Significant improvement of eczema with skin care and food elimination in small children

Aim: To evaluate common methods of investigation and treatment in children younger than 2 y of age with eczema, with or without sensitization to food allergens. Methods: One hundred and twenty-three children younger than 2 y of age with eczema and suspected food allergy were included in this prospective study. The children underwent skin-prick test with cow's milk, fresh hen's egg white and wheat. Specific IgE to milk and egg white was analysed. The eczema extent and severity was estimated with SCORAD before and after treatment. Children with a positive skin-prick test were instructed to exclude that food item from their diet. All children were treated with emollients and topical steroids when needed. Results: Sixty-two of the children were skin-prick positive to at least one of the allergens; 62% had mild, 30% moderate and 8% severe eczema at their first visit. After treatment, 90% had mild, 10% moderate and 0% severe eczema. Forty-six per cent of the children had circulating IgE antibodies to milk or egg white. Ten per cent had specific IgE but negative skin-prick test to the same allergen. This subgroup improved their eczema significantly without elimination diet.

Conclusion: The conventional treatments for children with eczema, i.e. skin care and food elimination, are effective. The beneficial effect of skin care as the first step should not be neglected, and it may not be necessary to eliminate food allergens to relieve skin symptoms in all food-sensitized children with eczema.     

High levels of IgG4 antibodies to foods during infancy are associated with tolerance to corresponding foods later in life

Children with eczema and sensitization to foods are recommended skin care and, if food allergy is proven by challenge, an elimination diet. For most children the diet period is transient, but the process behind tolerance development and the influence of decreased allergen exposure is not fully known. The aim of the study was to investigate the effect of elimination diet on serum and salivary antibodies and to identify immunological parameters related to the ability to tolerate foods. Eighty‐nine children, below 2 yr of age, with eczema and suspected food allergy were included. Recommended treatment was skin care to all children, and 60 children had a period of elimination diet. At 4½ yr of age, the children were divided into two groups, based on if they had been able to introduce the eliminated foods, or not. Serum and salivary antibodies were analyzed with enzyme‐linked immunosorbent assay and UniCAP^® before and after a 6‐wk treatment period and at 4½ yr of age. Children sensitized to egg and/or milk that could eat and drink the offending foods at 4½ yr of age, had higher levels of Immunoglobulin G₄ antibodies to ovalbumin and β‐lactoglobulin and also higher IgG₄/Immunoglobulin E ratios on inclusion in the study, than those who had to eliminate egg and/or milk from their diet, beyond 4½ yr of age. The highest IgG₄/IgE ratios were found in children with circulating IgE antibodies to egg and/or milk but negative skin prick test on inclusion. The 6‐wk treatment period did not significantly affect the levels of serum and salivary antibodies. In conclusion, eczematous, food sensitized infants with high levels of IgG₄ and high ratios of IgG₄/IgE antibodies to food allergens are more likely to consume these foods at 4½ yr than infants with low levels and ratios.     

Complementary feeding practices and associated factors of dietary diversity among uncomplicated severe acute malnourished children aged 6–23 months in Burkina Faso

Nutritional treatment of children with uncomplicated severe acute malnutrition (SAM) is based on ready‐to‐use therapeutic foods (RUTF). With treatment provided at community level, children could have access to other foods, and a reduction in the dose of RUTF could further increase dietary diversity during treatment. We assessed the dietary diversity score (DDS), the minimum dietary diversity (MDD), the minimum meal frequency (MMF) and the minimum acceptable diet (MAD) of 459 infants and young children aged 6–23 months being treated for SAM with different doses of RUTF. We also investigated the factors associated with DDS. Dietary intake was estimated using a single 24‐h multipass dietary recall, 1 month after starting treatment, from December 2016 to August 2018. The DDS was calculated on the basis of eight food groups. Differences between children receiving the reduced RUTF and the standard RUTF dose and factors associated with DDS were assessed by Poisson and logistic regression models. RUTF dose was not associated with DDS (4.07 ± 1.25 for reduced RUTF and 4.01 ± 1.26 for standard RUTF; P = 0.77). Food groups most consumed by children were grains, roots or tubers (96%) and legumes and nuts (72%). Eggs consumption was low (3%). DDS was positively associated with child''s age, mother''s education, household wealth index, urban residence and rainy season. The present findings show that children with SAM consumed a variety of foods during treatment in addition to the RUTF ration prescribed to them. Reducing the dose of RUTF during SAM treatment did not impact DDS.     

Food intolerance and food allergy in children: a review of 68 cases.

The clinical and laboratory features of 68 children with food intolerance or food allergy are reviewed. Young children were affected the most with 79% first experiencing symptoms before age 1 year. Forty-eight (70%) children presented with gastrointestinal symptoms (vomiting, diarrhoea, colic, abdominal pain, failure to thrive), 16 (24%) children with skin manifestations (eczema, urticaria, angioneurotic oedema, other rashes), and 4 (6%) children with wheeze. Twenty-one children had failed to thrive before diagnosis. A single food (most commonly cows'' milk) was concerned in 28 (41%) cases. Forty (59%) children had multiple food intolerance or allergy; eggs, cows'' milk, and wheat were the most common. Diagnosis was based on observing the effect of food withdrawal and of subsequent rechallenge. In many children food withdrawal will mean the use of an elimination diet which requires careful supervision by a dietician. Laboratory investigations were often unhelpful in suggesting or confirming the diagnosis.     

Anaphylactic shock during elimination diets for severe atopic eczema.

Eighty patients with atopic eczema were treated with various elimination diets. Some or all foods were withdrawn then later reintroduced singly to the diet. In four patients reintroduction of a single food (soya, chicken, corn, cows'' milk) caused anaphylactic shock. In two patients spontaneous recovery occurred but in two resuscitation and intensive care were required. Anaphylaxis is a definite hazard of these elimination diets. Other than warning the parents, practical precautions are difficult because of the unpredictability of violent reactions and uncertainty about the life saving efficacy of injected adrenaline.     

“Then you raise them with Shirchoy or cookies”: Understanding influences on delayed dietary diversity among children in Tajikistan

Dietary diversity is a key component of infant and young child feeding (IYCF) as well as adult health. In Tajikistan, a predominantly rural, former Soviet country in Central Asia, we conducted formative research to identify barriers to dietary diversity and strategies for nutrition behaviour change. In Spring, 2016, mixed‐methods data collection took place across 13 villages in all five regions, collecting collaborative mapping; structured assessments of stores and markets; home visits for dietary recalls; food storage, preparation, and meal observations; focus groups with pregnant women, mothers of young children, fathers, and mothers‐in‐law; and in‐depth expert interviews with local nutrition and health influentials. Overall, maternal diet was adequate in terms of diversity (only 13% reported <5/10 food groups in the past 24 hr); however, only 42% of index children 6–24 months met WHO guidelines for diversity, and only 34% met minimum acceptable diet criteria. In addition to issues of poverty and food scarcity, qualitative data reveal many behavioural barriers to timely introduction of diverse complementary foods. Women's strategies focused on gradual introduction of household diet components, without regard for diversity or nutrition. Foods such as meat were seen as costly and thus inappropriate for IYCF, and food taboos (i.e., fresh vegetables) further reduced diversity. Infant food preparation methods such as grinding were seen as impractical, and many foods were withheld until children develop teeth. Possible nutrition education strategies include point‐of‐purchase campaigns to improve availability and appeal of IYCF‐friendly foods, as well as influencing other key household members through mosques, schools, and health care providers.     

食物特异性IgG抗体检测在儿童慢性腹泻中的应用价值

目的：儿童慢性腹泻病因复杂,难以明确病因,常给治疗带来很大困难,目前认为食物过敏可能是儿童慢性腹泻的重要病因,特别是IgG介导的迟发型变态反应起主要作用。该文就食物特异性IgG与儿童慢性腹泻的相关性进行分析研究,探讨食物特异性IgG检测对儿童慢性腹泻病因诊断和治疗的价值。方法：采用ELISA法,检测患儿血清中食物特异性IgG抗体浓度,根据IgG浓度分为4级：0级,+1级,+2级,+3级。其中 0级采取“安全进食”, +1级采取“轮替”进食,+2级、+3级采取“忌食”的健康饮食指导,并观察患儿腹泻症状改善情况。结果：82例慢性腹泻患儿中,79例有1~11种不等的食物特异性IgG升高,阳性率96.2%,而对照组阳性率仅为26.7%,慢性腹泻组中对2~5种食物过敏的比例最高占58.5%。其中对牛奶、蛋清/黄敏感性最高,分别为68.3%、62.2%,而针对鸡肉和猪肉的特异性IgG升高者较少,分别为2.4%和0%。79.3%病人经过健康饮食指导治疗后疗效显著。17例（20.7%）病人症状在3个月内无明显缓解,其中5例大便培养有细菌感染,6例家属或患儿未严格执行健康饮食指导,6例原因不明。结论：食物过敏是引起儿童慢性腹泻的重要原因,根据食物特异性IgG抗体检测结果对患儿进行健康饮食指导是治疗儿童过敏性慢性腹泻的最好方法。     

Early solid food diet and eczema in childhood: a 10-year longitudinal study

The relationship between early solid feeding in the first four months and risks of eczema in childhood was examined in a birth cohort of 1265 children studied to the age of 10 years. The major findings of this analysis were: 1) children exposed to a diverse solid food diet during their first four months had risks of eczema in early childhood which were about 1.6 times those of children who were not introduced to solid food by age four months. These associations persisted when a range of confounding factors (including family history of atopic disease, infant milk diet (breast/bottle) and family social background factors) were taken into account. 2) Similar associations between early infant diet and risks of chronic and recurrent eczema up to the age of ten years were also found. It was estimated that after adjustment for confounding factors, children exposed to an early diverse solid food diet had risks of eczema which were over 2.5 times those of children not introduced to solid feeding. These results are generally consistent with the hypothesis that early exposure to a diverse solid food diet may increase risks of eczema in children who are susceptible to this condition.     

Maternal pre‐pregnancy body mass index is not associated with infant and young child feeding in low‐income Mexican children 1–24 months old

Pre‐pregnancy overweight and obesity is associated with shorter breastfeeding (BF) duration. Whether pre‐pregnancy overweight and obesity is associated with other aspects of infant and young child feeding (IYCF) has not been investigated. We used data from 370 children born January 1999–September 2001 in a semi‐urban community in Morelos, Mexico, where information on how they were fed was available at 1, 3, 6, 9, 12, 18 and 24 months of age. We modified the World Health Organization's dietary diversity indicator to assess the quality of the complementary foods. An index that included BF, quality of complementary foods and other behaviours was constructed to measure IYCF. We used survival analysis to examine the association of pre‐pregnancy body mass index (pBMI) category and BF duration and mixed models for quality of complementary food and IYCF index. Mean maternal pBMI was 24.4 ± 4.1; 31% were overweight, and 9% were obese. pBMI was not associated with BF duration. Quality of complementary food improved over time (6 months, 1.3 ± 1.3; 24 months, 3.8 ± 1.04). Compared with normal‐weight women, overweight and obese women were more likely to feed from more food groups (0.24 ± 0.11 point, P = 0.03), but this did not improve diet diversity from 6 to 24 months. IYCF index decreased throughout follow‐up (1 month, 7.8 ± 2.4; 24 months, 5.5 ± 1.8), and pBMI was not associated with IYCF (?0.11 ± 0.13 point, P = 0.4). We conclude that heavier women were not engaging in IYCF behaviours that were distinct from those of normal‐weight women from 1 to 24 months post‐partum.     

Concerns and expectations of parents with atopic infants

The incidence of atopic diseases has rapidly increased in developed countries. The purpose of this study was to describe the problems that parents experience when atopic disease occurs in their children at an early age and what parents expect and get from health care professionals in the management of these problems. The parents of 81 high‐risk atopic infants completed a questionnaire during the infant's first attendance at the Tampere University Hospital, Finland. The patients were treated by an intervention team comprising a pediatric nurse and two pediatricians consulting with dietician and a dermatologist to detect the infant's specific food allergies and to introduce and advise on appropriate diets at weaning. After a 9‐month intervention period, the parents' perception of the intervention was evaluated by a second questionnaire. The skin prick test was positive to cow's milk in 30%, to egg in 26%, and to cereals in 19% of infants during breast‐feeding. Double‐blind placebo‐controlled cow's milk challenge was positive in 56% of infants. Upon introduction of a tolerated weaning diet, subjective symptoms and the extent and intensity of atopic eczema diminished as evidenced by lowered SCORAD scores, from 19.3 to 8.2 (F = 57.6, p < 0.0001; SCORAD – scoring index combining extent, severity and subjective symptoms of atopic eczema). Ninety per cent of parents found the care of an atopic infant more demanding than that of a healthy child. This was because of the persistence of symptoms, such as atopic eczema and pruritus, and restlessness during sleep. For the management of these problems the parents advocated diagnostic evaluation and elimination of specific foods from the diet of the lactating mother. They expected from the intervention accurate diagnosis of food allergies, practical advice on elimination diets, alleviation of symptoms, and follow‐up of growth and nutrition, and they considered the care provided by the intervention team to suffice in these aims. The present data support a comprehensive team approach to the care of atopic infants and their parents.     

Nausea and vomiting in early pregnancy: Effects on food intake and diet quality

Experiences of nausea and/or vomiting in pregnancy (NVP) vary greatly, but the paucity of studies with pre‐pregnancy dietary data mean that little is known about the effects of NVP on diet. Using an administered food frequency questionnaire, diet was assessed before pregnancy and at 11 and 34 weeks' gestation in 2270 participants in a UK birth cohort study (Southampton Women's Survey). Experience of NVP in early pregnancy was graded as none, mild, moderate, or severe. Participants reported their level of food consumption as more, the same, or less than before pregnancy. “Prudent” diet scores (derived using principal component analysis) were used to describe participants' diet quality before, in early and late pregnancy. In early pregnancy, 89% of women were nauseous, although most commonly, the NVP experienced was mild (48%) or moderate (30%); 11% had severe NVP. A total of 39% of women reported an increase in their level of food intake in early pregnancy; 34% reported a reduction. Increasing severity of nausea was associated with changes in intake of a range of foods, most notably reduced consumption of vegetables, tea/coffee, rice/pasta, breakfast cereals, beans/pulses and citrus fruits/fruit juices and increased consumption of white bread, and soft drinks. Increasing severity of nausea was also associated with decreasing prudent diet score from before to early pregnancy, such that women with severe nausea had prudent diet scores 0.29 SDs lower than those with no nausea (P < 0.001). However, this was transient as NVP was not related to change in diet quality from before to late pregnancy.     

Egg allergy

Egg allergy is one of the most common food allergies in infants and young children. The great majority is not life-threatening and management involves exclusion of egg from the diet and regular review with the expectation that the majority of children will outgrow the allergy by school age. Judgment is required as to when the dietary elimination of egg is no longer required. This decision may be helped by demonstrating loss of sensitivity by skin prick or specific IgE testing and in some cases a supervised food challenge. Particular issues in management arise with more severe, potentially life-threatening reactions, with immunization with vaccines prepared in eggs, with the diagnosis of egg hypersensitivity as a cause of delayed exacerbations of eczema which can be non-IgE mediated, and in deciding whether a child can be allowed to ingest small amounts of cooked egg through egg-containing foods while continuing to avoid raw egg or larger amounts of whole egg. Cases which illustrate these issues are presented.     

Food choices made by low‐income households when feeding their pre‐school children: a qualitative study

The growing concern about poor dietary practices among low‐income families has led to a ‘victim blaming’ culture that excludes wider social and environmental factors, which influence household food choices. This small‐scale qualitative study investigated influences on the diets of young children in families on a low income in the West Midlands, UK. Using semi‐structured interview schedule, rich data was gathered through individual interviews with 11 mothers of pre‐school children. Information was collected about the type and range of food given following the introduction of solid foods including factors influencing parent's knowledge and diet, sources of nutrition advice and financial constraints. Food accessibility and storage issues were also explored. Interviews were audio‐recorded, transcribed and analysed using a modified grounded theory approach. Findings highlighted that parents and professionals may have different interpretations about ‘cooking from scratch’. The results indicated that some parents have poor understanding of what constitutes a healthy diet. However, most parents included fruit and vegetables to varying degrees and were motivated to give their children healthy foods, suggesting that, with adequate support and information, the diets of these children could be improved. There was evidence that when striving to improve the diet of their children, many parents' diets also improved. The findings from this small‐scale in‐depth study highlighted a number of issues for local and national policy and practice in the area of nutrition and child health in the early years.     

The effect of changes in dietary fat on the food group and nutrient intake of 4- to 10-year-old children

OBJECTIVE: To determine how young children changed their overall diet when they changed their fat intake after 3 months of participating in a nutrition education demonstration study designed to lower low-density lipoprotein cholesterol and cardiovascular risk. METHODS: Three 24-hour dietary recalls were collected from 303 4- to 10-year-old children at baseline and 3 months later. At both times, mean number of servings from food groups, grams of fat contributed from food groups, and intake of calories and nutrients were calculated and compared among quartiles of children formed according to change in their percent of calories from total fat after 3 months. RESULTS: Children who reduced their percent of calories from total fat most (ie, by an average of 8.5%) after 3 months consumed fewer servings from meats, eggs, dairy, fats/oils, and breads but tended to increase their number of servings from lower-fat foods within those food groups, particularly from dairy foods. These children also increased their mean intake of fruits, vegetables, and desserts, and maintained average intakes of all nutrients (except vitamin D) in excess of two thirds of the respective recommended dietary allowance. CONCLUSIONS: Young children who reduced their percent of calories from total fat in accordance with the current National Cholesterol Education Program recommendations accomplished this by reducing their overall intake of higher-fat foods, replacing higher-fat foods with lower-fat foods within several food groups, particularly within the dairy group (eg, drinking skim milk instead of whole milk) and by consuming more servings of fruits, vegetables, and very-low-fat desserts. These behaviors did not compromise their mean calorie or nutrient intakes, showing that it is possible for young children to lower their fat intake safely to reduce their risk of future heart disease.     

Child feeding in rural northern Ghana: Carer's perceptions of food and their children's diets

A child''s diet should be composed of appropriate nutrients to achieve optimal nutritional status, and though there is a substantial evidence base for child feeding recommendations, developing countries continue to face challenges regarding optimal child feeding. This paper describes an ethnographic study undertaken in rural northern Ghana to explore community perceptions of what ‘counts’ as food for children and the impact this had on the nutrients they received. Fifteen households with children under 5 years were purposively selected. In‐depth interviews were held with 25 mothers, 7 fathers and 8 grandparents within these households as well as 2 diviners. Participant observations were also undertaken. Findings show that satiety rather than nutrition was the key consideration in adult choices about a child''s diet. The community regarded carbohydrate‐based meals as food, but considered protein, vitamins and mineral‐based foods as nonessential elements of a child''s diet, and important sources of these nutrients were regarded as treats.     

Food allergy: the major cause of infantile colitis.

Forty six children presented with colitis between 1977 and 1981, and all 8 of those below the age of 2 years had food allergic colitis which resolved completely after exclusion of certain foods. In most of the 8 the onset was soon after starting foods other than breast milk. The most common offending food was cows'' milk protein, but soya (3 cases) and beef (1 case) were also implicated. A history of allergy in the child or family was common as were blood eosinophilia, high concentrations of serum IgE, and positive IgE antibodies. Colonoscopic appearances were distinctive and biopsies showed a noticeable increase in eosinophils and IgE-containing cells in the lamina propria. We suggest that food allergy is the major cause of colitis in infancy and that an exclusion diet is the treatment of choice.     

Poor dietary diversity and low nutrient density of the complementary diet for 6‐ to 24‐month‐old children in urban and rural KwaZulu‐Natal,South Africa

Infants and toddlers have high nutritional requirements relative to body size but consume small amounts of food and therefore need nutrient‐dense complementary foods. A cross‐sectional study included children aged 6–24 months, stratified in three age categories (6–11 months, 12–17 months and 18–24 months) and randomly selected from an urban (n = 158) and a rural (n = 158) area, both of low socio‐economic status, in the KwaZulu‐Natal Province of South Africa. Dietary diversity and nutrient density of the complementary diet (excluding breast milk and formula milk) based on a repeated 24‐h dietary recall was assessed. For breastfeeding children, nutrient density of the complementary diet was adequate for protein, vitamin A and vitamin C; and inadequate for 100% of children for zinc, for >80% of children for calcium, iron and niacin; and between 60% and 80% of children for vitamin B6 and riboflavin. Urban/rural differences in density for animal and plant protein, cholesterol and fibre occurred in 18–24‐month‐old children. Fewer than 25% of children consumed ≥4 food groups, with no urban/rural differences. Higher dietary diversity was associated with higher nutrient density for protein and several of the micronutrients including calcium, iron and zinc. The poor nutrient density for key micronutrients can probably be ascribed to lack of dietary variety, and little impact of mandatory fortification of maize meal/wheat flour on infants/toddlers' diet. Targeted strategies are needed to enable mothers to feed their children a more varied diet.     

Food-based recommendations to reduce fat intake: an evidence-based approach to the development of a family-focused child weight management programme

OBJECTIVES: To develop food-based recommendations to lower fat and energy intake for use in a family-focussed weight management programme for 6-9 year old children. METHODS: Secondary analysis of the 1995 National Nutrition Survey (NNS95) informed the development of food-based recommendations aiming to reduce fat and energy intake. Each recommendation was used to progressively modify a model 3-day high fat dietary intake with the accumulative effect on energy and nutrient intake of each recommendation assessed. RESULTS: Six to nine-year-olds in the NNS95 consuming 35-45% energy as fat (n= 280) consumed more total energy (mean +/- SD, 8671 +/- 2741 vs. 7571 +/- 2328 kJ/day) than children consuming a 'low fat' (23-27% energy as fat, n= 85) diet (P < 0.002). Food-based recommendations found to be most effective for reducing energy and fat intake included; changing to reduced fat milk, reducing intake of cereal-based and snack foods and replacing juice or soft drink with water. These changes, together with avoiding adding fat to vegetables and using sources of lean meat, reduced energy intake by approximately 10%, total fat intake by approximately 30% and saturated fat intake by 53%. CONCLUSIONS: Modifying six areas of food choices results in a moderate reduction in fat and energy intake. An eating pattern that is consistent with Australian dietary guidelines and uses foods commonly eaten by children is achievable for children aged 6-9 years. These food-based recommendations provide an evidence-based dietary framework for prevention and management of overweight in children.     

Nutritional content of few foods diet in atopic dermatitis.

The nutritional content of a few foods diet, supplemented with a casein hydrolysate formula (n = 24) or a whey hydrolysate formula (n = 21), was studied in 45 children with atopic dermatitis. The six day weighed food inventory record method was used to estimate the mean daily intake of energy, protein, calcium, iron, zinc, folate, and vitamin C on normal diet and on the few foods diet. The diet was associated with a significant reduction in protein and calcium intake in both groups, and in energy intake in the casein hydrolysate group. The median daily volume of hydrolysate milk taken was 10.5 ml/day (range 0-840 ml/day) for the casein hydrolysate group and 267 ml/day (range 0-1300 ml/day) for the whey hydrolysate group. Whey hydrolysate appears to be more palatable than casein hydrolysate, which is a potential advantage in the maintenance of an adequate intake in children on a few foods diet.