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Recently a parent was surprised to hear me mention that food allergies and sensitivities can create growth impairments in infants and children. Like many parents, this one had been told to turn to products like Pediasure to help his child gain and grow. But it wasn’t working.

I see this a lot in my practice. Undiagnosed and poorly managed food allergy, sensitivity, or food protein induced enterocolitis syndrome (FPIES) are probably the most common problems I encounter. But it still surprised me when a blog I posted on alternatives to Pediasure went viral. I realized that this means that Pediasure is possibly the top go-to for pediatricians nationwide, when they see an underweight child. And that is downright unfortunate.

As I explained in that Pediasure blog, if a child has a reaction to the proteins in Pediasure (milk and soy), then this product is going to do more harm than good. Besides weakening growth pattern, these reactions can cause diarrhea or constipation, rhinitis, dermatitis, or brochospasm. But, it’s routine for pediatricians to hand out Pediasure samples or coupons anyway, without checking if a protein intolerance, allergy, or other reaction is part of the problem.

If your child is experiencing symptoms described on this page, and especially a growth lag, it’s time for some lab work or professional guidance on an elimination trial. Inconvenient? Sure. But you might prevent months or even years of frustration as your child struggles with a withering growth or feeding pattern, frequent malaise, cognitive or developmental delays from low nutrition, or picky eating. This I have seen, all too often – and it’s all preventable.

Coincidentally, not long ago, I was contacted by Abbott Nutrition, the makers of Pediasure. They wondered if I would like to create webinars for them about autism and nutrition. I would have loved to, but I gently explained on the conference call that I rarely recommend dairy or soy protein sources for kids with autism, because our lab work-up usually shows these proteins to be reactive in these cases. So, no, I could not create webinars for fellow RDs or MDs that would keep this long-known piece of the autism puzzle out of the powerpoint.

That was sticky. So I threw the Abbott folks an olive branch by explaining that these kids can at times thrive with an amino acid based formula like Elecare, which Abbott also makes – and this is true. However, apparently, the Abbott people had somehow remained in the dark about all this for the last fifteen years. Needless to say, they later decided to “move the project in a different direction” – which I took to mean, find a dietitian who would help them sell Pediasure to families of kids with autism.

Hopefully that’s not you. There is so much more you can do, and do better. Solutions? If your child is already stuck in a growth or developmental rut, and showing diffuse signs like frequent colds or illnesses, fatigue, shiners at eyes, crabby or anxious affect, underweight, or funky stools, then it’s time to look for why this is happening. So far, in my fifteen years in practice, I’ve never met a kid who didn’t have a “why”. And we can usually find a solution.

Start with some thorough testing for reactions to foods. Here’s the rub: There are many kinds of reactions that the immune system or gut can contrive. If you’ve had basic allergy testing that was negative for your child, there’s probably more to the story. Here’s a strategy:

– If your child has IgE allergy symptoms like hives/vomiting/tingling of still unknown origin, complete a comprehensive IgE food antibody panel – go beyond the usual few foods tested (milk, wheat, corn, soy, peanut, egg). Great Plains Lab (GPL) and Genova Diagnostics (GDX) offer full panels, and I will request these for my patients where indicated.

– If your child does not have IgE allergy symptoms or positive results, but does have any of these: Bloating, reflux, mixed irritable stools, constipated stools, loose stools, anxiety, intermittent skin rashes, picky weak appetite, or trouble sleeping, then consider an ELISA IgG food antibody panel. GPL and GDX offer test panels to screen over 90 foods with one small blood sample. These reactions can appear often and independently of the IgE reactions, so testing both can be important.

– If you’ve done all this testing and still have no answers, consider a white blood cell antigen test with ALCAT labs. This is another option I offer in my practice. It examines yet another way that the immune system may react to a food protein, separate from antibody production. Looking at how white blood cells respond to food proteins is fraught with challenge because there can be false positives, but this test can uncover missing pieces in some cases.

– Even more detail can be scrutinized with IgG reactions to other compounds derived from food proteins in our bodies, and for cross sensitivity to our own tissue (autoimmune reactions exacerbated by food proteins) . Cyrex Labs offers these panels.

– If your child has firm or constipated stools, an extremely rigid appetite for wheat or dairy foods, and horrible behavior if he doesn’t get those foods, consider a gluten casein urine peptide test from GPL. This reaction to wheat and dairy protein is not immune-mediated. Instead, it assesses how completely the gut digests these proteins, and whether the gut wall is overly permissive in taking up poorly digested protein fragments (peptides) of gluten and casein. Not an allergy, but a reaction that can make your child miserable never the less. Peptide chains from these proteins mimic endorphins in the brain. This means they are addicting, and will not only create fierce rigidity in eating patterns, but will exert an opiate like effect on your child’s brain as well. Children with poor verbal or social skills, who have aphasia (no speech), or who have very delayed speech may be under the influence of these dietary opiates. Other features of dietary opiates are high pain tolerance, happy affect except when hungry (Jekyll/Hyde) or uncontrollable tantrums. Toddlers and young kids with an active opiate effect also tend to wake between midnight and three AM, when they may laugh, babble, want to play, or make noise, though may not be unhappy or crying for parents.

– If you already know that gluten is a problem, but aren’t sure what other grains are safe, several labs offer an array of tests to review this very question.

– If you’re still wondering if gluten is the problem, visit my blog on gluten free diets to learn about that testing.

There is no shortage of options for lab testing on food reactions. The trick is in picking the right ones based on your child’s history and presentation, and this is precisely what I do for my patients. Many of these tests are not in your pediatrician’s repertoire, or even your pediatric allergist’s repertoire (if they were, they would have offered them already). Once we have some results in hand, we interpret them in the context of your child, and can create a plan for what to eat.

Transitioning to new foods for a youngster isn’t as hard on them as it is on mom and dad. It means parents have to learn new shopping, cooking, and kitchen routines, and this can be disruptive at first. Balancing this with siblings is a challenge too. But for many families who have watched a child wilt into growth regression, weakness, developmental delays, or frequent infections, it’s worth it.

If Pediasure helped your child, fabulous. If it hasn’t worked in your family’s case, rest assured – there are many options, many answers. If you’d like help with your child’s feeding and growth, schedule an appointment – I look forward to hearing from you!