3 questions at the bottom related to case study Nutrition Assessment of Child wi
ID: 3511131 • Letter: 3
Question
3 questions at the bottom related to case study
Nutrition Assessment of Child with Potential Food Allergy
Patient History: 16-month-old female was a term newborn with no perinatal complications. At 2 months of age she developed atopic dermatitis that keeps getting worse, not better, with medically directed skin care.
Family History: There is a family history of seasonal allergies in the child’s mother.
Food/nutrition-related History: Infant was breastfed and had mild reflux that worsened when supplemented with a milk-based formula around 5 months of age. The child’s physician placed the child on an extensively hydrolyzed formula at 6 months; reflux improved. Mom took child off formula at 12 months and tried whole milk; 15 minutes later the child vomited and broke out in hives. The physician told mom to avoid milk, measured food-specific serum IgE, and referred the child to an allergy and immunology clinic. Mom has been avoiding milk and cheese in the child’s diet. The child is eating table food; eats a wide variety of fruits, vegetables, grains, and meats; and drinks juice, no milk alternative. She has not been offered peanuts or tree nuts, but eats salmon and catfish and has had shrimp without any problems. She takes no vitamin or mineral supplement.
Anthropometrics
Weight: 9.8kg (25th percentile)
Length: 78cm (50th percentile)
Weight for Length: (25-50th percentile)
Estimated Energy Needs: 792kcal [(89xwt(kg)-100)+20]
Estimated Protein Needs: 11 grams [1.1xwt(kg)]
Medical Test: ImmunoCAP (kU/L): milk-13, egg-0.9, soy-0.35, wheat-0.35, peanut-1.1, walnut-0.35, cod-0.35 (Note: 0.35 is considered negative)
Diet Order: Avoidance diet for milk, egg, peanuts, and tree nuts
Head Circumference: 27 cm
Nutrition Diagnoses
Food and nutrition-related knowledge deficit related to newly diagnosed food allergy test
Inadequate mineral (calcium) intake and inadequate vitamin intake (Vitamin D) related to food allergy as evidence by current diet restrictions requiring the avoidance of dairy foods
Intervention Goals
Remove all forms of milk, egg, peanut, and tree nuts from diet.
Increase consumption of calcium and vitamin D to meet AI.
Nutrition Interventions
Comprehensive nutrition education:
Instructed on strict avoidance of milk, egg, peanut, and tree nuts
Reviewed how to read labels
Discussed sources of cross-contact
Explained how to eat out
Instructed how to prepare safe foods at home
Provided sources of information on food allergies and daycares for the future
Vitamin/mineral supplement:
Offer a fortified soy beverage instead of juice at meals (minimum of 16 ounces/day to provide >500mg of calcium/day to meet AI).
Begin a multiple vitamin for vitamin D (to provide a minimum of 200 IU of vitamin D/day to meet AI).
Monitoring and Evaluation
Evaluate for accidental ingestions associated with allergens at follow-up clinic visits.
Assess intake of calcium and vitamin D (goal of 16oz of fortified soy beverage and multiple vitamin) at follow-up clinic visits.
Monitor atopic dermatitis improvement with elimination of food allergy triggers.
Educate parents regarding possible food challenge to egg in future.
Questions
What will you do during the follow-up visit 2 months later:
1. If the child only has the fortified soy beverage on their cereal in the morning, and refuses to drink it?
2. If the child’s atopic dermatitis has not improved?
3. If the child has not gained any weight since her last visit?
Explanation / Answer
Answer 1. In the follow up visit after 2 months, the child has to be evaluated growth and development occurred in child after suggestion. For growth and development one has to make assessment of growth chart and developmental milestones of child. If there's no development then we has to give some other food supplement also. Green vegetable soup, dalia, other semisolid fortified foods may be given.
Answer 2. Atopic dermatitis is hereditary diseases and runs in generation. If atopic dermatitis of the child does not improved then you may tell mother to discontinue breast feeding. Avoidance from allergens are the best treatment of any allergic disease.
Answer 3. If the child has not gained any weight since last visit then this is the point of concern. The child must be now given vitamin D in other forms like syrup and injection. Vitamin D is important for bone formation and development of body of the child. The dry fruits and other vegetables are also included in the diet. Dry fruits like dates may be given in crushed form. Dates are rich source of calcium. Many vitamins and minerals are found in fruits and vegetables that helps in immunity development of the child.
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