Read What to Expect the Toddler Years Online
Authors: Heidi Murkoff
What to Expect the Toddler Years (254 page)
It’s rare that a child is allergic to more than three foods, so be wary of such a diagnosis. Keep in mind that under-tongue, hair, urine, and skin titration tests have no scientific basis. Once the offending allergen (or allergens) is identified, it’s important to treat; untreated children are at increased risk for developing asthma. There are several approaches to treating the allergic child:
1. Abstinence/removal.
The most successful treatment and prevention for allergy, though also often the most difficult, is elimination of the offending allergen from the life of the allergic individual. If your child turns out to be allergic, here are some ways in which you can remove the offenders from his or her environment:
Food allergens. In infants and young children, the foods most likely to trigger an allergic response are egg whites and cow’s milk, followed by wheat and citrus. Many children are also allergic to soy and soy products and some to food additives, such as aspartame, BHA/BHT, certain dyes (Yellow No. 5, for example), monosodium glutamate (MSG), nitrates and nitrites, and sulfites. Fortunately, children are less often allergic to the foods with the greatest potential for triggering a severe response—peanuts, sesame, shellfish, and other fish.
Not every adverse reaction to a food is allergy. Some people have food “intolerances” or “idiosyncrasies,” reactions that don’t involve the immune system. If a food bothers your child, even if the response isn’t allergic, remove the food from your child’s diet.
LIFE-THREATENING ALLERGIES
Most allergy symptoms are just annoying: scratchy throat, runny nose, teary eyes, itchy bumps. But some allergic reactions—primarily anaphylactic responses to a specific food or drug or, rarely, to a bee sting—can be fatal. Serious reactions include any of the following groups of symptoms: wheezing, stridor (noisy breath ing, crowing), hoarseness, and difficulty breath ing; flushing of the skin, itching, hives along with swelling of the face, lips, and throat (which can interfere with breathing); vomiting, diarrhea (sometimes bloody), and abdominal cramps; a sudden drop in blood pressure, dizziness, light-headedness, fainting, loss of consciousness, and cardiopulmonary failure (anaphylactic shock).
Such reactions require immediate medical treatment.
If a child experiences even a single severe allergic reaction, consultation with a pediatric allergist is in order. Asthmatic children are more likely than other allergic children to experience a serious allergic response.
If, after consultation with the specialist, it’s determined that your child is at risk for a life-threatening allergic response, everyone who cares for your child should be alerted to the situation and know what measures are necessary to avoid any possible exposure to the potentially deadly allergen. It is also recommended that you have an epinephrine kit nearby and on hand at all times and that all of your toddler’s caregivers (including parents, babysitters, day-care workers, teachers) be well trained to recognize symptoms and use the kit properly. (Some state laws do not allow non-medical personnel to administer epinephrine; so be sure to discuss this with your child’s doctor so you can be prepared.)
Epinephrine, a hormone that counteracts anaphylaxis by raising blood pressure and opening air passages, can be life-saving. It comes in ready-to-use, easy-to-inject, pen-like instruments (Epi-Pen) and should be administered as soon as symptoms are noted, which could be anywhere from a few minutes to a few hours after an exposure. A visit to the doctor or emergency room should follow. Even if the initial reaction is very mild and the child seems to recover spontaneously, he or she should get medical attention and be observed for 24 hours; sometimes there is a secondary reaction that is much more serious than the first. Contact 911
immediately
if your child has a severe allergic reaction and you do not have epinephrine on hand.
A child with severe allergies should also wear a warning tag (such as a Medic-alert bracelet) that lists the allergy or allergies.
Since many allergens are “hidden” in processed foods (nut oil, milk proteins, and hydrolyzed vegetable protein from soy beans, for example), it’s necessary to become a relentless label reader; since formulations can change, be sure to check labels every time you buy a product. And, if your toddler is allergic to milk (see page 15), keep in mind that a label that reads “nondairy” or even “pareve” does not guarantee a totally milk-free product (such products can apparently be mislabeled). Ask about ingredients at restaurants and when visiting; be sure that anyone who cares for your child, at home or away, is completely informed about any food allergies. To prevent leaving gaps in your toddler’s diet, always use nutritionally equivalent substitutes. Substitute oat, rice, and barley flours for wheat; man-goes, cantaloupe, broccoli, cauliflower, and sweet red peppers for orange juice; meat, poultry, and cheeses for eggs.
Delayed introduction of highly allergenic foods for children with a known family or personal history of allergy may help prevent the development of food allergies. Ideally, it’s best to wait until twelve months for introducing cow’s milk, soy, wheat, corn, and citrus; twenty-four months for eggs; thirty-six months for peanuts and fish.
WHEN THE FOOD-ALLERGIC TODDLER STEPS OUT
Parties and play dates don’t have to be off limits for toddlers with food allergies or intolerances. But special precautions are necessary when your toddler goes visiting. First of all, begin teaching your child that some foods are forbidden. As he or she becomes more verbal, rehearse such lines as: “I can’t have milk, thank you.” When it seems appropriate, supply your toddler’s meal or snack. When it’s not, let your child’s host know in advance what foods your child can’t have. Either way, be sure that both your child and the host understand the possible consequences of eating “just one bite” of such foods; that such foods are not hidden ingredients (again, careful label reading is a must), and, if your child could have an anaphylactic reaction, that they know what to do in case of an accidental exposure.
Pollens. If you suspect pollen allergy (the clue: persistent symptoms when pollen is in the air and the disappearance of symptoms when the season is past), keep your child indoors as much as possible when the pollen count is high (usually in the morning) and when it is particularly windy during pollen season (spring, late summer, or fall, depending on the type of pollen). Give daily baths and shampoos to remove pollen, and use an air-conditioner in warm weather rather than opening the windows and admitting airborne pollen. Cut grass short to reduce pollen output. If you have a pet, the animal can also pick up pollen when out of doors, so it, too, should be bathed frequently. For children with severe pollen allergies, a trip to a pollen-free or low-pollen area during the height of the pollen season, if feasible, may be advisable.
Some people have a reaction to the family Christmas tree or to other evergreens brought into the home. This may be because of the pollen attached to the needles (in which case washing the tree down in the tub before setting it up will help); but more often the reaction is due to a sensitivity to the strong odor. In such instances, it’s a good idea to avoid spruce trees or boughs, which are the most fragrant.
Pet dander and other pet allergies. Dander, the tiny scales sloughed off by the skin of animals, is the most common offender. But some people are allergic to the saliva or the urine of animals, in which case, the litter of cats or of small caged animals can be a problem. Cat dander is more often a problem than dog dander, and long-haired pets cause more problems than short-haired ones. If you suspect or have confirmed that your child is allergic to a pet, try to keep your animal and your child in different rooms. It may also help to relegate the animal to the yard, the basement, or the garage as much as possible (if you have these options), bathe it weekly, get rid of wall-to-wall carpets, minimize upholstered furniture and other furnishings that retain dander, and use an air purifier with a high-energy particulate filter. In severe cases, the only solution may be to find the pet another home. Since horsehair can also trigger allergy, don’t use horsehair mattresses or brushes; animal-hide and animal-hair rugs, carpets, and ornaments should also be avoided. Some children are
allergic to birds, so if you can’t figure out your toddler’s problem, consider that it might be your feathered friend. Find it a new home, and opt for synthetic rather than goose-down-filled comforters, pillows, and upholstered furniture.
Household dust. It isn’t the dust that triggers the sneezes in most dust-allergic people, it’s the dust mites. These microscopic insect-like creatures can fill the air in your home and may be inhaled, unseen, by everyone in your family. That’s no problem for most people, but for someone who is hypersensitive to these substances, it can mean misery. Limit your toddler’s exposure, even if you only suspect this allergy, by keeping the rooms he or she spends the most time in (the bedroom, especially) as dust-free as possible. Dust daily with a specially treated dust cloth, a damp cloth, or a cloth moistened with a bit of furniture polish when your toddler is not in the room; damp-mop floors and thoroughly vacuum rugs and upholstered furniture often. If possible, invest in a vacuum with proven high-allergen containment or a HEPA filter. Or use a special high-filtration dust bag in your present vacuum so that you don’t recirculate dust particles back into the air when you vacuum. Avoid carpeting, heavy draperies, chenille bedspreads, and other dust catchers in rooms where your toddler sleeps and plays; wash stuffed toys—and give away toys that aren’t washable—and blankets or comforters frequently in hot water, if possible. Water over 131°F seems to kill dust mites; warm water kills some and cold water only disables the mites’ allergy-producing capacity. Blankets that can be washed in hot water should be washed monthly; items that require warm or cold water wash should be laundered about every two weeks. Wash any curtains, throw rugs, or other such items at least twice a month (or pack them away). Keep such dust collectors as books behind doors, if possible, and store clothing in plastic garment bags. Sheathe mattresses and pillows in airtight casings (crib mattresses usually come with airtight covers). Put filters over forced-air vents; install a central air cleaner, if feasible (table-top models are of questionable effectiveness). And, probably most important, keep humidity in your home moderately low (see page 838); dust mites generally can’t survive where humidity is below 50% (some experts recommend keeping humidity levels even lower—between 20% and 30%). For suggestions on sprays or powders that can be used to kill mites in your carpeting and upholstery, and advice on their safety, check with your child’s allergist.