A Unique Child: Nutrition - Common sense

Childhood food allergies can have serious consequences, so it is understandable that parents are often apprehensive when entrusting a child with a known allergy to a nursery. Cross-contamination, hidden ingredients and a child not receiving a balanced diet are all real concerns. But practitioners can work with parents and reassure them that food allergies are very manageable in a nursery setting.

Food allergies and intolerances affect around 5 per cent of children in the UK, although many do grow out of them. It is essential that affected children avoid culprit foods because even small amounts can trigger life-threatening reactions such as mouth swelling, vomiting, a drop in blood pressure and anaphylaxis (see More Information). While any food can potentially cause an allergy, two of the most common reactions are to eggs and milk, as well as soya, wheat and peanuts.

Kimberly Munro, owner of Blue Grass Purple Cow nursery in Stockport, notes that food allergies - especially dairy - are becoming increasingly common, 'When we opened seven years ago there were one or two children with a known allergy; now around ten are dairy free out of 90 registered children.'

She says good communication with parents is essential. Information about children's special dietary requirements is gathered before a child starts at the nursery, the menus are discussed and a management plan is compiled. Children should have received a diagnosis of their allergy from a doctor or dietician, including advice on what foods they should avoid, so parents can be asked for this information.

All staff should be aware of a child's food allergy, and clear information should be displayed in the kitchen for reference. Care should be taken to check the ingredients of all pre-packaged foods for hidden ingredients and to ensure separate cooking utensils are used to reduce risk of cross-contamination.

A GOOD BALANCE

It is essential that children with food allergies still receive a good balance of nutrients. Children's Food Trust nutritionist Claire Wall advises that as long as children have a portion of a protein source (such as meat, fish, beans or meat alternatives like soya) as part of their daily meals, children will have enough protein in their diets even if they don't eat eggs.

It is trickier for children with dairy allergies. Calcium is needed for strong bones and teeth, and is especially important for children because their bones are growing quickly. It is also needed for muscles and nerves to work properly and for blood to clot. If children can't drink milk or eat dairy foods, they need to be given a variety of other sources of calcium.

Ms Wall says, 'Bread and foods made with flour, dark green leafy vegetables like cabbage, broccoli, spring greens and kale, dried fruit, canned fish with bones such as sardines and pilchards, pulses such as kidney beans, chickpeas and haricot beans, seeds and nuts all contain calcium. If children are able to have soya milk and yoghurts, then choose products that are fortified with calcium.'

At Dizzy Ducks nurseries in Essex, parents are consulted on the alternative products that they use. 'Many use lactose-free products that our cooks are fabulous at incorporating in the original recipe - for example, our blueberry cupcake will be made using normal margarine and also a dairy-free butter,' says head of early years practice Lillie Baxter.

COOKING FROM SCRATCH

Children with allergies should not be made to feel 'different' from the others. 'I try to make all the dishes look the same,' says Tristian Strover, chef at Tootsies Private Day Nursery in Farnham, Surrey. 'All the food is cooked from scratch and, for example, the base sauce will be identical, then I will add and take away ingredients as necessary.

'At some nurseries, children with food allergies are sat at a separate table but we don't do that because it makes them feel left out. Staff sit down and eat with the children so that they can see what is happening. There's never been a problem with children taking the wrong food.'

Mr Strover makes himself available to parents so they can discuss any concerns and builds up knowledge of what the children with allergies like and dislike. 'I want to ensure that they feel included and enjoy their food,' he says. 'It's not their fault they have an allergy.'

INGREDIENTS TO LOOK OUT FOR

Milk allergy: butter, casein, cheese, cow/sheep/goat's milk, evaporated or condensed milk, cream, curd, ghee, lactoglobulin, lactose, milk solids, whey, yoghurt, milk proteins

Egg allergy: albumen, dried egg, egg powder, egg protein, egg white and yolk, frozen egg, globulin, lecithin derived from egg, livetin, ovalbumin, ovoglobulin, ovomucin, ovovitellin, pasteurised egg, vitellin

CASE STUDY: MAYA, AGED NINE MONTHS

Reena Mistry, from Woking in Surrey, is mother to nine-month-old Maya. She says, 'We first suspected that Maya had a dairy allergy when she was around six months old. I spilt milk on her skin and blotches appeared. She also suffered from eczema on her cheeks that wouldn't heal. I did some research online and found a link between facial eczema and food allergies.

'Our doctor advised us to avoid giving Maya all dairy products and, as I was breastfeeding, told me to stop eating dairy products because milk protein can secrete into the breast milk.

'We were referred to the hospital and attended an allergy workshop, which was incredibly helpful and gave guidance on what foods to give to replace dairy products, such as soya milk fortified with calcium and vitamins. Maya also had allergy skin-prick testing, which confirmed her dairy allergy and found an allergy to some nuts.

'I'm returning to work when Maya is a year old. How a nursery deals with food allergies was a big priority when selecting childcare. The nursery we've chosen already caters for children with allergies and demonstrated to me the firm procedures that it has in place. The chef has done courses on children's food allergies and is very aware of the issues. They use colour-coded chopping boards and plates to keep food separate.

'The allergy clinic gave us a chart that lists the foods Maya is allergic to, possible reactions and what to do in the event of an allergic reaction - such as to give antihistamine - which we'll give to the nursery. Thankfully, we're confident that the nursery understands how serious Maya's allergy is.'

MORE INFORMATION

- 'Health - adverse reactions', www.nurseryworld.co.uk/article/1062512

- Children's Food Trust's Eat Better, Start Better guidelines, www.childrensfoodtrust.org.uk/eatbetter startbetter

- Anaphylaxis Campaign www.anaphylaxis.org.uk

- Allergy Action, www.allergyaction.org

- For more on hidden ingredients, visit www.vegsoc.org/sslpage.aspx?pid=604.