Saturday, 31 January 2015

Milk Alternatives for your Toddler and Preschooler

Small Child with a Milk Allergy? Now what?



original glass of milk courtesy of Hobbies Sudoneighm
via Flickr Creative Commons

Learning your child has a dairy allergy, or a dairy intolerance can be far from straightforward. Small mammals are supposed to have a diet predominantly consisting of milk for the first year of life and  although during an infant's first year you will probably have prescription formula as a main feed, there is little advice out there for weaning, let alone what to do for the older dairy allergic child.

Current advice is that a prescription non dairy and usually non soya feed is prescribed as a main food source for infants under a year. In some circumstances this is extended to the first two years.  (always consult your health professional, since a) I am not one, b) I don't know your child and c) advice changes fairly frequently) After this time you are pretty much on your own, with the responsibility of giving your child a varied, tasty and nutritious diet with sufficient calcium since milk is often the main source of this mineral for young children.
There are several alternatives available though, many of them fortified with additional vitamins and minerals.

Soya Milk 
Soya Formula used to be the fall back when dairy intolerance was suspected. (My eldest was on Wysoy for most of his first year.) But due to the fact that it is high in phytoestrogens, and because it is also highly allergenic this is no longer recommended, and you cannot buy it off the shelf in the UK any longer. The other issue with soya formula was the glucose content, which is more harmful to infant teeth than lactose.

Soya milk is however  highest in protein of all the non-dairy options. It’s the only one that’s comparable to cow’s milk, providing between 8 and 11 grams of protein per glass - one reason why older children are often encouraged to have soya milk and yoghurts if they cannot tolerate dairy. But even if you are not intolerant or allergic to Soya it is very easy to develop an intolerance to it if you overdo it. After breastfeeding my twins for 16 months on an exclusion diet I became intolerant to dairy. Whilst gradually trying to wean myself back on to regular milk I substituted wholesale with soya.... and quickly developed an intolerance to it. Moderation is key!

Soya milk is not heat stable and needs careful heating, or it will curdle. It's definitely not a good alternative for cooking and is rubbish in sauces.

Rice Milk
Rice milk has been in the press recently due its naturally "high" levels of arsenic. Concern originally stemmed from a study of arsenic levels in Baby Rice. You can read the NHS report here. Rice and rice products are known to have higher levels of inorganic arsenic compared with other foodstuffs, but the real concern for many was twofold. First a small child drinking rice milk daily is going to ingest more arsenic per unit body mass than an adult as they are smaller. Second, anyone on an exclusion or "freefrom" diet is going to eat a LOT of rice, because it's in EVERYTHING. So drinking it as well is perhaps not ideal.

It's heat stable though - which is great for cooking and making sauces, and has a pleasant taste. It's  the one you are least likely to be allergic to but tends to be higher in sugar and therefore calories and is likely to give your child a "sugar rush". So chocolate rice milk is really NOT a good idea!

UK advice is that Rice milk should not be given as a main drink to children under the age of 5.

Oat Milk
I LOVE oat milk. Heat stable, thick and "creamy" with a lovely nutty taste, it makes excellent sauces, is lovely stirred in porridge, and Oatly Cream works wonders in baking. BUT... and it's a big but, it's not gluten free, due to possible cross contamination. It is very low in gluten - some might tolerate it, but do ensure you ask your health professional first since according to a top paediatric dietician, oat milk is not suitable for coeliacs and others sensitive to gluten might not tolerate it either. Rude Health do however say their oat drink is gluten free.

Oat milk has around 4g of protein per glass, is a little higher in sugar and fat but has additional fibre which is good.

You can make your own oat milk - which will not need to have oil added unlike bought oat milk.

Almond Milk
As with oat Milk - you can make your own Almond Milk quite easily, although it is expensive in large volumes!

Almond milk has a lovely nutty taste and is pretty heat stable, it won't curdle when you warm it in sauces or hot drinks. Bizarrely it is quite low in protein, but also lower in fat and sugar than other milk-alternatives. It is high in minerals but these are less bioavailable due to something called physic acid present in Almond Milk.

Obviously a big no for nut allergy sufferers!!

Hemp Milk
When I first tried this 8 years ago, friends thought I was mad! It is an acquired taste, and I would never use it in a sweet recipe, but I like it. Likewise Hemp oil is great for cooking too - especially stir fries. It has Omega 3 Oils - 6 x as much as cows milk and 4 x as much as soya milk. It also has a variety of vitamins and minerals such as vitamins A, E, and B12, potassium, phosphorus, magnesium, iron, and zinc. It also contains all 10 essential amino acids! It's not very high in protein though.

Coconut Milk
Coconut milk is high in minerals like magnesium, iron and potassium, and vitamins B, C and E. It is high in medium chain fatty acids which are easily burned as fuel by the body, so good fats readily broken down. It is also uniquely high in lauric acid which is found in breastmilk, and has antiviral and anti fungal properties.

There are also now plenty of single carton coconut milk alternative drinks around. KoKo coconut milk comes in several flavours, it's very palatable and kids usually enjoy it.

Vitamin D
There has been concern that since cows milk contains Vitamin D, using milk alternatives reduces a child's Vitamin D consumption. This is very relevant as low Vitamin D has been linked with gut (non IgE) food allergies in recent research, and the UK has seen a return of the condition Rickets since there are now increasing numbers of children deficient in Vitamin D in the UK.

However, there is actually very little Vitamin D in cows milk, and it is not fortified in the UK. it is however sensible to ensure your child gets sufficient dietary Vitamin D and sufficient time in sunlight to make their own Vitamin D.

Conclusion
  • Babies need a prescription formula if they are Cows Milk Allergic or Intolerant. 
  • Infants under the age of two ideally should also have a prescription formula as a main drink. 
  • Weaning - It is however absolutely fine to use any of the above that a tolerated in cooking when weaning, and as the occasional drink (although not rice before age 5). Always take extra care when weaning a child with suspected food allergies and/or intolerances though and ALWAYS consult your health visitor or doctor before making changes to your child's diet.
  • Older Children - From experience I would suggest variety is best, if they tolerate food keep it in their diet but don't switch to just one milk alternative unless you have to. Children with food allergies are always at risk of developing more, and it's best not to give too much of any new alternative for this reason. 

So here I make sauces with rice milk, bake with rice, coconut or almond, use coconut or almond milk on the children's cereals, oat milk or almond milk in my tea,  hemp milk in curries....... we have them all. And my guilty pleasure, safely in the utility fridge with MUM ONLY written all over in Sharpie pen.... soya milk in my coffee frothed in the aeroccino !!!!


Thursday, 15 January 2015

Clearspring Organic Flat Noodles - 100% Rice

Just before Christmas the very lovely people at Clearspring Foods sent me a little "hamper" with some goodies in to try. This was entirely as a gift but since the products were new to me I thought readers might like to learn about them too.

Tried and tested



We love Clearspring, I reviewed their fruit purees here last year. The little pots are incredibly versatile, one of my children's favourite desserts is a pot of fruit puree with a sprinkling of crumble mix (I keep them a bag of this in the freezer ready) baked for a few minutes in the oven. (Because the pots are tinfoil, you don't have to transfer to another dish!)




But on to the noodles. 

I had a large box of vegetable stew in my fridge, my daughter struggles to chew and swallow meat and together with her allergies is almost Vegan - save for some baked egg occasionally. So I'm always looking for ways to add pulses, protein etc and bulk out her meals.

Clearspring organic rice noodles are 100% rice, nothing else. And brown rice at that - with makes them more filling and nutritious too. They are *so* easy to cook - just soak (not boil) in freshly boiled water for ten minutes. (That just gives you long enough to microwave the stew)

She was delighted with the result - as was I!



I haven't yet found a local stockist, but ordering online at Clearspring is easy enough. I've just placed an order for more!

Sunday, 14 December 2014

Birthday Cakes!

Proving that free from allergens needn't mean free from taste or impressive presentation, our Facebook Group members have been bust catering for some Winter birthdays!



I am always quite humbled by the efforts mums go to to make sure their children's allergies and exclusion diets don't limit their experiences of special occasions. Every time I feel as if I can't be bothered, one look at cakes like these, sweets or special meals others are making amidst the normal busy lives they lead pulls me back on track!

Clearly the group's icing and decorating skills are extremely impressive! Perhaps we should start taking orders??!

Have you checked out our Facebook Page yet?


Monday, 8 December 2014

Pulsetta Breadcrumbs - a Review

Disclaimer - The Recipe Resource was sent a tub of Pulsetta breadcrumbs for the purpose of an independent review. The views expressed are entirely my own - or rather those of my fussy, hard to please taste-testers!




Pulsetta is a relatively new company, their mission statement says:-
Our Pulsetta mission is to provide naturally nutritious foods to be enjoyed by as many people as possible, including those wishing for a healthy alternative to other foods, with or without gluten. 
Pulsetta seeks to craft bake the best possible products without compromise on quality, and without adding anything artificial. We only use ingredients that are GMO free and ethically sourced.

History

"Pulsetta began as a kitchen experiment that grew into something much more. By using milled pulses (peas and lentils), rather than traditional flour, Pulsetta has a nutritional profile that is truly world-class amongst gluten-free foods. The health benefits of including peas and lentils means Pulsetta contributes towards your 5-a-day of fruit and vegetables!

Pulsetta is completely natural, with nothing artificial added. Pulsetta is nutritious, naturally packed with vitamins, minerals, vegetable protein and fibre. Yet Pulsetta is also free-from most major allergens, without gluten, milk, diary, or egg. This means Pulsetta can be enjoyed by vegetarians, vegans, and coeliacs. Pulsetta is an excellent choice for families, dieters, athletes, and anyone who wishes to follow a healthy lifestyle. With Pulsetta, free-from is only ever an advantage."

We really struggle to get sufficient protein into our daughter in particular, and breadcrumbs which add to both her veg intake AND her protein intake are a fabulous idea. You can replace breadcrumbs with Pulsetta breadcrumbs in so many dishes, as a crispy coating on fish, chicken nuggets, on top of shepherd's pie or vegetable pies.... the list is pretty long. We couldn't wait to try!!

Crumbed Cod Steaks

My boys love their fish, and really miss crumbed cod steaks. A couple of supermarkets now sell gluten free crumbed fish (e.g. Marks and Spencer) but it's not always easy to find. I have tried Hale and Hearty crumbs, which do work well, but are more powdery and less crispy. I also love the idea of a protein boost with added vegetables so was thrilled to have the opportunity to try Pulsetta breadcrumbs.

Method
  • I cut the cod fillets into large pieces and brushed them with olive oil. (If your children can tolerate egg then beat an egg and coat the fish in egg first) 
  • Then I transferred the cod to a bowl with Pulsetta crumbs in to coat the fish. At first, I thought that insufficient crumbs had stuck, but once the fish was frying I realised I was wrong.


  • I pan fried the cod for 5-7 minutes until the crumb had turned golden, like the pieces on the left in this picture.

  • Serve with your choice of rice/new potatoes, mashed potatoes, chips and vegetables!

We all ate this meal, not just the children, and everyone spontaneously announced how much they loved the crumb. It was crispy, and really tasty. Definitely something we will be buying in future!

Result - A definite thumbs up, on several counts. Tasty, easy to cook with and offering new possibilities. Perhaps best of all a nutritious non-carbohydrate addition to the children's diet!




Sunday, 30 November 2014

Christmas Lollies!

So, following on from Emma Cawood's amazing efforts making single ingredient lollies... I decided these would be perfect for the twins' school bazaar next week. After much psyching myself up.... I set everything out and got started...

Ingredients

  • 2 cups white caster sugar
  • 2/3 cup light corn syrup - if you have this your lollies will stay fairly clear. I desperately wanted to source some, but so far no luck. After reading some excellent info here I decided to use Agave nectar instead. It worked fine, but the lollies were toffee coloured instead.
Equipment
  • Lolly sticks
  • silicone baking sheet
  • sugar thermometer
  • non stick pan
  • bowl of cold water large enough to submerge lower half of the pan.

Tip:- Add flavouring if desired - mint or vanilla, but your lollies will darken unless you have clear flavouring! 




Method
  • Heat the sugar and syrup in the pan and using a sugar thermometer heat and stir until it is boiling at 310F
  • Remove from the heat. Submerge the lower half of the pan in the cold water bowl for 10-15 seconds, keep swirling/stirring.
  • As it thickens up pour the liquid sugar on top of the lolly sticks in 1 inch circles. (If it spreads too much, it's still too hot)
  • Quickly add sprinkles etc before the surface cools!
NB lots of sprinkles contain major allergens. I used these which do have egg white and soya lecithin in. We are lucky and these are ok for us, soya protein would not have been.

I honestly don't think I have *ever* been so nervous about a recipe before. I had never made anything like this - but it was surprisingly easy and I will be far more confident next time! Clearing up took a while, perhaps because I knocked over the sprinkles.....

Clearing up Tips

  1. DON'T panic!!! You have't ruined your pan etc (unless and liquid sugar gets burned underneath.) as long as you have a large bowl of hot water to submerse the lower half in you an manage this really easily.
  2. Once you have poured your lollies, the remaining sugar will be hardening and impossible to remove from the pan. Heat gently until it starts to move again, and literally POUR it into the cold water. It will set immediately, and your pan will have so little left in that the rest will easily dissolve in hot soapy water!


Friday, 28 November 2014

Single Ingredient Lollies

As promised, here is how to make #freefrom lollies, from the lovely Emma Cawood who is part of our Facebook Group. 


Emma describes so emotively the reality of catering for a child with few safe foods, and the lengths we mothers go to to ensure they don't miss out more than they have to.



Over to Emma:-

With the Christmas holidays fast approaching I could feel that feeling off doom overwhelming me once again. The dreaded season of parties and family get togethers, where every event seems to focus around food. If I'm being truthful I think T deals with it all much better than I do. He just takes it on the chin and accepts it for what it is. I'm the one that carries the burden and constantly questions whether this is having an impact on his childhood. Are his Christmas memories going to be ruined in someway because he never had a Candy Cane or Mince Pie? Because his selection boxes didn't contain chocolate will he somehow grow up unhinged? Ridiculous I know but it's the kind of thing that goes through my head on a regular basis.

So the day arrived that I thought I owed it to T to try and make a sweet of some sort out of his 6 safe foods. If I tried and failed at I would be able to hold my hands up and say at least I had given it my best shot. The good news is after a week of trawling books, the web and dismissing so many things due to too many ingredients I came upon a simple Sugar Lolly. The original recipe had more ingredients in it than T could tolerate so I omitted them all and went with pure sugar. Not the best option I know when you think of those little teeth and with my biggest boy I would have been hyperventilating at the sheer thought of it but these wouldn't be given more than once a week and as T gets no other sugar in his diet I took the bulls by the horns and went for it.

The first day I tried to make them I boiled the sugar in a solid bottomed pan on a low heat. It went through the various stages. Melted, grainy, back to powder again and then finally just as I was giving up hope it turned to a lovely golden caramel colour. I quickly poured over plastic cake pop sticks that I had laid out lovingly on plastic sheeting. However it soon turned into disaster. Without a mould the sugar didn't stay in neat round lollypop shapes, it ran everywhere. The pan began to boil and burn so when trying to remove the sugar from the pan I flicked it into my eye and nearly blinded myself. My husband arrived home to smoke, screams and chaos. Ok I thought! This isn't going to be as easy as it seems.

Day 2, I was prepared with goggles, a new bag of sugar and a positive attitude. I had ordered a chocolate lolly mould online and set my stall out properly. The sugar started to melt and go through its various stages again but this time I was ready for it. As soon as it turned a lovely amber colour I took it straight off the heat and poured into the moulds. Yay!!!! I had lollies. Safe, gorgeous lollies for my beautiful boy. Ok, not the easiest thing to make but if they bring a teeny bit of joy to his life then worth every ounce of effort, after all when you're 7 years old to be able to eat something similar to other children means everything and even more so at Christmas.


Emma has inspired me - we are supremely fortunate that corn syrup is not an issue so I might manage to make some without the moulds, all being well!

Tuesday, 25 November 2014

No more Mr NICE guy.

I'm actually fuming. Really spitting angry. Because of THIS.


I joke that I've been "riding the reflux roller coaster" for many, many years. But actually, it's no joke at all. Not even a tiny bit amusing. Because when you can be accused of something as utterly ridiculous as not feeding your baby appropriately/sufficiently because an arrogant health professional has never heard of reflux occurring in children without considerable disabilities after the age of twelve months you begin to lose your cool. And that was after many years of (relative) restraint, anxiety, despair, sleepless nights, screaming babies and nearly losing the plot all together.

Most babies DO outgrow their reflux. It isn't always a long-term debilitating problem. Neither is it a "disease". It is a symptom - usually of an immature sphincter, perhaps due to a developmental disorder and is often present in those with other underlying health conditions, but increasingly it is due to the gut responding inappropriately to food proteins (most commonly cow's milk) and causing inflammation.

The gut is basically a hosepipe. inflammation anywhere will, can and DOES have an impact anywhere along it's length. So kids with constipation will commonly have reflux and people with a slow emptying stomach will have reflux due to backwards pressure too. It's really not rocket science - yet STILL top consultants cling to the outdated notion that reflux is a Disease in its own right.

And babies with bowel inflammation will most likely have significant acid reflux. 

WHY?

Because they are on a liquid diet, because they spend a long time lying down and because their gut is immature (and the sphincter muscle sealing the stomach may not be quite tight enough) meaning they regurgitate more and also swallow more air, which needs to come up. (How many reflux mums will tell you that the entire feed will come back until the wind, trapped at the bottom *finally* comes up? probably almost all.)  Babies are also at higher risk of gut allergies too - at least in the short term due to a permeable gut which is designed to allow maternal antibodies through and offer extra immunity. (Which is why the WHO recommend delaying weaning until 6 months of age.)

There is increasing evidence that gut bacteria play a role in the infant gut, immunity and gastrointestinal disorders. Babies have a suppressed immune system at birth which gives a narrow window for the colonisation of their gut with healthy, protective bacteria. But in the West too many babies are given antibiotics early, or born by caesarean section, or are formula fed and all these factors do have play a contributory role.

We also have this ridiculous notion in the West that babies should be allowed to cry. Babies cry to communicate with their mothers - you won't come across babies sleeping in separate rooms, "crying it out" or suffering from "colic" in the indigenous populations of the Third World. And this bizarre acceptance of infant distress is a hang-up from bygone times - yet STILL mothers have to try and explain to their (usually male) doctors that something is not right, that their baby is suffering - struggling to have some recognition of their (very valid) opinion.

So this paragraph made me particularly furious:-
"A lot of this is about the relationship between the baby and the mother and the mother's reaction to anything unpleasant or abnormal happening to the baby. "This guideline will empower GPs to reassure mothers there is nothing is wrong and they will get better on their own."
We should not have mothers sent away being told a persistently unhappy child is acceptable, a figment of our imaginations or in any way appropriate to ignore. 

I've been fighting, campaigning and persistently spreading the word about reflux for 17 years now. We all suffer here - possibly partially due to a connective disorder, certainly due to gut inflammation - but I spent months of Hell with ALL four of my children trying to obtain appropriate support. Even when lack of answers led to the finger being pointed at ME I refused to stay quiet, because I have reflux. It hurts! My Dad has suffered all his life - nearly died of aspiration pneumonia when younger, we have a family history as long as your arm, and whilst I would have LOVED those years of sleepless nights to have been a figment of my imagination, my husband would testify to the contrary.

So WHY, after years of progress are NICE seeking to turn the clock back?


https://www.flickr.com/photos/dad/

I do think we have lost our way a bit. GPs began to play "catch up" and realise that infant Gaviscon only helps a tiny percentage of babies with reflux. It is a thickener too, creating a "raft" over the stomach contents and whilst this can be useful in some babies, it slows down gut motility and often causes constipation - which makes reflux worse! Even when this is less obvious it can slow gastric emptying sufficiently to make things worse.

(Some!) Doctors also began to realise that early weaning is probably not a good idea. Babies with reflux may sometimes be low in weight and solids fill them up but are less calorie dense. They slow down the gut too as their take longer to digest so yes, a risk of constipation and making reflux worse! The infant gut is permeable for the first six months and foreign food proteins can often get through and cause a local allergic response.

NICE Guidelines for diagnosing and treating food allergy INCLUDING non IgE responses was published in Feb 2011 and whilst there is still a VERY long way to go more anymore doctors are recognising that food proteins are causing the (very real) conditions such as FPIES, Proctocolitis, IBD and Eosinophilic Disease. Top paediatric allergists like Adam Fox have explained how food proteins such as Cows' Milk can and do cause problems and the message was very, very slowly starting to get through......

So stronger medications were prescribed - acid blockers like Ranitidine and Proton Pump Inhibitors like Omeprazole which definitely help hugely in appropriate cases. And the pharmaceutical industry responded in full, omeprazole is now one of the top prescription drugs in the UK, across all age groups!

And now, it seems there is concern that too many infants - and children, are taking these drugs. 

Absolutely. 

I would not disagree with that at ALL. But apart from the tiny minority that maybe are over-prescribing, I assume doctors would correctly refer cases on to professionals best able to judge whether such drugs are necessary?

Surely the bigger issue here, is WHY so many infants and children are NEEDING these medications?

Even our consultant in London has said there is an "epidemic" of such cases.

DOES THAT NOT BOTHER ANYONE?

Apparently not, it's easier to blame mothers, after all what do we know about our own children?

But most of all, I'm furious that this slipped under the radar - the article is from AUGUST, when most mothers are in the middle of the summer holidays busy with families or away. The directive is here and the draft guidance here.I hope to goodness someone actually addresses the real issues here. 


  1. Infant reflux with additional food related concerns is on the rise, and reaching almost epidemic proportions.
  2. IgE food allergies are also on the rise. Approximately 30% of children in all primary school classes will have an allergy.
  3. Gut allergies (non IgE) allergies are under recorded and poorly understood. Recent research and progress is actually now being diluted to fit in with National opinion.
  4. Somehow, the way live, the way we produce and process our food is contributing to this exponential rise in both food allergies and gut inflammation which cause reflux and bowl disorders in our young people.
  5. Less than 1% of medical research funding in the UK goes on gastrointestinal topics, NONE on paediatric gastroenterology. Isn't it about time we recognised not only the importance of the gut, but it's role in our overall health?
  6. The way we view mothers, babies and families has to change. Because slapping down mothers who are worried about their babies is certainly not the way forward. Scapegoating them will NOT address the fundamental concerns in the West about our gastrointestinal health, reflux is not going to go away, and neither are bowel disorders relating to food allergy.


Have your say - sign the epetition to change outcomes for mothers and their babies with reflux.



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