+ Cows' milk allergy

Up to 1 in 20 children under 3 years of age are allergic or intolerant to cows’ milk. If your baby has eczema, diarrhoea, colic, constipation, vomiting, reflux, or is irritable, unsettled and back arches after breast or bottle feeds they may have a cows’ milk protein allergy. Lactose (milk sugar) intolerance is very often confused with cows’ milk protein allergy as they both cause similar gastrointestinal symptoms; however, it is crucial from a treatment point of view that the correct diagnosis is made as they require different dietary therapy.

Joan can provide a detailed clinical dietetic assessment to help identify whether your baby or child has a cows’ milk allergy or lactose intolerance, and provide appropriate nutritionally balanced dietary advice excluding all forms of milk protein or lactose, including those hidden in foods. The timing of reintroduction of milk back into your baby’s diet is critical to successful resolution of the allergy or intolerance, and Joan will be able to guide and support you through this detailed process.

+ Lactose intolerance

Up to 1 in 20 children under 3 years of age are allergic or intolerant to cows’ milk. If your baby has eczema, diarrhoea, colic, constipation, vomiting, reflux, or is irritable, unsettled and back arches after breast or bottle feeds they may have a cows’ milk protein allergy. Lactose (milk sugar) intolerance is very often confused with cows’ milk protein allergy as they both cause similar gastrointestinal symptoms; however, it is crucial from a treatment point of view that the correct diagnosis is made as they require different dietary therapy.

Joan can provide a detailed clinical dietetic assessment to help identify whether your baby or child has a cows’ milk allergy or lactose intolerance, and provide appropriate nutritionally balanced dietary advice excluding all forms of milk protein or lactose, including those hidden in foods. The timing of reintroduction of milk back into your baby’s diet is critical to successful resolution of the allergy or intolerance, and Joan will be able to guide and support you through this detailed process.

+ Iron deficiency anaemia

Iron deficiency anaemia is the most common nutritional disorder reported during early childhood and can often contribute towards fussy eating. Cows milk is a poor source of iron, so it is essential that either breast milk or formula are offered to babies as their main drink until the age of 1 year. Babies require a weaning diet that is rich in iron containing foods.

If you suspect your child has a low iron intake or you have been told by your doctor that your child has anaemia, then Joan can provide a nutritional assessment of your child’s diet and design individually tailored advice to help treat this deficiency.

+ Coeliac Disease

Coeliac disease is a lifelong autoimmune disease caused by intolerance to gluten and affects 1 in 100 people. Symptoms include bloating, diarrhoea, nausea, wind, constipation, tiredness, sudden or unexpected weight loss, hair loss and anaemia.

Until diagnosis, it is essential your child remains on a normal, gluten containing diet otherwise the test may result in a false result. Once diagnosed, Joan can advise on a nutritionally balanced gluten free diet individually tailored to your child’s requirements and lifestyle.

Gluten is found in wheat, barley and rye and once removed from the diet, your child should start to feel better. Prevention of cross contamination in the child's diet is very important and dietetic advice is essential to ensure adequate exclusion of gluten and to maximise micronutrient intake for growth on this restricted diet.

+ Constipation

Constipation in children is defined as having fewer than 3 stools per week, which can be either, hard and large or resemble “rabbit droppings”. Constipation can also alternate with diarrhoea due to an “overflow” effect and the resulting abdominal discomfort can reduce a child’s appetite and interest in food.

If your child has been diagnosed with constipation by your doctor or you suspect they may be constipated, Joan can provide a nutritional assessment and individually tailored dietary plan that can be the first step towards resolving this issue.

+ Food allergy

A food intolerance is not the same as a food allergy.
The principle differences between a food allergy and a food intolerance are:

• The symptoms of a food allergy occur immediately after eating the food, rather than after several hours as is usual for a food intolerance.
  
• A smaller amount of food is required to trigger an allergy than an intolerance.
  
• A food allergy can be life-threatening, unlike an intolerance.
  
  Food allergies may cause a raised itchy rash (urticaria), eczema, tingling or itching in the mouth, swelling of the face (angioedema) vomiting or diarrhoea within minutes or seconds of eating the food. Skin prick testing and specific IgE blood tests are the only tests that can identify whether a food allergy is present. Following an initial dietetic assessment, Joan can arrange a referral to a consultant paediatric allergist for skin prick and blood testing if a food allergy is suspected, prior to providing an individually tailored, nutritionally balanced ‘free from’ diet to treat your child.
  

+ Food intolerance

A food intolerance is not the same as a food allergy. The principle differences between a food allergy and a food intolerance are:

• The symptoms of a food intolerance usually occur several hours after eating the food, rather than immediate in an allergic reaction.
  
• A larger amount of food is required to trigger an intolerance than an allergy.
  
• A food intolerance is never life-threatening, unlike an allergy.
  
  A food intolerance may cause symptoms such as diarrhoea, bloating and stomach cramps. This may be caused by difficulties digesting certain substances e.g. lactose intolerance. Common food intolerances include wheat intolerance and soya intolerance. The only reliable way to identify a food intolerance is by eliminating and reintroducing foods, a process best undertaken, particularly for children, with the advice and support of a registered paediatric dietitian. Common food intolerances include wheat intolerance and soya intolerance.
  

+ Faltering growth

Faltering growth or weight faltering is most commonly caused by undernutrition relative to a child’s specific nutrient requirements. Causes tend to be multifactorial and may be due to dietary deficiencies or feeding behaviours that usually respond to specific dietary goals and advice.

In addition to Joan's paediatric dietetic qualifications, she has a diploma in Child Psychology and extensive experience in altering feeding behaviours in children. Joan can provide easy to follow step by step advice and support to help resolve the issue. Examples of cases that Joan has successfully managed are toddler food refusal, delayed weaning in infants due to refusal of lumps and textures and feeding behaviour problems such as those demonstrated in autism or attention deficit disorder.

Organic disease is rare in otherwise asymptomatic children, but it may be important to rule out any medical conditions prior to dietetic treatment. Joan can arrange a referral to a paediatric consultant gastroenterologist if required to exclude or confirm whether this is the case following an initial dietetic assessment.

+ Colic

Colic in babies is defined as distress or crying that lasts more than 3 hours a day for more than 3 days a week. It occurs in up to 1 in 5 babies and begins when a baby is a few weeks old and tends to resolve naturally once your baby is 4 months old unless there is an alternative cause for the colic.

Joan can provide a detailed clinical nutritional assessment for persistent unresolving colic, and offer professional help and support if dietary changes are indicated for your child following an initial assessment.

+ Inflammatory Bowel Disease

Inflammatory bowel disease or IBD is a group of inflammatory conditions of the colon and small intestine. Crohn's disease and Ulcerative Colitis are the principal types of inflammatory bowel disease. Crohn's disease affects the whole intestinal tract whereas ulcerative colitis primarily affects the colon and the rectum. Symptoms are abdominal pain, vomiting, diarrhoea, rectal bleeding, severe internal cramps/muscle spasms in the region of the pelvis, lethargy and weight loss.

Joan can provide a detailed nutritional assessment and individually tailored dietary advice for children with a confirmed diagnosis of IBD to improve their growth and nutritional intake, ensuring adequate intake of energy, protein and micronutrients which, in combination with IBD medication, may help to prolong length of remission.

+ Irritable Bowel Syndrome

Irritable bowel syndrome or IBS is the term used to describe a number of gut symptoms. It is a common condition of the digestive system causing bouts of stomach cramps, bloating, diarrhoea and/or constipation. It is important to have a diagnosis of IBS confirmed and other conditions such as coeliac disease and inflammatory bowel disease excluded, prior to making any changes to your child’s diet particularly if your child is passing blood in their stool or has lost weight.

Joan can arrange a referral to a paediatric consultant gastroenterologist to assess your child for these conditions if this is the case. Once a diagnosis of IBS is confirmed, dietary changes can often help IBS symptoms and advice differs depending on whether diarrhoea or constipation is the predominant symptom. There is evidence to suggest that a low FODMAP diet, a diet low in fermentable carbohydrates, may help to control IBS symptoms. JOan can guide you through this dietary elimination and food reintroduction process to identify which foods high in FODMAPs may be exacerbating your child’s symptoms.