boy eating ice cream
Photo by Jared Sluyter

Nutrition Services Coordinator, Anne Arundel Medical Center
A Little Bit CAN Hurt  Book Excerpt



Q: How does a food-allergic family know if they need to consult a dietitian? How should they prepare for the first appointment and what should they expect during that visit?

A: Often families are referred to the RD by their physician or healthcare provider. In some cases families realize the help of a professional will take the food issue/battle out of the parent-child arena and put it in the lap of the nutritionist.

I ask families to keep a detailed food log of three to five days before they come to see me. It gives us a place to start the dialog. It gives me a quick snapshot of the family’s fueling patterns including foods that the child likes and doesn’t like, and it helps me ask the right questions to drill down to obtain specific information.  This is where I start regardless of why I’m seeing somebody.

So to prepare for the first appointment, for three to five days write down everything that you eat and drink so we can take a look at that, the time pattern and the amount of food/beverages. Be sure to include exercise! The simple act of logging food/beverage brings an awareness of intake that is impossible to obtain without this focus.

I use a computer program to analyze seven to nine days of food logs. This enables me to pinpoint nutritional issues and set realistic goals. For example, I can see in black and white what percentage of calcium the child is getting. The computer program helps me determine not just whether the growing child is getting enough protein, fat and carbohydrates but also whether he or she is taking in sufficient minerals and vitamins.


Q: How may a food-allergic family or individual find a reputable dietitian if their family doctor or allergist is unable to provide a recommendation or referral?

A: The Academy of Nutrition and Dietetics is the best place to find a reputable dietitian. The web site,, has a link called “Find a Dietitian”. You put in your zip code and obtain a list of RDs in your area. The list will include contact information and the RD’s area of expertise.


Q: Nutritional deficiency is among the top concerns of parents of food- allergic children. Regarding each of the most common food allergies in children (milk, egg, peanut, tree nut, fish, shellfish, soy, wheat), what specific nutritional deficiencies pose a threat to good health? What substitutions or supplementations can be made to help provide adequate nutrition?

A: Managing one food allergy is much easier for children than having to manage multiple food allergies. That’s where a dietitian can help families map out a plan. In some cases, families living with food allergies do a better job of meeting nutritional needs because they must be great at reading food labels and planning for meals and snacks.


milk pouring into glass

One of the most common allergenic foods for children is milk. During peak growing years, milk provides a good source of many nutrients needed for bone mineralization and growth. These nutrients include protein, calcium, vitamin D, vitamin A, vitamin B12, riboflavin and phosphorus. Selecting food substitutes to meet these nutrient needs is vital. Protein needs can easily be met with meat, poultry, fish, nuts and legumes. However, in order to obtain calcium, children need to eat a ton of non-dairy food sources of the nutrient and most can’t meet the need. Parents need to read food labels to seek out calcium-fortified foods. Fortified juices can help with additional calcium but are not a good source of other nutrients. In some cases, supplements may be needed. In young children drinking milk-free formulas, this concern isn’t an issue. Fortified soy, rice, grain (oat) and nut (almond) milks can also be considered but need to be fortified with additional nutrients.


Egg-allergic children must avoid whole egg in all forms. Eggs provide a source of quality protein. Eggs also offer iron, biotin, folacin, riboflavin, selenium and vitamins A, D, E and B12. Children generally get enough protein from other food sources. Selenium and B12 are obtained from meat. Folacin can be found in legumes, leafy green vegetables and fruits. If the child is eating a wide variety of non-egg foods, the egg-free diet should not place a child at nutritional risk.



Soybeans do provide high quality protein in our diets. They contain thiamin, riboflavin, iron, phosphorus, magnesium calcium, zinc and vitamin B6. Restricting soy in a child’s diet will not result in nutritional risk because these nutrients can be obtained through other food sources. The real issue for families is avoiding soy products because they are found in so many of our processed foods.


assortment of baked bread

Wheat is the grain that has been most reported to trigger allergies. Grains contain protein and, as they are fortified, provide a great source of B vitamins and iron. Other grains such as corn, rice, barley, buckwheat and oats can be substituted, but you need to make sure they are from reputable sources and are fortified and enriched. A serving or two of an enriched fortified grain at each meal will help meet important nutrient needs for B vitamins, iron and folacin. Families incorporating a variety of grains enhance the meals for everyone in the family.


Assorted nuts

With regard to tree nuts and peanuts, the trace minerals, manganese, magnesium, chromium, copper and biotin are important but are easily obtained in a child’s diet from other food sources. Peanuts and tree nuts are also very rich in protein, but again, this nutrient is abundant in other food choices. Vitamin E and B6 are also easy to obtain in diets providing a variety of foods.


Uncooked fish and seafood,

If fish and shellfish must be avoided, you can find the same nutrients in other protein sources including meats, poultry, grains and legumes. In addition to protein, niacin, vitamins A and E, phosphorus, selenium, magnesium, zinc and iron are also found in fish and shellfish. These nutrient needs can easily be met by eating a well-balanced diet without fish or shellfish.




Nutrition Services Coordinator, Anne Arundel Medical Center


Text excerpt from:
A Little Bit Can Hurt: The Shocking Truth about Food Allergies — Why We Should Care,What We Can Do

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Food Allergies and Nutritional Deficiencies:  What You Need to Know

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