pediatric dietitian

fpies baby

Understanding FPIES: The Basics of Food Protein-Induced Enterocolitis Syndrome

By The LCWNS Team Caring For Babies with FPIES Food Allergy Parents and caregivers of young children with food allergies face a myriad of complexities and anxieties when it comes to managing their child’s dietary needs.  The constant fear of accidental exposure to allergens can be overwhelming, leading to heightened vigilance in monitoring food encounters, meal preparation, and eating out.  This level of caution is necessary to prevent potentially life-threatening reactions in their child.  Similarly, parents and caregivers of children with Food Protein-Induced Enterocolitis Syndrome (FPIES) also face significant challenges in this area.  Keep reading as we explore the definition, causes, and presentation/signs and symptoms of FPIES, as well as its diagnosis and management.   What is FPIES? Food allergies and FPIES both cause abnormal reactions to specific foods1; however, the main difference between the two lies in the mechanism of these reactions.  Food allergies involve an immune system response to a specific food protein, leading to immediate symptoms such as hives, swelling, or anaphylaxis2.  In contrast, FPIES is not mediated by the immune system and does not typically result in immediate reactions3. Instead, FPIES causes delayed gastrointestinal symptoms such as vomiting, diarrhea, and dehydration hours after consuming the “trigger” food1.   Common FPIES Triggers Any food can instigate an FPIES reaction, but the most common culprits include the following:1,3 Cow’s milk Soy Grains, particularly rice and oats Individuals may also react to:  Poultry Seafood  Egg Peanut   It is important to note that each child’s triggers can vary widely, and some may react to more than one type of food4.   FPIES Symptoms As previously mentioned, FPIES symptoms mainly impact the digestive system1 and can be classified as acute or chronic.   Acute FPIES symptoms usually appear within hours after consuming the trigger food, causing cyclical vomiting and diarrhea3. Prompt treatment with intravenous fluids is essential to prevent dehydration and potential life-threatening complications4. Chronic FPIES symptoms, on the other hand, are more insidious and may present as failure to thrive, malabsorption, and chronic diarrhea3.  These symptoms can have a significant impact on a child’s growth and development if left unaddressed.   FPIES Diagnosis One of the most frustrating and challenging aspects of FPIES is that symptoms may not occur immediately after food ingestion but instead present a few hours later1,3.  Unlike traditional allergy testing, FPIES also cannot be detected via blood or skin testing4.  Instead, diagnosing FPIES requires health care professionals and parents to take a more investigative approach by closely monitoring symptom development, keeping detailed records of foods and reactions, and collaborating closely4.   FPIES Management and Treatment Fortunately, FPIES rarely persists past age 3-41, but it is still important to know how to manage the condition.  Key considerations include the following:  Trigger Food Identification and Avoidance: Identifying and avoiding trigger foods is the main way to prevent FPIES reactions.  To achieve this, individuals can read food labels and research restaurants ahead of time to ensure they have safe options available. It is also crucial to understand how to interpret labels for hidden sources of allergens, such as cross-contamination or alternate names for common allergens, in order to prevent adverse reactions.  Emergency Action Plan: An emergency action plan outlines specific steps to take in case of a reaction, including recognizing symptoms and seeking immediate medical assistance. Having a plan in place can help reduce the risk of complications and improve outcomes for individuals with FPIES. Medical Complications: Dehydration is a common complication of FPIES due to the excessive fluid loss from persistent vomiting and diarrhea. It is essential to closely monitor individuals with FPIES for signs such as dry mouth, decreased urine output, and lethargy5 and seek prompt medical intervention (i.e., IV fluids, medications) to prevent further complications3. Nutritional Implications: Due to the wide variety of foods that individuals with FPIES could react to, ensuring adequate nutrition for growth and development and preventing deficiencies is essential. Thus, it can be extremely helpful to consult with a dietitian and/or your pediatrician.     References Food Protein-Induced Enterocolitis (FPIES) | Symptoms & Treatment. ACAAI. Published March 21, 2019. Accessed June 26, 2024. https://acaai.org/allergies/allergic-conditions/food/food-protein-induced-enterocolitis-syndrome-fpies/ Mayo Clinic. Food Allergy – Symptoms and Causes. Mayo Clinic. Published December 31, 2021. Accessed June 26, 2024. https://www.mayoclinic.org/diseases-conditions/food-allergy/symptoms-causes/syc-20355095 Food Protein-Induced Enterocolitis Syndrome (FPIES). www.chop.edu. Published February 23, 2014. Accessed June 26, 2024. https://www.chop.edu/conditions-diseases/food-protein-induced-enterocolitis-syndrome-fpies Food Protein-Induced Enterocolitis Syndrome (FPIES). Aaaai.org. Published 2023. Accessed June 26, 2024. https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/food-protein-induced-enterocolitis-syndrome-fpies Cleveland Clinic. Dehydration. Cleveland Clinic. Published June 5, 2023. Accessed June 26, 2024. https://my.clevelandclinic.org/health/diseases/9013-dehydration

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baby led weaning baby eating

Baby Led Weaning vs. Spoon Fed Weaning

By LCWNS team  How to Wean Your Baby Everyone knows that good nutrition is essential for children to grow healthy and strong.  But as a new parent, you may feel overwhelmed with information surrounding the best way or the best foods to feed your infant.  For the first few months of life, the answer is pretty clear cut- breastfeeding and/or formulas are the way to go, exclusively.  But what happens when it’s time to transition to more exciting foods?     What Is Baby Led Weaning? Baby led weaning (or baby led feeding) is one way to introduce your infant to solid foods,1 where he or she is essentially in charge of the eating process.  Picture the infant enjoying his/her first birthday cake: messy hands covered in frosting, given free rein to eat (or destroy) their dessert as they please … that would be an example of baby led weaning. This self-feeding method allows the infant to control what and how much to consume.  The foods offered should be large enough for the infant to grasp and to prevent choking and soft enough that they can be easily mashed.  Examples include pasta, half of a banana, steamed fruits or vegetables, and finger sized strips of beef (parents.com). Many parents are opting for this method due to its benefits in developing fine motor skills and hand-eye coordination,  learning to regulate appetite and food intake, and in providing exposure to a variety of foods, flavors, and textures1, which may prevent picky eating later on as the child matures.  Additionally, baby led weaning encourages participation in family meals as the foods offered are simply those you already have on your plate1. Spoon Fed Weaning In contrast, parents have the option to spoon feed their child, typically beginning with purees and progressing to soft and then solid foods2. In spoon fed weaning, the parent is responsible for feeding the infant and responding to signals of hunger/fullness.  An advantage of this method is less mess, particularly when compared to baby led weaning.  Parents may also feel more at ease regarding the potential for choking as well as knowing their baby is getting enough food, though research shows nutritional deficiencies and choking risk do not differ between baby led and spoon fed weaning3, 4.   When To Start Baby Led Weaning Before deciding whether to use baby led weaning or spoon-fed weaning (or a combination of the two), it is important to evaluate your baby’s readiness to experiment with solid foods.  Developmental milestones, such as head and neck/postural control and the ability to sit upright without support are prerequisites to baby led and spoon fed weaning.  Other signs that your infant is ready for more advanced foods include the following5:  Able to push food to the back of the mouth and swallow  Bringing objects to their mouth Pincer grasp (thumb and forefinger) present Opens mouth when offered food Shows interest in foods served for the rest of the family (i.e. looking at what’s on your plate, reaching for your food, etc.)   Typically, these indicators occur when the child is around 6 months old; however, the decision to start offering complimentary foods should be made with the aforementioned markers in mind6.    Baby Led Weaning Foods It is also important to note that baby led weaning and spoon-fed weaning do not necessarily address the nutritional needs of the growing infant. While breastfeeding and formula feedings usually continue during this transition period, complementary weaning foods should be nutrient and energy-dense, high in iron and zinc, and come from a variety of food groups7.  Additionally, the USDA Dietary Guidelines for Americans recommend limiting added sugars and salt7.  Regardless of which method you choose, it is important that the foods be safe and appropriate, and that supervision is provided at all times.  Strategic introduction of allergens and avoiding “choke foods” are other factors to keep in mind. 7, 8   Key Takeaways Baby led weaning and spoon-fed weaning are two ways to introduce and transition your infant to foods other than breast milk or formula Certain developmental milestones must be present before an infant can transition to solid foods An adult should be present while the infant is eating  Choking hazards include anything that can get lodged in the trachea (i.e., popcorn, hot dogs, whole grapes, nuts, anything clumpy/sticky/dry) A registered dietitian can help you navigate this exciting but often scary time   References [1] Helwig, J., & Carrus, E. (2023, April 21). Is baby-led weaning right for your baby?. Parents. https://www.parents.com/baby/feeding/solid-foods/dos-and-donts-of-baby-led-weaning/  [2] Mother and Baby. (2023, April 4). What is spoon-fed weaning?. Mother and Baby.  https://www.motherandbaby.com/baby/weaning/what-is-spoon-fed-weaning/  [3] Utami, A. F., & Wanda, D. (2019). Is the baby-led weaning approach an effective choice for introducing first foods? A literature review. Enfermería Clínica, 29, 87–95. https://doi.org/10.1016/j.enfcli.2019.04.014  [4] Rice, D. K. (2019, March). Children’s nutrition: Embracing baby-led weaning. Today’s Dietitian. https://www.todaysdietitian.com/newarchives/0319p10.shtml [5] Centers for Disease Control and Prevention. (2023, June 27). When, what, and how to introduce solid foods. Centers for Disease Control and Prevention. https://www.cdc.gov/nutrition/infantandtoddlernutrition/foods-and-drinks/when-to-introduce-solid-foods.html  [6] Start solid food based on what your baby can do, not how old she is. Ellyn Satter Institute. (n.d.-b). https://www.ellynsatterinstitute.org/family-meals-focus/78-baby-led-weaning/  [7] Dietary guidelines for Americans 2020-2025. (n.d.). https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf  [8] Centers for Disease Control and Prevention. (2022, February 25). Choking hazards. Centers for Disease Control and Prevention. https://www.cdc.gov/nutrition/infantandtoddlernutrition/foods-and-drinks/choking-hazards.html   [9] Feed in the right way for your child’s stage of development. Ellyn Satter Institute. (n.d.-a). https://www.ellynsatterinstitute.org/how-to-feed/child-feeding-ages-and-stages/

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5 Essential Tools For Homemade Baby Food

From The Best Baby Food Maker To Baby Food Storage, This Is The Equipment You Need Hey moms and dads!  Ever wanted to make your own baby food but are not sure where to begin?  Whether you’re in the process of baby-led or spoon-fed weaning (see previous blog post) or are just about to transition your infant from breastmilk and/or formula to solids, having the right tools to prepare homemade, baby-approved cuisine is essential.  We asked new parents to share their 5 favorite kitchen tools to make meal prep easier and more efficient for your cooking needs.  Here’s what they said:   1. For the parent who wants an “all in one” gadget:  Baby Beaba Babycook Solo Baby Food Maker Processor If there were one appliance to do it all, this would be it!  The Babycook Solo Baby Food Maker Processor steams, purees, thaws, and reheats food.  Its ease of use and wide variety of functions made it a top pick among parents-turned chefs. And, because it essentially takes on the roles of 4 pieces of equipment, is an excellent option for those looking to save space in their kitchen! 2. For parents and baby on-the-go:  Squeeze Station – Baby Food Pouch Maker for Children with 10 Fresh Squeezed Pouches This is a great product for parents looking to take their homemade (or store-bought) purees wherever they go. It can also be used for yogurts, juices, or smoothies. Simply pour your prepared food item of choice into the top portion of the device, insert the press, and push down to fill the reusable pouches.  This mess-free packaging process offers an eco-friendly way to store, transport, and consume different purees no matter where your adventures may take you and your infant. They can also be frozen to use for make-ahead options.  3. For the parent who likes to plan ahead: WeeSprout Glass Baby Food Storage Jars w/Lids (4 oz, 12 Pack Set)  As dietitians, we always recommend meal prep for our busy clients to simplify their week- but why should this be limited to adults? The WeeSprout Glass Baby Food Jars can be stored in the refrigerator or freezer so meals can be made in advance in batches and saved for later consumption.  They are a wonderful way to store/salvage the baby food you’ve put so much love and effort into preparing.  Plus, these jars are microwave and dishwasher safe, so you can safely reheat your baby’s food and when finished, place in the dishwasher for an easy clean-up.  The time you save with meal prep allows you to put your energy into other things, such as spending quality time with your infant. 4. For the infants whose food doesn’t always end up in their mouths: EZPZ mini mat While not a cooking tool per se, the EZPZ mat is a mealtime must-have!  When I was just learning how to eat solid foods, my parents would put a huge mat under my high chair at restaurants to catch any food that didn’t make it into my mouth (which, in the beginning, was a lot)!  The EZPZ mini mat was the solution we didn’t know we needed.  This placemat, plate all-in-one is made of 100% silicone and can be used in the microwave, oven, and dishwasher.  Plus, its suctioning capability and portability helps to prevent any accidental/unnecessary spilling (and all too familiar mess).  As dietitians, we love the 3-sectioned design as it’s great for serving balanced, healthy meals that check all the boxes in terms of nutrition.   5. For parents who want to keep it simple:  Sopito 2 Pack Stainless Steel Integrated Masher Kitchen Tool Food Masher  Sometimes, a simple potato masher is all that is needed to create baby-safe purees.  Despite its name, it can be used for other fruits and vegetables to create the perfect texture/consistency for your infant. An advantage is that you have more control over the final product’s consistency than you might if using an electric food processor.  It is also an inexpensive tool that can be used for other recipes you may prepare for your family.     In short, there are many ways to make homemade baby food— with or without the need for specialized equipment.  These parent-tested and RD-approved tools offer some useful options designed to simplify the process and yield tasty, baby-friendly meals!    

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