What to feed a baby with fpies

FPIES Tips - Feeding Made Easy

By Krystyn Parks, MS, RD, IBCLC / Last Updated On: January 2, 2023 / 4 minutes of reading

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If your child has recently been diagnosed with FPIES, you may find yourself overwhelmed and confused. Most parents have never heard of FPIES before they are given the diagnosis. You are probably wondering what you should do now. Here is some information to get you started.

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What is FPIES?

Food Protein Induced Enterocolitis Syndrome (FPIES for short) is a rare form of food allergy. Unlike traditional food allergies, FPIES will not show up on a normal allergy panel. It affects the immune system in a different way. Traditional food allergies create what we call an IgE mediated response which is what those tests are looking for. FPIES is considered a non-IgE mediated reaction. (Looking for more information on introducing the top 9 allergens? Check out this handbook).

How common is it?

The incidence and prevalence is unknown, but in the US it is estimated to be about 0.28% (1). It is most common in infants and young children. It is less common in infants who are exclusively breastfed.

Is it hereditary?

The exact cause of FPIES is still unknown. Currently, we do not think there is a genetic factor, however there is a family history of allergy in 40-80% of cases (2).

What does a reaction look like?

FPIES affects the gastrointestinal system and causes diarrhea and vomiting. What makes it different from other food allergies is that there is a delayed response of 2-6 hours (3). This can make it tricky to figure out food triggers, since there is not an immediate response. If left untreated, the vomiting and diarrhea can lead to dehydration and shock, sometimes requiring hospitalization.

Additional symptoms include appearing pale, lethargy, abdominal distension, and appearing blue due to low levels of oxygen in the blood. In children who go undiagnosed and have multiple episodes of vomiting and/or diarrhea, you may also see weight loss or failure to grow at expected rates.

How do you diagnose FPIES?

There is no simple test for diagnosis. Generally diagnosis depends on reported history and symptoms (3). In some cases, doctors may do an oral food challenge in a controlled setting, but often this isn’t necessary. Because FPIES is rare and the symptoms are quite common, often the diagnosis is delayed. Many children are only diagnosed after ending up in the emergency room due to dehydration.

Is there any treatment for FPIES?

The only treatment is strict avoidance of food triggers. If a child ingests an allergen, they may require hydration at a hospital. The good news is that children usually outgrow this allergy, usually by age 3 or 4.

Young infants may need to be exclusively breastfed or offered a hypoallergenic formula, similar to ones offered to babies with milk protein allergy,

Common Food Triggers

Please note that any food can be a trigger. Some children will react to 1-2 foods, others may react to many. Every case is very individualized. Milk and soy are the most common FPIES triggers.

Milk
Soy
Rice
Oats
Other Grains

FPIES Food Introduction

It can be very helpful to keep a food/symptom log as you are introducing new foods, especially since the reactions are delayed. You can continue to offer foods that you know your child tolerates while offering new foods. Continue to avoid any foods that your child hasn’t tolerated (even if they are on the list below). Introduce 1 food at a time every 5-7 days. Monitor for tolerance before adding a new food. Once you know that your child can tolerate that food, you can move onto the next.

Lower Risk Foods:

Vegetables: broccoli, cauliflower, parsnip, pumpkin, turnip
Fruits: avocado, blueberries, peach, plum, strawberries, watermelon
Grains: quinoa cereal, miller (look for iron-fortified when available)
Proteins: lamb, tree nut butter and seed butters (sunflower/pumpkin)
Fats: avocado oil

Moderate Risk Foods:

Vegetables: carrot, chard, green bean, spinach, squash, white potato
Fruits: apple, orange, pear
Grains: barley cereal, corn cereal, grits, wheat (look for iron-fortified when available)
Protein: beef, peanuts and other legumes
Fats: canola oil, coconut oil, olive oil

Higher Risk Foods:

Vegetables: green pea, sweet potato
Fruits: banana
Grains: buckwheat, rice, oat (look for iron-fortified when available)
Protein: poultry, fish

Just because something is on the higher risk food list doesn’t mean that your child will react to it (just as a food on the lower risk doesn’t necessarily mean it’s safe).

Krystyn Parks, MS, RD, IBCLC

Krystyn Parks is a Registered Dietitian and Lactation Consultant who specializes in feeding children. She has a Master’s Degree in Nutritional Science from California State University Long Beach. She is an International Board Certified Lactation Consultant and has been registered with the Commission on Dietetic Registration since 2013.

Meeting Nutrition Needs for Children with FPIES

Bill: 16 RS SB 193/GA

> Weblink: https://apps.legislature.ky.gov/LRCSiteSessionSearch/dtSearch/
> Mandates that health benefit plans with prescription drug coverage provide coverage for amino acid-based elemental formulas for insureds with a medical diagnosis of an eosinophilic disorder. Further, mandates that insurance policies for state employees and their dependents provide coverage for amino acid-based formulas for insureds with eosinophilic disorders. In addition, the bill requires that the state provide payment for amino acid-based formulas where the affected person has a medical diagnosis of an eosinophilic disorder and does not have coverage under any public or private health benefit plan for amino acid-based formulas.

Pertinent Language of Bill 16 RS SB 193/GA:
Section 1. KRS 205.560 is amended to read as follows:
The scope of medical care for which the Cabinet for Health and Family Services undertakes to pay shall be designated and limited by regulations promulgated by the cabinet, pursuant to the provisions in this section. . . . . The selection of another class or other classes of medical care shall be recommended by the council to the secretary for health and family services after taking into consideration, among other things, the amount of federal and state funds available, the most essential needs of recipients, and the meeting of such need on a basis insuring the greatest amount of medical care as defined in KRS 205.510 consonant with the funds available, including but not limited to the following categories, except where the aid is for the purpose of obtaining an abortion:

(c) Drugs, nursing care, medical supplies, and services during the time when a recipient is not in a hospital but is under treatment and on the prescription of a physician, dentist, or podiatrist. For purposes of this paragraph, drugs shall include products for the treatment of inborn errors of metabolism or genetic, gastrointestinal, and food allergic conditions, consisting of therapeutic food, formulas, supplements, amino acid-based elemental formula, or low-protein modified food products that are medically indicated for therapeutic treatment and are administered under the direction of a physician, and include but are not limited to the following conditions:

24. Food protein allergies;
25. Food protein-induced enterocolitis syndrome;
26. Eosinophilic disorders; and
27. Short-bowel syndrome;

Section 2. KRS 213.141 is amended to read as follows:
The cabinet shall prescribe by administrative regulation pursuant to KRS Chapter 13A a fee not to exceed ten dollars ($10) to be paid for a certified copy of a record of a birth:

(b) One dollar ($1) of which shall be used by the Division of Maternal and Child Health to pay for therapeutic food, formulas, supplements, amino acid-based elemental formula, or low-protein modified foods for all inborn errors of metabolism and genetic conditions if:

1. The therapeutic food, formulas, supplements, amino acid-based elemental formula, or low-protein modified food products are medically indicated for the therapeutic treatment of inborn errors of metabolism or genetic conditions and are administered under the direction of a physician; and

2. The affected person’s therapeutic food, formulas, supplements, amino acid-based elemental formula, or low-protein foods are not covered under any public or private health benefit plan.

Section 3. KRS 304.17A-258 is amended to read as follows:
(1) For purposes of this section:

(a) “Therapeutic food, formulas, and supplements” means products intended for the dietary treatment of inborn errors of metabolism or genetic conditions, including eosinophilic disorders, food protein allergies, food protein-induced enterocolitis syndrome, and short bowel disorders, under the direction of a physician and includes amino acid-based elemental formula; [and]

(b) “Low-protein modified food” means a product formulated to have less than one (1) gram of protein per serving and intended for the dietary treatment of inborn errors of metabolism or genetic conditions under the direction of a physician; and

(c) “Amino acid-based elemental formula” means a product intended for the diagnosis and dietary treatment of eosinophilic disorders, food protein allergies, food protein-induced enterocolitis, and short-bowel syndrome under the direction of a physician.

(2) A health benefit plan that provides prescription drug coverage shall include in that coverage therapeutic food, formulas, supplements, and low-protein modified food products for the treatment of inborn errors of metabolism or genetic conditions if the therapeutic food, formulas, supplements, and low-protein modified food products are obtained for the therapeutic treatment of inborn errors of metabolism or genetic conditions under the direction of a physician. Coverage under this subsection may be subject, for each plan year, to a cap of twenty-five thousand dollars ($25,000) for therapeutic food, formulas, and supplements and a separate cap for each plan year of four thousand dollars ($4,000) on low-protein modified foods. Each cap shall be subject to annual inflation adjustments based on the consumer price index.

Section 4. KRS 18A.225 is amended as follows:
(16) Any policy provided to state employees or their dependents pursuant to this section shall provide coverage for obtaining amino acid-based elemental formula pursuant to Section 3 of this Act.

The diet of a one-year-old child / What and how to feed a baby - an article from the "What to feed" section on Food.ru

Principles of nutrition for a child per year

If a child has 6-8 teeth per year, and he looks with interest into the plates of his parents , this does not mean that it is time for him to change to a common table. At the very least, the diet of a one-year-old child should be very different from that of an adult.

Adult food is often unbalanced, prepared in an unsuitable way for a baby, contains a lot of sugar, salt and spices. Such food harms the growing organism. Therefore, first of all, build the right diet.

It is recommended to eat 3-4 times a day for 300-400 g plus 1-2 snacks between feedings.
From the first year of life, the baby can chew solid food.
If lactation continues, breastfeed until 2 years of age.
Avoid fast food and sugary sodas.

A one-year-old's diet might look like this:

8:00 - breakfast.
12:00 - lunch.
16:00 - afternoon tea.
19:00 - dinner.
21:00 - snack.

Advice

600 ml is the recommended amount of milk for a baby to drink daily.

If breastfeeding, feed your baby after waking up, in the afternoon after dinner, or before bed. You need to feed at the same time with a delay of 15-20 minutes.

Proper nutrition helps to form reflexes, which improves the absorption of nutrients in the body.

How much should a one year old child eat

A baby's diet should include 1000-1400 kcal per day. The calculation is as follows: multiply the weight of the child by 100 kcal.

The calorie content is distributed as follows:

Breakfast - 250 kcal;
lunch - 350 kcal;
afternoon tea - 200 kcal;
dinner - 200 kcal.

Healthy food contains enough vitamins, minerals and nutrients: proteins, carbohydrates and fats. It is necessary to include fatty foods in the child's diet: milk, butter, sour cream, cream. Fatty food promotes the absorption of trace elements in the body.

Interesting fact

10% of one-year-old children in Russia are overweight. They are not properly fed, they are allowed to eat fast food and drink soda. Obesity at an early age leads to vascular disease, heart disease, diabetes, mental disorders and other serious disorders.

Child's menu per year

Balanced menu includes specialty meals designed to meet the needs of children, plus "adult" foods: meat, fish, eggs, dairy products, fruits, vegetables, cereals, bread, pastries and legumes.

It is good to eat milk porridge for breakfast. It is a rich source of vitamins, minerals and fiber. Fiber is good for intestinal microflora: it regulates the balance of beneficial and harmful bacteria.

Meat is a source of animal protein, indispensable for a growing organism. WHO recommends that children eat 60–70 g of meat per day. It can be served as steam cutlets, meatballs in soup, or any other attractive form. Offal and meat products are harmful to a one-year-old child.

It is also desirable to gradually expand the vegetable menu. Vegetables contain many vitamins, minerals, trace elements and organic acids that are beneficial to the body. Gradually introduce boiled carrots, cabbage, zucchini, turnips, beets into the baby's diet.

Legumes are a source of vegetable proteins. Beans, lentils, green peas diversify the baby's diet. They contain useful trace elements, vitamins, as well as coarse fiber. Therefore, legumes need to be boiled and chopped in a blender. Beans should not be eaten too often either, as they cause bloating and, in rare cases, diarrhea.

Fruit diet improves immunity, especially in winter when the body is weakened. Fruit goes well with cereals or served as smoothies and juices.

Sugar and salt lead to nutritional imbalances, cardiovascular problems and obesity. Avoid cakes, pastries, chocolate bars and other sweets. Replace sugar with fructose, which is abundant in fruits, or honey.

What to drink? Water, lots of water. It is advisable to make sure that the child has drunk a glass of liquid after eating. He himself will not ask, because he still does not know how. When a one-year-old child is thirsty, he begins to act up. Sweet soda should be excluded from the diet of the baby.

What foods should not be given to a one-year-old child

Approach the baby's menu carefully. Do not rush to transplant him to an adult table. Among the forbidden foods for a one-year-old child:

Fried foods, including chips, snacks and fast food.
Meats and offal such as sausages and sausages, other than liver, heart and tongue.
Curds, ice cream, condensed milk, koumiss.
Mushrooms.
Products containing colorants and flavors.
Cream confectionery containing vegetable protein.
Carbonated drinks.
Concentrates like Doshirak.
Caramel and gum.
Pickled vegetables and fruits.
Spices and condiments, including ketchup, mayonnaise and other sauces.
Smoked products.

Advice

Buy food from stores labeled "Baby Food". The label often says for what age this product is intended. There are no additives, GMOs, artificially grown products and other things in baby food. Read the contents of the label carefully. Often unscrupulous manufacturers use false labels for marketing purposes.

What to do if the child does not want to eat

It is difficult to persuade children to try unusual food. There are four ways to deal with this problem:

Lead by example before introducing new foods. When he sees that adults eat with appetite, he involuntarily wants to try it. But remember that the baby gets used to a new food only from the tenth time.
Try one new product at a time. A child needs time to get used to it. New food should be combined with what is already loved.
Don't force your child to eat something they don't like. Let him choose what he wants.
Food should be as simple and familiar as possible. Children do not like dishes with many obscure ingredients like casseroles.

Tip

Babies eat better when they are relaxed. Work up an appetite during a walk or after a game. Never teach children to watch TV or smartphones while eating. Eating should be extremely calm.

Benefits of pre-mixed formula

Don't be afraid to switch babies to formula instead of breastfeeding. They benefit the baby's body, unlike, say, goat's milk. Goat's or cow's milk is too low in nutrients and high in protein. Its digestion increases the load on the gastrointestinal tract of the child and leads to obesity.

Three advantages of mixtures:

Contains polyunsaturated fatty acids that are beneficial for the baby's body.
Rich in probiotics and prebiotics, live bacteria that maintain normal intestinal microflora.
Give your child the necessary balanced intake of vitamins and minerals.

Tip

Formula will not replace breast milk.

What can be done?

Set a clear power mode. Make a menu for every day: breakfast, lunch, afternoon tea, dinner, snack. Write down the products and their quantity. The children's menu should be varied and balanced, contain sufficient nutrients, minerals and vitamins. Introduce new foods gradually and do not force the child to eat something that he does not want in a year.

How to feed a child on vacation: advice from a pediatrician

Summer is in full swing and the long-awaited vacation is just around the corner. Ahead of the sea, the sun, a variety of delicious food and unforgettable days full of new experiences. Many parents are no longer afraid to travel with children and go on vacation even with babies, because now almost all hotels provide excellent conditions for relaxing with a child of any age, and young travelers can be found at almost every step. But to feed a child on a trip so that it is tasty, healthy, varied, and most importantly, safe is not an easy task. Any, even the best and most desired vacation, can be overshadowed by poor health, digestive problems and even food poisoning. To avoid this, it is important to properly organize the food of a small traveler on vacation. And it's not as difficult as it might seem at first glance.

Today we will talk about how to feed your baby so that your vacation is not spoiled by health troubles. What to take with you on the road? Is everyone's favorite buffet dangerous for kids? What to feed the youngest adventurers? The pediatrician, gastroenterologist of the SMITRA Clinic, Maria Nikolaevna Karasenko, will tell us about all this and not only.

Let's hit the road

It doesn't matter what you travel on - by plane, car or train - you need to think about the nutrition of the child in advance. If the baby is breastfed, of course, there is no need to worry, because food is always with you. The only thing that a nursing mother should not forget about is that any changes in her diet can affect the well-being of the baby. Therefore, it is necessary to maintain the usual diet, not to use unfamiliar and allergenic foods.

If your baby is bottle-fed, be sure to bring baby water that does not need to be boiled, sterile bottles and regular formula. You can heat water to the desired temperature in a cup of hot water both on the plane and on the train.

If your baby is already receiving complementary foods, take well-tested jars of vegetable, fruit and meat purees, preferably in soft packs, and don't forget enough baby water.

Do not introduce the first complementary foods or new foods into your baby's diet before or right on vacation. Also, formula-fed babies do not need to introduce new formulas during or before a trip.

For a snack, older children can take fruits, nuts (for kids over 4 years old), vegetable sticks, bread or crackers, a boiled egg, dryers, dry cookies (like a biscuit), sweets - candy without sugar. If there is a cooler bag in the car (the conductors also have it on trains), then take boiled meat (not sausage!), Boiled buckwheat or pasta for the first time.

On vacation

Before the trip, we advise you to prepare and study the infrastructure of the place where you plan to relax. This can be done using applications of popular mapping services. Open the maps and see which stores are located near your intended place of stay. Then go to the website of these stores and study the assortment: which of the usual products you can buy on the spot, and which you will have to bring with you. After all, in some countries in stores there may not be not only the usual, but also more or less suitable products for feeding your child.

If the baby is bottle-fed, it is better to take the usual formula with you in an amount greater than necessary for the days of the trip. The same goes for complementary foods. It is better to take proven jars of vegetable, fruit and meat puree with you. Of course, the luggage will become heavier, but the health of the baby will certainly be safe.

Further recommendations depend on whether you are staying in a private apartment with a kitchen or in an all-inclusive hotel.

If you prefer to cook on your own on vacation, then be as careful as possible when buying products - vegetables, fruits, dairy products, meat. Buy products in the market only from sellers who have a quality certificate. The smallest travelers may need a mini blender to prepare their meals. With older kids it's easier - chicken, potatoes and carrots are sold in any country in the world. To prepare healthy steamed dishes, you can take a steamer insert into the pot with you. This very inexpensive and compact gadget will help you prepare the most healthy and delicious dishes at no extra cost. For example, fresh fish bought on the seashore, in just 20 minutes of steaming, will turn into a full-fledged, healthy and very tasty lunch or dinner.

Everyone's favorite buffet is certainly convenient and very tasty, but not always suitable for children's food. Firstly, an unlimited amount of food threatens with overeating and, accordingly, problems with digestion. Secondly, buffet tables, as a rule, have a lot of tasty, so loved by children, but unhealthy food - fast food, sweets, carbonated drinks. Therefore, it is necessary to agree with older kids that french fries are not a permanent dish on your table, but a rare treat, the same goes for soda and confectionery. Often there are dietary products on the buffet - omelettes, cereals, steam dishes, bread, cheese, boiled eggs, freshly squeezed juices, etc. For a young traveler, this is the best food option. Such a diet will help the baby to be full, active and not experience digestive problems.

After a hearty meal, do not eat watermelon and melon “on top”, this threatens with serious indigestion. It is better to leave these products for a snack as a separate dish, and then they will only benefit.

If you eat in restaurants, order dishes for children in the most gentle processing - steamed, boiled, baked, but not fried. Don't forget about allergies! If the child has a reaction to some foods, ask them not to add them to the dish.

Give any new foods (exotic fruits or seafood) even to grown-up children gradually, "little by little" and carefully monitor the reaction.

The main thing in any trip and in any country is hygiene. Wash your hands often, do not drink tap water, use only bottled water for drinking and eating!

Visiting grandma

And what if your grown-up child went to rest not to the sea coast, but to his beloved grandmother in the village? Is it necessary to take care of his nutrition in this case? Of course you do. Grandmothers are so fond of pampering their long-awaited, beloved grandchildren, so they can not limit their use of sweets, fast food or the same soda. Such food can hardly be called healthy, so it is necessary to agree on the amount and frequency of eating junk food. Ask your grandmother not to feed the child with sweets from the store, but to offer more berries, fruits, or homemade cakes, where the amount of sugar can be adjusted independently.

Also, in order to avoid problems with digestion, ask your grandmother not to fry fatty pancakes and pancakes too often, especially in combination with fatty homemade sour cream (it can be used in the same way as butter).

If you plan to eat homemade milk, ask your grandmother to boil it (minimum 2 minutes). Homemade unboiled milk can cause serious infectious diseases, up to tick-borne encephalitis, if a cow or goat has been bitten by an infected tick.

Self-grown berries, fruits and herbs are a storehouse of vitamins and microelements. But do not forget about hygienic treatment - before eating, we wash all fruits and berries well with running water (especially strawberries, which are often heavily soiled and can cause a serious infection).