The paediatric dietetic team has put together a list of useful links and resources for you to have a look at whilst you wait for your appointment. They are divided into specialist areas, choose the one that is applicable to you or your child.

Cow's milk (and other food) allergy

Diagnosis:

The most reliable way to diagnose a food allergy is to identify which foods your child reacts to and whether the reaction is reproducible. We would only carry out blood or skin prick tests in very few cases. If you’re concerned that your child’s allergy is severe – talk to your GP about a “safety plan”, they may refer you to an allergy specialist service at the hospital.

Note: asthma or eczema can be co-existing with a food allergy, and may not necessarily be caused by it.

- Allergy UK: Food Allergy

- British Dietetic Association

- Allergy UK: Cow’s milk allergy

Management:

It is recommended that all babies (6 months +) and children take a daily multivitamin containing 8.5-10mcg vitamin D. It is also important that you meet recommended calcium needs for their age, by choosing products that are fortified with calcium (not all are!) or naturally rich in calcium – check the label if in doubt.

Note: if you’re breastfeeding you may need to consider a calcium supplement.

- British Dietetic Association: Calcium

- Allergy UK: Weaning

- British Dietetic Association: Milk Free Diet

- Allergy UK: Milk free diet

Reintroduction:

If your child has got non-IgE mediated allergy, your GP or consultant may advise reintroduction of the allergen. We would do that using a reintroduction ladder – here are some examples below – however you should ideally speak to your doctor or dietitian before reintroducing allergens especially if your child’s allergy is severe.

- British Dietetic Association: soya ladder

- Allergy UK: iMAP cow’s milk reintroduction ladder

Further reading

Beyond Food Allergy

iMAP Guidelines

Allergy UK Dietitian

Selective eaters

Most children will go through a faddy eating stage between the ages of 1-7 years. It is important to ensure that they are still growing and meeting their needs. Try to compare your child’s diet to the Eatwell guide, are they managing to eat something from each food group?

It is always worth considering an age-appropriate multivitamin with calcium and iron where possible – especially if your child avoids the dairy and/or protein food groups.

- Infant and toddler forum

- Cambridgeshire Sensory Toolkit

- Caroline Walker Trust Publications (pdf)

Books:

“Helping Your Child with extreme picky eating”, Katja Rowell and Jenny McGlothin

“Helping Children Develop a Positive Relationship with Food” Jo Cormack

Food fortification

When your child has a small appetite it is important to try to introduce more foods higher in fat and protein.

Examples of these foods can include oils, pesto, cheese, double cream, full-fat mayonnaise, creamy yoghurts or custards (>100kcal per 100g), nuts, ground nuts or nut butters, dried fruit, hummus, avocado, seeds, tahini paste, full-fat milk or a high-calorie plant alternative (e.g. Alpro Soya 1-3 or Oatly Barista), homemade “energy bites”*

For example, fruit and vegetables are notoriously low in fat and protein, but you can fortify their vegetables by melting butter over them or roasting in oil, or adding oil/vinaigrette/sauce and seeds to a salad.

Just ensure that all foods and textures are suitable to your child’s developmental age and ability.

It is also important to make sure that you’re offering foods little and often, every 2-3 hours where possible. You might wish to offer a small snack (like a cube of cheese or a biscuit with peanut butter) a few hours before the next meal – it will offer extra calories but hopefully not impact their appetite for mealtimes.

Tips for Gaining weight

Home-made “energy” bites

Iron deficiency

If your doctor thinks that your iron deficiency has an underlying dietary cause, it might be worth having a look at how you can incorporate more iron-rich foods into your or your child’s diet.

- British Dietetic Association: Iron

- Vegan Society: Iron

- Vegetarian society: Iron

- Vegetarian Eatwell Guide

If you would still like to talk to one of our Paediatric Dietitians for more personal advice, talk to your GP or consultant about a referral.

Please note, that we currently have significant waiting times due to the demands on the service.

Healthy Eating

Download the be food smart app to see how much total sugar is in everyday food and drink. In particular, try to limit soft drinks and fruit juices for special occasions and encourage your child to drink more water.

NHS live well pages - Gives general advice on being more healthy and lunchbox ideas

For weight management advice for teenagers.

For more information about portion control for toddlers to preschool.

For information on being more active. Children should enjoy 60 minutes of activity on top of their school day.

Other useful resources:

British Nutrition Foundation

Start4Life

British Dietetic Association

Eat, Move, Learn

Eating well for 12-18 year olds

Eating well for 5-11 year olds

Information:

Patient webinars

The Best Care For Everyone