crohn's disease. Even removing the involved areas does not prevent Crohn's from returning. While surgery sometimes becomes necessary to get the disease under control, diet and one (or more) of the many medicines are usually preferred to lessen symptoms, to help heal the intestine, and, in children, to restore growth.

Nutrition and Crohn’s Disease

Nutrition is beginning to have an increasing role in the treatment and in furthering our understanding of Crohn's disease. The goals are to:

  • Prevent nutrient deficiency
  • Provide the additional protein, calories needed
  • Support the patient's growth
  • Return patients to healthful functioning
  • Bring the patients into remission
  • Help the intestine heal, when possible
  • Support a healthy intestinal flora (microbiome)
  • Maintain their health when all the other goals have been met

While these seem like a long list of difficult goals, they are sought as if they are a single goal, good health. It may be that they are achieved by encouraging a healthy microbiome, since many researchers feel that the overactive immune system in Crohn's disease is reacting to alterations in the intestinal flora.

There are a number of different nutritional strategies being used to pursue these goals

  • Standard nutrition with additional nutrients as needed
  • Enteral nutrition
  • Specific Carbohydrate Diet
  • Other restrictive diets
  • Herbal supplements

Irrespective of the nutritional and medical strategy, kids need to consume additional protein and calories, and adequate vitamins and minerals to compensate for the additional needs they have with IBD. They also need be monitored routinely in order to achieve the best results.

Frequent Monitoring Is Important

Those at increased risk

  • The child or teen whose growth or puberty is delayed
  • Those with deep ulcers
  • Those with strictures or penetrating disease
  • Those who have already had surgery
  • Those who can't get off of steroids

Those patients who aren't responding to dietary therapy or their current medicine should be re-evaluated. They often need to be placed on one of the more effective medications to get their Crohn's under control. Clinical symptoms often provide a useful guide if a child isn't doing well. Repeated abdominal pain, waking at night to have a loose bowel movement or passing blood usually indicates that either the child has an infection or needs to have their treatment redirected. For the child with few intestinal symptoms, blood or stool tests may suggest the need for a change or or re-evaluation of the intestine.

Cystic Fibrosis

Cystic fibrosis (CF) is a disease where both parents contribute an abnormal gene to cause a problem with the salt that is in most of the fluids that the body produces.  This results in a build-up of mucus in the lungs, pancreas, and other areas of the body (including the intestines and sweat glands).

The Symptoms of Cystic Fibrosis

  • Chronic cough, wheezing or difficulty breathing (can look like asthma)
  • Fatty, bulky bowel movements (the stools may float in the toilet)
  • Difficulty gaining weight and growing
  • Constipation in some infants of older children
  • Salty sweat (sometimes, can detect by kissing the skin)
  • Male infertility

Fortunately, screening tests are performed when every baby is born in the US and those tests usually detect the most severe cases.  If not, tests of the sweat and bowel movements can help to make the diagnosis.

Nutrition in Cystic Fibrosis

Good nutrition is very important

  • to achieve optimal growth
  • to improve lung function
  • to improve quality of life
  • to prolong health

 

To help patients with Cystic Fibrosis achieve the best results, they are usually taught to add

  • Increased calories
  • Increased protein 
  • Unlimited fat
  • Extra salt
  • Additional vitamins (particularly, A, D, E, K)
  • High calorie drinks
  • Tube feedings (if they are unable to drink enough)
  • Pancreatic enzymes with each meal to replace what their bodies can't produce
  • Fiber to prevent constipation
  • Antacids or acid blockers to help the pancreatic enzymes work better

Dental Disorder

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Diabetes Type 1

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Diabetes Type 2

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Diarrhea

Diarrhea is, quite simply, the passage of loose or watery stools (bowel movements).  They are often quite frequent and sometimes contain fat or mucus. These loose bowel movements may be accompanied by gas.  It's more of a problem when they contain intestinal tissue or blood, or when there's also fever, vomiting or cramping pain.

The underlying reason that diarrhea occurs is that the large intestine isn't working as well as it needs to.  Usually the large intestine absorbs the extra water that comes downstream from the small intestine.  In an adult, the large intestine may filter as much as 10 quarts of fluid a day.Even when there's diarrhea,the intestine may still absorb 9 1/2 quarts.But it's that 1/2 quart of extra fluid that loosens the bowel movements.

The Causes

Typically, the different causes of diarrhea can be grouped.

  • Infections--the most frequent cause, can come from viruses, bacteria or parasites.
  • Inflammation--where the intestinal surface can't absorb and swelling causes pain and diarrhea  (in Crohn's disease and ulcerative colitis, for example).
  • Incomplete absorption--this group can be divided into problems like lactose intolerance and celiac disease where the foods that aren't absorbed go downstream and drag extra water with them; and problems like an overactive thyroid or where surgery has shortened the intestine, so that nutrients don't have time to be absorbed.
  • Irritation--certain medications can irritate the intestine or the normal bacteria that live there (the flora).  That's the case with antibiotics, and some cancer or heart medicines.  That's also the main feature of what's known as Irritable Bowel Syndrome, where the intestine goes into an often painful spasm that can then send the intestinal contents right on through.

Treatment

Infections that come quickly generally leave quickly.  But when they come make sure to:

  • Rehydrate-drink plenty of fluids, especially with fruit juices and soups that have the salts your body needs to replenish.  Hydration fluids like Pedialyte or Oralyte are preferred over sugary sports drinks.
  • Gradually introduce bread, pasta, rice and potatoes that tend to slow your intestine.  You can slowly add lean meats, fruits and yogurt.  
  • Avoid spicy or greasy foods, extra sugar and even high fiber foods that create more gas.
  • Consider a probiotic, especially if it seems to be an infection.
  • And if an infection is likely, make sure to wash your hands frequently so you don't spread it.  Also be careful not to let the kids share their cups, drinks, foods or towels.  
  • If the diarrhea continues, this is known as persistent or chronic diarrhea.  Make sure you bring your child to the doctor for further evaluation and to check and see that you are accomplishing the hydration that's needed.

Eating Disorder (Anorexia or Bulemia)

Eating disorders include

Anorexianervosa(often just called anorexia)or self-starvation,which can be accompanied by obsessive exercise

Bulimia, which is self-induced vomiting or purging

Binge eating or Gorging, where patients over-eat

Combined types, where for example, binging is followed by purging

These disorders, which often start in the per-teen and early teen years, can be accompanied by serious emotional and physical problems. They are best treated early and actively before the patterns become ingrained, so it is important to recognize the symptoms as soon as possible.

Symptoms

  • Weight loss
  • Preoccupation with weight, "being fat," body shape, or specific body parts Comparing to others
  • New eating habits
    • Refusing to eat certain foods or food groups (carbs or fatty foods)
    • Avoiding family meals
    • Drinking large amounts of water or diet sodas
    • Going to the bathroom right after eating
  • Obsessive exercise
  • Laxative use or the smell of vomit.
  • Hiding body in baggy clothes
  • Withdrawal from friends and previously enjoyed activities

Children and teens rarely lose weight unless it's intentional or they have an unrecognized illness, so it's important that they see their physician promptly,

Nutritional Consequences

The body is not getting the nutrients needed, leading to serious potential problems:

  • Salt (electrolyte) imbalance and nutrient deficiencies
  • Muscle weakness and wasting
  • Bone loss (osteoporosis)
  • Hair loss and dry skin
  • Tooth staining and decay, if vomiting
  • Fatigue, weakness and depression
  • Dehydration (kidney failure is possible)
  • Slow heart rare and low blood pressure (heart failure is possible)

As a result, it's important to recognize the symptoms and obtain the medical help needed to avoid the consequences and to begin treatment, often with an entire team of skilled professionals.

Egg Allergy

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Eosinophilic Esophagitis (EoE)

Eosinophilic Esophagitis (sometimes called EoE or EE) is 10 times more common than it was just 20 years ago. In the same way that asthma can be an allergic conditions of the lungs and eczema can begin as allergies affecting the skin, EoE is an allergic condition of the esophagus (the tube that transports food from the mouth to the stomach). In fact, EoE has been called  “eczema of the esophagus” that comes from allergies, most often from foods.  

Symptoms

  • Choking
  • Difficulty swallowing
  • Chest pain
  • Poor or picky eating
  • Abdominal pain
  • Vomiting

Because many of these symptoms are similar to acid reflux, the two conditions can be confused. But difficulty swallowing (and choking on food) are the most common features of EoE. That's why many kids have difficulty swallowing breads, rice, meat and apple peels. Some children and young adults will even get food stuck in their esophagus, requiring a procedure (an upper endoscopy) to remove this food. And on questioning, family members may report that they've needed that procedure or a "stretching" of their esophagus in the past.

Diagnosis and Treatment

The only reliable test for EoE is an upper endoscopy and the pinch biopsies from the lining of the esophagus. They show swelling (inflammation) and eosinophils which are not usually seen in rhe esophagus. Children with acid reflux also may have a few eosinophils in their biopsies, in smaller numbers than usually seen in EoE.    

EoE can get better with treatment, but the inflammation will likely return if treatment is stopped. Treatment consists of removing the foods (and environmental factors) the child might be allergic to. At least in the beginning, blocking the acid that may be coming up from the stomach seems to help although steroids that work directly on the esophagus and the eosinophils are often required as well.

EOSINOPHILIC GASTRITIS AND GASTROENTERITIS

Eosinophilic Gastritis and Eosinophilic Gastroenteritis are rare disorders (compared to Eosinophilic Esophagitis).  The white blood cells that are increased in allergic conditions, eosinophils, gather in the lining of the stomach alone (gastritis) or the stomach and intestine (gastroenteritis). The esophagus is usually spared.

Symptoms

The eosinophils are indicators of inflammation and they may actually cause part of the injury. That can lead to

  • Abdominal pain
  • Nausea, vomiting
  • Diarrhea,
  • Weight loss
  • Poor growth
  • Anemia (low blood counts)  
  • Fatigue and difficulty performing well at school
  • Malnutrition
  • Low protein and vitamin levels

These do not all occur in every patient.

Diagnosis and Treatment

Adults and children with these conditions may have environmental and particularly food allergies, that can trigger the problems and make it harder to treat. As a result, patients often need to undergo a battery of blood tests, allergy studies, upper endoscopy and often a colonoscopy for evaluation. Pinch biopsies from the lining of the esophagus, stomach and intestine are examined to look for inflammation and the presence of eosinophils.

If either Eosinophilic Gastritis or Gastroenteritis is present, treatment attempts to lessen inflammation, protect the stomach and intestine and reverse nutrient losses. This often requires medication and dietary treatment involving  an allergist and pediatric gastroenterologist, a dietitian and occasionally a psychologist to determine and maintain the diet, avoid nutrient deficiencies and bring your child to his optimal health so that he or she can return to a normal life.   

Eye or Ear Disorder

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Feeding or Swallowing Disorder

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FODMAP Diet

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Food Access Issues

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Food Protein Induced Enterocolitis (FPIES)

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Food Texture Disorder

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Fructose Sensitivity

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Gastroenteritis (Intestinal Infection)

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Gastroesophageal Reflux

"Gastroesophageal reflux" or GER or just plain "reflux" is where the stomach (gastric) contents come up into the esophagus.The other term for that is regurgitation.GERD, where a "D" is added to indicate reflux disease, when the GER is more troublesome and causes more than simple spitting.

Symptoms in Infants

  • Spitting up, or it just rolls out of babies' mouths.  Can be after feedings or hours later
  • Discomfort and crying, often improving when they are held upright
  • Can hear or see them trying to re-swallow what's come up
  • Gagging, choking, wheezing
  • Feeding difficulties
  • Repeated ear or respiratory infections
  • Tilting the head to the side
  • Silent reflux is when one or more of these last symptoms happen, but the baby isn't spitting

Causes in Infants

Almost all babies have some spitting because they have:

  • Smaller, less stretchable stomachs
  • The angle the stomach and esophagus make with each other allows stomach contents to come back easily (that's regurgitation)
  • Less strength (or tone) of the valve (the lower esophageal sphincter) between the esophagus and stomach

Symptoms in Older Children and Teens

  • Heartburn or chest pain
  • Stomach pain, especially after eating
  • Re-swallowing
  • Difficulty swallowing
  • Wheezing, coughing with asthma or reactive airway disease
  • Aspiration, particularly in kids who have disabilities or swallowing problems  
  • Repeated respiratory or sinus infections
  • Dental problems with the enamel or cavities

These problems are present because the "valve" between the stomach and stomach (the lower esophageal sphincter) is weak or no longer functions properly.  As a result, stomach acid and juices and the stomach contents can reflux into the esophagus and cause significant damage, enough that the esophagus may develop scars that interfere with the passage of food into the stomach or the damage can irritate the tissue enough that esophageal cancer can develop.

Testing and Treatment

Several different tests are available to make the diagnosis, determine how severe the condition is and to monitor the effectiveness of treatment.Treatment options range from dietary and lifestyle modifications to blocking acid production, whether it’s a young infant or older teenager with active symptoms.Surgery remains an option as well to prevent further esophageal or lung damage.

And 95% completely outgrow the condition by 13 months of age.  But until then, they spit--often a teaspoon to a tablespoon right after feedings.  But it can be hours later or larger amounts (an entire bottle at times).  Some can come through the nose or cause a brief cough or sputter.  When it’s merely like that, it’s GER (meaning, the return of stomach (gastro-) contents into the esophagus).

GERD: Reflux is always simple

If 95% outgrow GER by 13 months, that means 5% or 1 out of every 20 babies continue on with spitting, and sometimes the problems that can accompany it.  What's coming up can irritate or damage the esophagus or end up in the passageways of the lungs and ear canals.  That can even begin in early infancy. That’s when it’s the more significant GERD.  Six (6) warning signs that the baby has GERD are:

  • Poor weight gain
  • Excessive crying or irritability
  • Head usually tilted to one side
  • Feeding problems
  • Respiratory problems:
    • wheezing, apnea, noisy or difficult breathing,
    • repeated respiratory or ear infections
  • Symptoms that continue beyond that 13 month period

Sometimes these symptoms occur when the baby isn’t spitting.  He or she may have a feeding problem or pneumonia without any regurgitation.  That’s silent reflux, and as you might suspect, the GERD becomes much harder to detect.  Additionally, there are babies who do not have reflux as their main problem.  Instead the spitting or vomiting is part of a larger problem with a separate set of warning signs and symptoms.
Tests and medicines to help are available.Both testing and the treatment needed depend on the extent of the reflux symptoms. Spitting constantly or with GERD symptoms requires more attention than the child who smiling while having occasional "wet burps" during the day.

Nutrition in Infant GER and GERD

Dietary treatment is often the first step.  Some babies are spitters because they are overfed, getting too much at a meal. They do better with small, frequent meals--and with keeping their heads up after a meal, so that gravity can help keep the formula down.
Others improve with a small amount of cereal added to the formula, which thickens the liquid, making it less likely to return.  Thickening has an additional benefit for lower weight infants.  The extra cereal at 5 calories per teaspoon will quickly add to the babies’ weight.  In the same way, those extra calories can quickly add too much weight to the baby.  Both Enfamil and Similac both make formulas (Enfamil AR and Similac Spit Up) that have the same effect without the extra calories.  They substitute rice starch for lactose, keeping the calories the same as routine cows’ milk based formula.  But they need normal stomach acid in order to turn the starch into a thicker for the formula, so it's important that an acid blocker isn't used at the same time.
Another important note is that some babies will try to avoid their feedings turning their heads away or arching backwards.  They may be developing feeding issues as a result of their GERD -- this is often a reason for further evaluation.

Genetic Disorder

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Gluten Sensitivity

Gluten Allergy SymptomsWhen someone has celiac disease, the intestine is actually damaged by gluten and an auto-immune reaction develops. And usually, those antibodies can be detected by blood tests.

But there are others who are sensitive to gluten or wheat who do not have celiac disease. They feel better on gluten-restricted diets. This is now termed non-celiac gluten sensitivity.

Non-Celiac Gluten Sensitivity

There are important distinctions between

  • Celiac disease
  • Wheat allergy
  • Non-celiac gluten sensitivity

Celiac Disease and Wheat Allergy are their own Medical Conditions (you can read more below under “Further Reading”).  But the real importance in making the correct diagnosis is that those with celiac disease must watch their diet carefully, because gluten can damage the intestines, and they can have other problems too.  And those with wheat allergy don't have to avoid all grains, so their diet can be less limited.  So testing should be done before a gluten free diet is started.  Once someone is on a gluten free diet, the accuracy in making the diagnosis of wheat allergy or celiac disease may not be as good.
Once we don't have to worry about wheat allergy and celiac disease, those with gluten sensitivity can be recognized.

Symptoms can include:

  • Abdominal pain
  • Bloating and gassiness
  • Diarrhea or constipation
  • Headaches
  • Fatigue

They can be thought to have irritable bowel syndrome (IBS or spastic colon, which is a different term for the same condition).Some patients with autism or autism spectrum disorder, chronic fatigue or long-term intestinal complaints seem to be sensitive.

Trying a Gluten Free Diet

After testing for celiac disease and wheat allergy, a gluten-free diet can be tried. This eliminates all grains that contain gluten.It can be difficult, especially when going to restaurants, school or friends' homes.But the wider availability of gluten-free products in most groceries makes this considerably easier than it used to be.

You should see an improvement within 3-4 weeks.  If you are completely better, wonderful. If not, you are probably not gluten sensitive and can resume a normal diet.If you are a little bit better with your intestinal problem, you may actually have a problem with fructans that are a type of carbohydrate that often accompany gluten.  If that's the case, you may benefit from a wider carbohydrate restriction, the FODMAP diet.

Do recognize that with restrictive diets, you can miss getting some of the vitamins and minerals your body needs.  With a gluten-free diet, you can miss vitamin your B vitamins.If you have questions or concerns, discuss them with your doctor or dietitian.

Growth Issues

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Halal

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Healthy Child

Kids Stomach BugsYour child may be "healthy as a horse," as the saying goes, but horses get sick too.And kids go to school and out to restaurants,and what they eat there may not be what you would want them to eat.So you try to figure out:

  • what to offer at home
  • how to make the best of eating "out"
  • how to get more fruits or vegetables in
  • what to do if your child gets a stomach bug
  • what you can do to help her or him perform better as an athlete and as a student
  • how to prevent allergies or obesity and the problems that go with it
  • if you should give a vitamin, or iron, or a probiotic, or a prebiotic
  • the best sources for various vitamins or minerals
  • or the answers to a hundred different questions

Nutrition4Kids.com

For good reason,you've come to Nutrition4Kids.com.We have

  • Up-to-date articles and blogs on these topics and many more
  • Reliable, easily understood information and tables
  • Alerts that can tell you when there is more information on the topics you're interested in
  • Medical Advisory Board of some of the best known nutrition experts in the world
  • The ability to ask your questions--and get useful answers
  • The opportunity to have your own proud pinboard
  • The opportunity to connect to families like yours, sharing concerns and useful tips

So join us and put in your profile so we can send you updates and so you can meet others,if you'd like

Healthy Infant

You as parents are sometimes puzzled about how and what to feed your baby--even before the baby is born. Not surprising. Your doctors will give you advice, but then so will your parents ("you didn't do so badly, did you?" they'll remind you) and your neighbors and your friends and lots of mommyblogs. That's great when they all say the same thing, like breastfeeding is best. But what happens if you don't feel breastfeeding is going to work for you or if your friends, relatives, doctors and favorite sites say different things? You may have lots of questions about:

  • Breastfeeding and the best ways to make sure your baby's full or what foods and medicines you should avoid, for example <<links for each of these, or drop downs>>
  • Infant formulas, like which one to use and how to cut cost?
  • When and how to introduce baby foods and those from the table?
  • What should you do if your baby has colic or constipation or other problems?
  • Can you lessen the possibility of developing allergies?
  • All sorts of other issues

Nutrition4Kids.com

For good reason, you've come to Nutrition4Kids.com. We have

  • Up-to-date articles and blogs on these topics and many more
  • Reliable, easily understood information and tables
  • Alerts that can tell you when there is more information on the topics you're interested in
  • Medical Advisory Board of some of the best known nutrition experts in the world
  • The ability to ask your questions--and get useful answers
  • The opportunity to have your own proud pinboard
  • The opportunity to connect to families like yours, sharing concerns and useful tips

So join us and put in your profile so we can send you updates and so you can meet others, if you'd like.

Healthy Teen

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Heart Disorder

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Immune Disorders

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Infant Colic

 Colic in a baby can be distressing for the entire family.It's defined by

  • IInconsolable crying and irritability
  • Gas-filled Abdomen
  • Usually the same time each day
  • Often afternoons or evening
  • Between 3 weeks to 4 months of age

The Causes

Can be the result of (or confused with) a number of causes

  • Overfeeding
  • Underfeeding
  • Reflux
  • Milk allergy / Formula intolerance
  • Unrecognized infection (rarely)
  • Intestinal problems (rarely)
  • Fussy baby

No matter how the problem starts, the baby's crying results in swallowed air.  That air expands the stomach and is uncomfortable and causes the baby to cry more, repeating the cycle.

Nutrition for the Breastfeeding Mother

Breastfeeding can continue. Babies are not allergic to breast milk, though sometimes they are sensitive to a food the mother is eating.  Gassy vegetables and foods can be stopped. Spices can be lessened.

Colic and Bottle Feeding

If you are using formula, you may need to try a different formula or cut down the amount you are feeding.Your doctor might recommend partial hydrolysate formula,or soy formula or complete hydrolysates if milk allergy is suspected and the partial hydrolysates do not reduce symptoms.

Other Treatments

  • Probiotics may be helpful, particularly Biogaia drops (Lactobacillus reuteri).
  • Medications may be necessary—but beyond gripe water, simethicone to diminish gas, or an antacid, they may merely create a drowsy baby instead of a well one.
  • Learn how to take care of yourself.  You need to relax.  Guard your health, energy, and emotions so that you can be at your best in order to take care of your baby during this frustrating period.

Inflammatory Bowel Disease (IBD)

Crohn's disease and ulcerative colitis are the most common forms of chronic (or long-term) inflammation (or swelling) in the intestine (the bowel). A way to visually understand the inflammation is to think of someone with arthritis causing a swollen joint or to think of a cut that became sore but to then imagine that the sore never completely healed.

While Crohn's disease and ulcerative colitis can begin in adults, they can also begin in childhood with approximately 25% of patients with Crohn's disease beginning to have problems before they are 20 years old. Approximately 10-15% of those with ulcerative colitis will develop the disease in childhood and adolescence, meaning that in kids, about twice as many will have Crohn's as ulcerative colitis. (In adults, they seem to occur about equally). Children with IBD (pediatric IBD) tend to have more severe disease and in ulcerative colitis, more of the large intestine may be inflamed.

The Symptoms

The main symptoms are similar for both diseases:

  • Abdominal pain
  • Diarrhea
  • Intestinal bleeding
  • Joint and skin problems can occur in both
  • Growth problems

Those with ulcerative colitis tend to have more diarrhea and bleeding while those with Crohn's disease have more growth problems and they can have problems including skin thickening and draining tracts (fistulas) from the intestine to the skin near the rectum.

Patients with IBD have a problem with their immune systems responding (often over-responding) to a yet-to-be-determined trigger. The primary treatments are medications decrease inflammation or prevent the immune system from overreacting.

Nutrition in Pediatric IBD

Those with IBD have a difficult time

  • Absorbing certain nutrients
  • As many as 25% lose weight
  • Some become anemic and malnourished
  • Growing to their potential
  • Some foods seem to cause more diarrhea, pain and bleeding

As a result, greater emphasis is now placed on providing adequate protein, calories and nutrients; assisting the patient's metabolism and growth and returning the kids to healthful functioning through active nutritional support.

Enteral Nutrition provides liquid nutrition either by mouth or through tube feedings into the stomach as either sole therapy on in combination with medications for Crohn's disease. It is usually used for short periods when the disease is first recognized or when the disease is flaring. Because enteral nutrition is difficult to tolerate for long-term treatment and because no studies have been done to provide evidence of its long-term safety, patients are usually transferred onto medication or another, more comprehensive diet.

The Specific Carbohydrate Diet (SCD) has been used by numerous adult patients with a variety of different illnesses including IBD, with many reporting long term success. However, that experience is just now being collected and scientifically analyzed. So far there have been a few small studies in pediatric Crohn's disease showing improvement when patients follow the diet closely.
Other diets have been promoted and used with less scientific and medical scrutiny and therefore, can't be recommended. It's also important to note that restrictive diets in childhood sometimes eliminate important vitamins and minerals, are difficult to maintain and can cause emotional trauma for some children and teens.

Irrespective of the chosen diet, and even when kids consume what they normally do, they need to consume additional protein and calories, and adequate vitamins and minerals to compensate for the additional needs they have with IBD. As a result, it's essential that the patients are monitored for their general and nutritional and disease activity.

Iron Deficiency

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Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) occurs frequently in adults and occurs commonly in school children as well.  It's also known as a Spastic Colon, and as a result, the names sometimes get IBS confused with colitis and IBD--which are inflammatory bowel diseases.  But someone with IBS doesn't have to have any inflammation or bowel swelling at all.  Instead they have spasms in their large intestine (the colon).

The Symptoms

The spasms translate into cramps or intense pain in association with a change in their bowel movements.  According to the standard way of making the diagnosis (the Rome criteria), patients with IBS have.

Recurrent abdominal pain or discomfort at least 3 days a month in the last 3 months with two or all three of the following:

  • Improvement in the pain with a bowel movement
  • A change in the frequency of bowel movements
  • Onset associated with a change in form (appearance) of the bowel movement

Nausea or bloating can also occur.  But the required part is that the bowel movements are different than usual -- either more and usually loose (called IBS-D for diarrhea); IBS-C for constipation, IBS-M (mixed, meaning the BMs vary between C and D) or IBS-U for those that aren't yet assigned to one of the groups.

Dietary Factors

Bowel movements and colon function are greatly affected by diet.  Fiber, in particular, helps to regulate bowel contraction--it also seems to have an important role as a prebiotic feeding the healthy bacterial population in the large intestine, and that healthy microbiome may be very important in managing IBS.  As a result, a high fiber diet is a useful tool in controlling symptoms, though too much fiber can result in extra gas and bloating.   

If increasing fiber doesn't help or makes matters worse, you may want to use our symptom diary to track your / your child's symptoms in relationship to different foods and to stress and exercise as well You can also consider the more rigorous FODMAP diet that has been helpful for many patients with IBS.

IV Nutrition

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Kidney Disease

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Kosher

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Lactose Intolerance

Most people in the world can't drink milk without having intestinal upset. The enzyme, lactase, which breaks down milk sugar in infancy fades away in those with lactose intolerance. Almost everyone in the world is born with the lactase enzyme. Humans couldn't have survived without having babies who could drink breastmilk.

But for 60% or more of the world's population, including many of those whose families came from many parts of Africa, Asia, and the Mediterranean, lactase isn't produced and active after 7 or 8 years of age. They have permanent or primary lactose intolerance.

Because the enzyme sits on the tips of the intestinal surface, lactase can also be temporarily damaged if there's a virus or bacteria that disrupts the intestinal surface. The same is true for those with celiac disease where gluten has injured the surface. But after the infection is over or the gluten is removed, the enzyme usually returns within 4 weeks or so and lactose can be digested again.

The Symptoms

  • Bloating
  • Flatulence (gas passed from below)
  • Diarrhea
  • Abdominal pain

The symptoms are created when milk sugar can't be digested and absorbed, so the intestinal bacteria break lactose into water and different gases. The gases create a bloating sensation until they are passed, and the extra water causes diarrhea. And together, the gas and diarrhea cause the abdominal pain, often at the area around the belly button or to the left and below. How severe the symptoms are depends on the amount of lactose consumed and the severity of the disorder (it can vary greatly). If vomiting or a rash are present, lactose intolerance is NOT the cause. Milk allergy or other disorders need to be considered.

Nutritional Aspects

Milk and milk products are important sources for protein, calcium and phosphorus Additionally, cow's milk is supplemented with Vitamin D--a nutrient that most of us don't get in the quantity we need. When someone has lactose intolerance, and avoids dairy, those sources need to be replaced. Other beverages, often called milks, are available as are other lactose-free dairy substitutes . Additionally, a replacement enzyme, Lactaid, can be taken along with dairy products, which will lessen or eliminate the symptoms so that kids with lactose intolerance can once again eat normal ice cream and pizza.

Lipid Problems (Cholesterol or Triglycerides)

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Liver Disease

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Macrobiotic Diet

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Metabolic Disorder

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Milk Allergy

Milk SubstituteMilk allergy is a reaction to a protein in cow's milk (most likely the casein, but it could be one of the whey proteins). As a result, you have to read labels and see whether they list anything that could contain milk protein. These include:

  • Milk, cow's milk
  • Milk solids
  • Casein
  • Whey
  • Whey protein

The symptoms

As happens with any allergy, the body recognizes a foreign protein and essentially tries to fight it off. It doesn't take much. Some or all of the symptoms return (often within a few minutes) when even a few drops of that protein are consumed:

  • Vomiting
  • Abdominal discomfort or pain
  • Diarrhea
  • Rash
  • Runny nose
  • Irritability in infants

The Confusion

Even if someone doesn't have a true allergy, milk can increase mucus production. Milk fat can trigger gallbladder symptoms (for those who should be on a low fat diet) and can slow stomach emptying, making some quite uncomfortable and nauseous. Milk and milk products, particularly cheese, can be constipating.And whole milk (which has 4% fat) can raise cholesterol and add to calories, which is why health organizations suggest even children as low as 18 months begin drinking 2% milk and that older children who are at risk of becoming overweight switch to 1% milk.

Alternatives

No one needs cow's milk. But they do need the protein, calcium and phosphorous that milk provides. Additionally, cow's milk is supplemented with Vitamin D--a nutrient that most of us don't get in the quantity we need. There are substitutes that call themselves milks that are drinks with a milky consistency and that have some of the nutrients that cow's milk does (see link below). Organic milk and lactose-free milk do not work as substitutes for someone with milk allergy, however, because they still contain the proteins that body is reacting to. Goat's milk is available but it is severely folate deficient and is often unpasteurized.Unpasturized products can pose serious risks because tuberculosis or other infections will not be killed and can pass from infected animals to affect dairy lovers.

Milk Free Diet

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Mitochondrial Disorder

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Nut Allergy

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Nutrient Concerns

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Obesity

Overweight Children

We know the problems that can come from being overweight or obese (a more extreme form of being overweight):

  • High blood pressure
  • Diabetes
  • Heart disease with increased cholesterol
  • Strokes
  • Liver disease, even cirrhosis
  • Gallbladder disease
  • Some cancers (breast, colon, uterus, kidney, liver)
  • Pain and poor functioning
  • Depression

But these and other problems often don't begin until later, though more diabetes and liver disease are now developing in children from obesity.

Symptoms

There aren't many symptoms other than seeing that the child is gaining too much weight, or looking "fat." But what you can’t see from the outside is that in overweight or obese children their blood tests of the liver and the Hemoglobin A1C for diabetes slowly increase. And there may be darkening and thickening of the skin on the back of the neck. But often the first sign is that kids begin to lose their self-esteem and have a crushing blow to their relationships with other children.

What is Obesity?

  • A child is overweight when they are at unhealthy weight for their size. So it's often measured by comparing it to their height. This can be done with growth charts or a BMI (for those over 2 years old). BMI stands for the body mass index. This doesn't work well for muscular athletes, but for others, a BMI over the 85th percentile for their age means that the child or adult is overweight. And that means they are much heavier than most of the children their age and are at a greater risk of being obese as an adult--so it should be addressed.
  • A child is obese (which means "fat") when their BMI is over the 95th percentile and at greater risk of the problems that can come from carrying that excess weight.Sadly, once children are obese, it is harder to lose the weight and to exercise. That's why it is important for parents to get involved as soon as they can.

Overweight Babies

Racehorse thin babies look, to some, like they are underweight or unhealthy--especially since we see so many big cheeked, smiling babies in the streets and on advertisements, and because breastfed babies tend to be bigger during infancy and easily lose their extra weight when they become toddlers. But that doesn't mean those chubbier, angelic looking babies are healthier--some are overweight.

The tendency to be overweight can actually begin during infancy or sometimes, even when they are still inside their mothers. That's the reason women are cautioned about gaining too much weight when they are pregnant. Mothers who develop Type 2 diabetes when they are pregnant often have heavier babies who remain overweight during childhood and are 4 times more likely to develop diabetes themselves.

Babies who are overweight have no symptoms. But sometimes, babies who have reflux are started on cereal to thicken their formula --and those extra calories can contribute to gaining more weight that's harder to lose later.

The good news is that we can monitor weight gain and make sure babies aren't overfeeding or introduced to solids too soon. We can also encourage breastfeeding, since that tends to lessen later obesity and diabetes (as well as other problems) later.And parents of bottlefed babies can adopt an on-demand schedule where babies drink what they want and aren't encouraged to drink as much as they can.

Organic Diet

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Other Allergy

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Other Food Sensitivity

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Other Mineral Deficiency

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Parenteral Nutrition

When children are having such horrible vomiting that they can't keep anything down or they such bad diarrhea that everything goes right through them, intravenous (IV) fluids are often used to make sure they don't become dehydrated or lose too much of their salts (like sodium or potassium). 

That can help for a day or two, but if the illness or condition lasts longer, the child begins to use up his or her calories that provide the energy for the body's function--and the body begins to rob the muscle and tissues of its protein to use that as a source for the energy for the body's metabolism. That's known as negative nitrogen balance, because the protein's nitrogen isn't being replaced.

IV nutrition is designed to replenish what the body needs when regular or tube feedings can't be used. And in those situations ( or after a severe accident or major surgery), the body often needs extra protein and calories, at least for a little while. So the IV feedings (also known as total parenteral nutrition, TPN) or hyperalimentation) have to be adjusted daily in the beginning and regularly after that to make sure they deliver the

  • fluid
  • protein, sugar, essential fats
  • salts (sodium, potassium, chloride, bicarbonate)
  • calcium, magnesium, phosphorus and other minerals
  • vitamins

the body needs. TPN has to be critically balanced and carefully administered.

  • Too little and a deficiency can develop.
  • Too much and the liver, kidneys and other tissues can be affected
  • These children are tremendously susceptible to  infections that can enter through the IV tubing and connections
  • The IV tubing can clot which can prevent the nutrition from getting where it needs to go, or the clot can dislodge and cause strokes and other complications

Often, the TPN can be weaned as the child begins to eat and absorb or as he or she becomes stable enough so that tube feedings can replace the IV nutrition.

Peanut Allergy

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Pregnant Mom

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Premature Infants

Celiac Disease In InfantsBabies born more than 3 weeks before their due date are considered premature. Babies normally are born 40 weeks after they're conceived, so that means a baby under 37 weeks is premature and under-developed, needing more support and extra attention. The earlier they are born, the more premature, the smaller and more underdeveloped they are and the more needs they have.

That applies to their nutrition as well. They are at risk of remaining small if they don't catch up by 3 years of age. And their brains have an even tighter window, needing to grow and develop into their expected size by a year of age. But the odd thing is that they can't be overfed either, because that puts them at greater risk for high blood pressure, heart disease, diabetes, and osteoporosis later in life.

Even getting their feedings started can be tricky. For some of premature infants, small amounts must be given in the beginning (we're talking 1 milliliter over an hour-that's 1 /5 of a teaspoon) because they have such poor immune systems and such vulnerability that they can easily develop an intestinal perforation (a hole in their intestine).

So while nutrition is a critical piece of their growing into healthier kids, nutrition also remains a real threat. For that reason, Nutrition4Kids.com reviews the premature infant's

  • Special needs for protein, calcium and other nutrients
  • Vulnerable intestine
  • IV nutrition
  • Tube feedings
  • Potential for reflux and aspiration
  • Formulas and fortifiers

In addition to putting in your baby's profile, you can add pictures and comments, and even ask for help from other parents and caregivers or from our staff

Shellfish Allergy

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Skin Disorder

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Soy Allergy

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Sucrose Sensitivity

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Sugar Free Diet

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Tube Feeding or Enternal Nutrition

Most of us like to eat. Some of us "love" to eat--and of course, those who do often eat too much. But there are some who can't eat or can't eat enough to maintain their health. What happens then? Sometimes an appetite stimulant can be used or the foods can be changed to a different texture (a liquid diet, for example). But when that doesn't work, liquids can be dripped or pumped into the stomach or intestine to provide the necessary nutrition that person needs. They go through a tube (and so they are called tube feedings. In medical lingo, that's enteral nutrition.  

There are basically 3 types of feeding tubes:

  • Naso-gastric tubes (NG tubes). These go through the nose, down the esophagus and into the stomach. They are usually used for just a few days or a few weeks.
  • Gastrostomy tubes (G tubes)  go directly through the abdomen (with a hole made through the skin and muscle) going directly into the stomach. Obviously, they are not used unless the tube is going to be used for longer periods (months to years)
  • Intestinal tubes are simply extensions of the NG or G tubes that deliver the food into the intestine rather than the stomach. This is usually when the stomach doesn't empty well, or the patient has such severe reflux that it is likely the food will come back up into the esophagus (and perhaps spill into the lungs). So these tubes go down into the first part of the intestine, the duodenum; or the next part, the jejunum. The NG becomes an ND or NJ tube and the G tube becomes a GJ tube.

Buttons are similar to the tubes, but they are shorter versions, so that they don't have long "tails" always sticking out of the skin. Instead, a tube is attached when a feeding is going on and removed when the feeding is over.    

Enteral nutrition or tube feedings can be given in different ways.

They can be the only source of nutrition (this is called exclusive enteral nutrition or EEN) and is used for children who might aspirate their feedings, have problems with absorption or as the initial treatment for Crohn's disease, for example.   

Partial enteral nutrition is where the tube feedings are combined with normal meals. This might happen in situations where a premature infant or a child with heart disease, cystic fibrosis or cerebral palsy can't eat enough and the tube feedings are needed as supplemental nutrition.

In either case, the tube feedings may be pumped in as continuous feeds over several hours or all night or they may be dripped in over a short period of time (known as bolus feeds) so they are like having a regular meal.

Because these feedings have to replace what someone would normally eat, they have to be carefully balanced to make sure they meet all of that child's nutritional needs. It therefore essential to work with a qualified doctor or dietitian focused on pediatric nutrition.

Ulcerative Colitis

Ulcerative colitis (often just called UC) is medical speak for ulcers and inflammation in the large intestine (or colon). Along with Crohn's disease, UC is one of the Inflammatory Bowel Diseases (IBD). In adults, UC is usually milder, involving just the lower part of the large intestine. In children and teens, more of the colon is usually involved and as a result, kids with UC tend to have more symptoms.

The Symptoms

  • Abdominal Pain
  • Diarrhea
  • Intestinal bleeding
  • Anemia from the blood loss
  • Growth problems
  • Leg sores (rarely)
  • Arthritis (rarely)

Some patients just have diarrhea and bleeding without any abdominal pain. Others will have intense pain. Growth problems and arthritis can occur but those problems are more common in Crohn's disease.

The more of the large intestine that's involved, the more symptoms the patient is going to have. Because children tend to have extensive colitis more often than adults probably then explains why they tend to have a more severe course.

Ulcerative Colitis in the Small Intestine

Ulcerative colitis sometimes extends into the lower end of small intestine (the terminal ileum) as well. When it does, this is referred to as backwash ileitis. When the ileum is involved, this sometimes can make the diagnosis more difficult, because the pattern (the symptoms, location and severity) can resemble Crohn's disease, and sometimes, it becomes temporarily classified as “IBD-Undertermined,” which doesn't usually change treatment

We've even reported that, using a pill camera on patients with UC, parts of the small intestine (other than the terminal ileum) can look like they have surface resembling what we typically see in the small intestine. Some would call this Crohn's disease, since UC supposedly is localized in the large intestine, but we've elected to place it in the category of IBD-Undetermined.

Nutritional and Medical Treatment For Ulcerative Colitis

At the present time, there is no cure for ulcerative colitis, other than to remove the large intestine. While that sometimes becomes necessary, most doctors and patient-families would prefer to use their diet and one (or more) of the many medicines that are available to control their symptoms and to help heal their intestine.

However, nutritional therapy has not been as effective for UC as for Crohn's disease. As a result, enteral therapy is not used. Alternative, restrictive diets have been used with some success, particularly the Specific Carbohydrate Diet (SCD), according to those who have stuck closely to the diet for years, but scientific evidence is still lacking (though researchers are in the midst of studies to test its effectiveness).

Certain probioticshave been used with greater success for some patients. However, studies show that when these somewhat expensive medicines are used, they don't lessen hospitalizations or cost for the majority.

No matter what diet or medications are used, patients should be monitored for

Underweight

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Undiagnosed Difficulties

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Use of Herbal Supplements

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Use of Homeopathic Preparations

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Use of Vitamin Supplements

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Vegan

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Vegetarian

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Vitamin Deficiency

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Vomiting

Vomiting is the term for an active, sometimes powerful, return of stomach contents (and sometimes intestinal or esophageal contents) out of the mouth.  The reason for emphasizing the definition is because vomiting is different than reflux and rumination with different causes and mechanics.
With vomiting, the stomach is actively contracting, forcing the food and stomach juices up the esophagus and out.  It can be accompanied by nausea (a queasy feeling of discomfort that often feels like you might vomit, even when that doesn't happen).  It can occur repeatedly in waves over several minutes or hours until all of the stomach contents are emptied or in cycles where the pattern will happen intermittently.

Pain can come first, afterwards or not at all.
Diarrhea and / or fever can accompany the vomiting if there is an infection (gastroenteritis).
If there's no food in the stomach, the returned contents (emesis) are usually clear stomach acid.
Intestinal fluids (bile) can return as well.  If it is yellow, the bile is returning from the first portion of the small intestine.  Return of green bile is from lower in the intestine.

Red blood in the emesis that is present at the beginning of a vomiting episode often indicates a significant problem with an ulcer or other area that may be bleeding actively, and that may have caused the vomiting.  A brown substance that looks like coffee grounds may also indicate that blood is present and has been there long enough for the stomach acids to turn the blood into those brown grains.
If the person has had several forceful rounds of vomiting in a row, that force may tear a blood vessel where the stomach meets the esophagus.  This bleeding will usually stop when the vomiting subsides.

Vomiting and nausea can come from a number of causes

  • Intestinal infections, even kidney, sinus or other infections
  • Brain injury, swelling or pressure
  • Emotional upset or triggers (even the smell of food)
  • Gagging and swallowing problems
  • Narrowing in the esophagus
  • Ulcers and stomach disorders
  • Intestinal blockage
  • Food allergies
  • Hormone shifts (morning sickness in pregnancy)

Of concern:

  • Blood or green bile in the emesis
  • Dehydration (dry tongue, decreased tears)
  • Lethargy
  • High fever
  • Continued vomiting
  • Cycles of vomiting
  • Continued pain
  • Nutrition When Vomiting Is Present

  • The first need is to replace the fluids that have been lost with water and clear liquids (broths, popsicles and especially in children, the electrolyte replacement fluids.
  • Medicines may be needed to lessen the nausea and slow the vomiting--this and fluid replacement should be discussed with your primary care provider.  Medicines may also be needed to bring down a fever since higher temperatures do cause more fluid losses and greater replacement needs.
  • Food should be introduced as soon as the child is able to take it.  Crackers, rice, noodles and other easily tolerated foods often make good choices to begin with.
  • Ginger (ginger ale or ginger beer are often used to settle stomachs).  At times, flat sodas (the bubbles stirred out) can help.
  • Once stable, efforts should be directed to finding the cause and determining what else may need to be done.

Fortunately, intestinal infections are the usual cause of vomiting and they are often over within several days.

Further Reading

Diarrhea

Gastroesophageal Reflux

Wheat Allergy

Wheat Allergy Symptoms 

Wheat allergy can easily be confused with

  • Celiac disease
  • Non-celiac gluten sensitivity 

People suffering from celiac disease or non-celiac gluten sensitivity have problems with grains – as do people who are allergic to wheat.   But it is important to know which you have particularly because those with celiac disease must watch their diet carefully and they have to be watched for other problems as well.  So testing should be done before a gluten or wheat free diet is started.  If someone starts a gluten or wheat free diet before they are tested, making the right diagnosis can be harder.

True Wheat Allergy

People with wheat allergy will usually have

  • A rash (red, hive-like)
  • Itching
  • Abdominal discomfort (their stomach hurts)
  • Positive skin or blood tests

The symptoms usually develop within a few minutes or an hour after eating even a small amount of wheat.  If they are skin tested, they will have a redness and swelling where the wheat was placed.  The amount of swelling and redness may not show how severe their reaction will be when they eat wheat.  Blood tests can be done too, but the only ones most allergists trust are the IgE blood tests that link closely to skin reactions.  Even if one of these tests are positive, most allergists will still want their patients to try a small amount of wheat (a few crackers perhaps) to make sure that the tests are meaningful.

The patient with celiac disease needs to be devoted to their gluten free diet to prevent life-long consequences, while the patient with wheat allergy only needs to focus on eliminating wheat.  However, those with severe wheat allergy may need to carry an Epi-pen with them.  Someone with wheat allergy may develop other allergies, so it is important to watch for problems with other foods and to return to their allergist if symptoms develop.

Wheelchair or Bed Bound

Many wheelchair or bedbound children have Cerebral Palsy and are often termed "developmentally disabled," or "differently abled." Approximately 25% of these children had feeding problems in infancy as their first symptom.  And they have ongoing nutritional needs that have to be carefully addressed in order to improve their care.

The basic nutritional goals for healthy children and those who are wheelchair or bed bound are similar:

  • Maintain Metabolism (including hydration);
  • Provide Sufficient Energy to withstand stress; and
  • Correct and prevent any deficiencies.

But there are additional needs and considerations.  The disabled child may face other issues: inhaling their food and fluids into their lungs (aspiration), some have difficulty swallowing or problems with self-feeding and oral skills that may require assistance; and regulation of bowel movements, particularly if he or she isn't able to be toilet-trained.  Additionally, many developmentally disabled patients are totally dependent on their caretakers, including for mobility.  Thus, an overweight child (or even one who reaches full adult proportions) may be at risk for ulcers where their tissues press against the wheelchair or bed if they cannot be moved; or their caretakers may be at risk for hernias, back injuries, or heart attack due to the repeated strain of moving and positioning them.  And for overweight kids, the excess weight adds extra work for their lungs and heart.

The time of greatest nutritional risk are in early infancy and then again in the second decade of life, due primarily to feeding problems.  In infancy, low body tone (hypotonia) or increased body tone (hypertonia) often makes it difficult for some of these babies to acquire the oral and swallowing skills that are needed to feed successfully.

FEEDING AND SWALLOWING DISORDERS: CONTRIBUTING FACT0RS
  • Problems with the mouth, face, esophagus (example, Cleft palate)
  • Problems with the way they function (example, increased or decreased oral sensitivity)
  • Neurological problems (examples, seizures, poor tone or coordination)
  • Other medical problems (examples, heart or lung disease causing exhaustion)
  • Behavioral problems (example, irritability or resistance)
  • Environmental considerations (example, parent's emotional or mental disorder)

The problems for the older patient come because they need more food.  They need more nutrients and calories because of their increased size, which requires more effort and time to eat.  This extra effort can wear them out, and their caretakers too, so some older children don't get the nutrition they need.

MALNUTRITION NO LONGER

In the past, severe malnutrition was accepted as a part of their disabilities.  But now, advancements in feeding technology (often with tube feedings) have changed that view.  Several studies demonstrate that increased nutrient intake can improve:

  • Weight;
  • Muscle mass and function;
  • Energy stores;
  • Peripheral circulation;
  • Immune status; and
  • General well being -- 
  • While decreasing their irritability and spasticity.

But even with improved nutrition, children with cerebral palsy and other disabilities often do not grow as well in height well and they still often recover slowly from illnesses.