What should I feed my child with GERD?
High Fat Foods
Fried foods, potato chips and bologna are all examples of high fat foods. Foods high in fat may be difficult to digest and stay in the stomach too long causing an over production of acid. The typical American diet is full of fats and calories intended to make the food we eat more appealing. Be sure to read labels carefully and look for low fat alternatives. See box.
A word about Fast Food
While a typical fast food meal is known to offer an abundance of fat, calories, salt and sugar, it is hard to find an All-American kid who doesn’t want an occasional fast food meal.
Rebecca, age 9 loves getting a Kids Meal at Mc Donald’s or Burger King once in a while. She usually eats about ½ of the meal and discards the rest. It is too much food and she knows a full meal will make her sick. She even indulges in a soda, known to cause loud belching. After ½ of a serving of soda, she switches to juice or water. Love those self serve beverage dispensers! She feels like a normal kid and eats without stressing her sensitive stomach.
It may be important to avoid certain spicy foods for a while to see if symptoms improve. Some children may be able to tolerate a nibble here or there while others will need to strictly avoid certain foods/spices. It can be tricky to find substitutes for some foods, especially ethnic foods and holiday foods. Pizza, Mexican food and holiday favorites all taste delicious but can lead to pain and discomfort for a child with gerd.
Eating out can be a pleasure or a nightmare. Restaurant food tends to be high in fat with large portions and may harbor hidden ingredients that can cause discomfort. Many restaurants can modify their selections by omitting ingredients and sauces that may be difficult to digest. Some parents find it is easier to feed their child home and just eat one item or share from your plate at the restaurant.
On the other hand, eating out may offer a more relaxed atmosphere for an eating adventure. A careful eater may decide to try a new food and expand his/her repertoire of acceptable foods.
Hints for eating out
Avoid Spicy Foods
Choose Milder Food
Difficult to Digest Foods
A variety of fruits and vegetables may be difficult for your child to digest. It is likely that your child is a careful eater and already has made the decision to avoid some of these foods. Keep in mind that every child is different and you should not restrict a child from eating these foods if they are tolerated.
Easy to Digest Foods
So far we have discussed the abundant foods that should be avoided. So, is there anything left that is “safe’ to eat?
There are some foods that may be easier for your child to digest. Carbohydrates are burned more rapidly than proteins and high fat foods. This may explain why many of our gerdlings are carb junkies. Mashed potatoes, rice, bread, crackers and cereal. Gerdlings think these foods are delicious for any meal! Moms call this diet the White Diet or the Prison Diet. It has to be bland, white and available in massive quantities for every meal. While this diet may be deficient in nutrition, it is the ultimate comfort food diet. It just feels right for our kids. Some parents have found that adding a liquid nutritional supplement can provide the calories, protein and vitamins missing from the White Diet. Pediasure, Ensure, Peptamin Jr and Carnation Instant Breakfast are examples of nutritional supplements. Some parents also give their toddler or child a multivitamin to offset a poorly balanced diet.
Moira found that her daughter MacKenzie needed a nutritional beverage when she was a toddler. MacKenzie was too old for baby formula but hadn’t started eating or drinking enough to gain weight adequately. Moira gave her daughter 3 cans of Pediasure per day and let her explore table foods. She gradually decreased the number of cans of Pediasure per day as she was able to eat more food. Now at age 2 she is able to tolerate milk and eats a growing variety of table foods and her mom rarely uses the Pediasure anymore.
Clear liquids and foods are also easy to digest. Broth, soup and jello are well known examples.
Many children with GERD are intolerant to one or more foods. A food intolerance can cause pain, gas, belching, bloating and discomfort in the absence of a true allergic reaction (where there is a chemical change in the body ).
Lactose intolerance is a commonly known food intolerance. The digestive enzyme Lactose, found in cow’s milk cannot be broken down or digested by some people. A child or adult who doesn’t like milk or avoids dairy products may be lactose intolerant. It is important to keep in mind that lactose intolerance varies in severity from mild to severe so some dairy products may be tolerated. Kate, age 7 loves having a bowl of ice cream after school but wouldn’t dream of drinking a glass of milk. If she has two or more servings of dairy products per day, she tends to get bloated. Lactose intolerance and GERD are a common combination so a high level of suspicion is warranted when a child seems to avoid dairy products. Diagnosis is made by eliminating dairy products from the diet or taking a breath hydrogen lactose intolerance test. Treatment may include reducing or eliminating dairy products containing lactose from the diet or substituting lactose free milk or soymilk. There are also pills and liquid drops to break down the digestive enzyme available over the counter.
Other food intolerances include Wheat /Gluten Intolerance (Celiac Disease) and Fructose intolerance.
Sometimes a food just doesn’t seem to be tolerated and we cannot figure out why. Everyone has a food that they don’t enjoy eating. Remember George Bush and broccoli? While a food intolerance doesn’t cause a allergic reaction such as a rash, our bodies get a strong signal to avoid the food. Children with GERD seem to have a HUGE list of food they avoid or seem to be intolerant to. For some infants and children, all food gets washed in acid and is pretty unappealing. For others, their brains/stomachs just won’t accept the food.
Rebecca’s Peanut Story
By age 3, Rebecca already knew that she needed to avoid all nuts. If someone handed her a treat such as a piece of candy or a cookie, she always asked her mother if it contained nuts before she put it to her lips. At Halloween, she dumped her loot bag on the table and separated out all of the candy containing nuts before she would eat one piece. One year, she decided she couldn’t bear to give away all of the candy containing nuts. She kept it all and nibbled on a few pieced containing nuts. A day or two later, she presented the nut ladened candy to her mom and said in disgust, “Here, I don’t need this any more.” It became a family joke- There was Rebecca at the Easter Egg Hunt, only picking up candy that was nut free. Rebecca could never verbalize what it felt like when she ate nuts. However, her strict self-selection seemed to indicate that she felt some pain or discomfort.
Her mother became alarmed when Rebecca became hoarse and began wheezing after ingesting a pistachio nut. Rebecca was evaluated by a pediatric food allergy specialist and Rast Testing (blood test) and skin allergy testing were both negative for any kind of nut allergy. The physician shook his head in disbelief and said, I guess Rebecca REALLY doesn’t like nuts!” While there is no test for “peanut intolerance” and it is highly unusual, avoidance of this offending food from her diet has helped her digestion greatly.
Children who seem to avoid certain foods or food groups should be evaluated by a physician to rule out allergies. If it is determined that a child is intolerant to a food or food group, avoidance of the food may be necessary. A physician or nutritionist may be consulted to evaluate your child’s diet and determine “safe” foods to substitute.
Food allergies are defined as immune system reactions to foods. The most common food allergies include: dairy, wheat, soy, egg, nuts and fish.
Diagnosis is made by skin testing, a blood test an elimination diet or a combination. Symptoms of a food allergy may include nausea, vomiting, diarrhea, hives and breathing problems. Food allergies usually cause a quick reaction within a few minutes of ingesting a food. However, it may take a few days or weeks of abstinence from an allergy causing food for symptoms to abate completely. A child with a tree pollen allergy may have difficulty tolerating certain fruits (peaches, apples), berries (strawberries) and melons (cantaloupe, watermelon). Cooked fruits such as applesauce or peach pie may be tolerated and allow a child to continue eating fruit. Be sure to ask your doctor for clear instructions. Some children with food allergies need to have strict avoidance of foods without exceptions since some foods can cause life-threatening anaphylaxis.
There is growing evidence that food allergies have a genetic component. If one or both parents have a history of food allergies, their child may be affected too. There is also evidence that babies at risk for food allergies due to family history should not be exposed to certain foods too early. Some physicians advocate avoidance of peanuts and dairy products during the last trimester of pregnancy for at risk infants. Some newborns are given a dairy free, predigested formula from birth. Breastfeeding moms may need to avoid dairy, nuts, soy or other foods. Again, consult with a physician, nutritionist, or lactation specialist for advice.
Formulating a Plan
You may need to
It may be necessary to work with your child’s doctor to develop a plan to eliminate a food or food group
But My Child Only Wants Cheerios and Apple Juice!
Perhaps your child has decided that the best diet of all is the Elimination Diet-all foods are off limits except for Cheerios and Apple Juice! There are many reasons why a child restricts his/her diet and it will take some detective work to sort it out. Children with severe nutritional issues or food aversion may need a consultation with a feeding team or feeding clinic.
Here are some general ideas to consider:
Ages and Stages
There are different feeding issues from infancy to adolescence. Be sure to consider normal developmental stages for eating. While a child with a chronic illness such as GERD may exhibit delayed, divergent eating patterns, there may be some stages that are universal for all kids.
Same as children plus...
Feeding issues can seem enormous when you are in the middle of the day to day drudgery. It may seem like there is no hope for things to get better. An infant/toddler with overwhelming feeding issues will probably improve over time.
Rebecca’s mom kept a log of her intake for 2-3 days every other month. When she looked back on the entries, she realized that Rebecca has increased her intake of protein and fluids. It wasn’t a lot but it was progress.
When Rebecca was 2 years old, she ate 8-10 foods. Now at age 9, she eats a variety of foods, too numerous to mention. Her mother doesn’t need to carry a big purse anymore to transport Rebecca’s mobile kitchen nor does she play waitress at every meal. Eating is just a part of the day and not the central focus.
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