Allergy or Intolerance?

There is a lot of teaching that revolves around allergies - food, environmental, and seasonal.  But for today, I will try to be brief while I stress the importance of understanding the difference between an allergy, an intolerance, and a preference in relation to foods.

My kid doesn't like to eat.  On the surface, it's sort of a funny concept and one that a lot of parents struggle with, so its easy to laugh off.  And for most parents with kids who "don't eat", it's because they have preferences and are picky, so they hold out for what they like best.  For a few families, it's due to a sensory struggle, or oral motor delays, both of which make it very difficult for the child to mechanically put food in their mouth, chew, move it to the back of the mouth, and swallow.  I'm not yet sure which of the categories we fall into in our family.  I am highly suspicious of just pickiness, but unfortunately for us his strong will and food stand offs also come with the failure to gain weight.  Not to a dangerous level by any means, but he is slow to gain and burns off nearly every calorie he takes in as he's a bit of an energizer bunny. 

But to get to the point.... I've had a surprising number of parents ask me lately if I think he has food allergies and he's avoiding foods because of this.  Unfortunately, our little ones aren't that intuitive.  Newborns will sometimes scream and pull away when offered milk when they have allergies - either to cow's milk or something in mom's diet.  But rarely is this the only symptom in a true allergy.  More often than not, what we consider "allergies" in regards to food is an intolerance.  Now I do not mean to imply that your child's allergy is made up, or that they should ever be given foods that they have been deemed allergic to by a medical provider.  Cow's milk is actually a great example of this.

To keep the explanation simple I will try not to get too into the science jargon.  Cow's milk has very large proteins.  Proteins are hard to digest in general, but the larger they are, the harder the gut works, and this can cause gas, irritation or discomfort, changes in bowel movements, and sometimes traces of mucous in the stool if consumed in high volume.  The proteins in other alternate milk choices are much smaller, such as soy, almond, silk, or goat's milk.  Smaller proteins = easier digestion process = symptoms resolve.  Of course it's easy as a parent to now assume an allergy exists.  But please, if you think your child is allergic to cow's milk (or any food for that matter) advocate for them to be formally tested at either your pediatrician's office (simple blood draw believe it or not), or at a pediatric allergist specialist.  Because here is where the difference lies between an allergy or an intolerance.  An allergic child is at risk for physical damage, and yes sometimes death in severe cases, if they consume or come in contact with the allergen.  This includes all forms of the allergen that may not be known to the average person.  In the example of cow's milk, all labels have to be read intensely to rule out casein, and whey too.  If peanuts were the problem, beyond the peanuts and peanut oil it's important to know if pink peppercorns were used in a restaurant dish, because those are in the same nut family and have been a hidden trigger.  An allergy is serious medical condition and should be treated as such.

Intolerance is common, and should still be treated with respect.  Avoiding foods that your child is intolerant to is important, but should they accidentally become ingested, or if they are given in small quantities, no real harm should come to your child.

Bottom line, if your child is "allergic" to milk, "but can have ice cream" you are also confusing your child.  They need to clearly understand the importance of an allergy too so that they can speak up for themselves in time.  I have had a child in my office tell me they were allergic to chocolate, and I looked up to see the parents giggling behind him and confided in me later that this is how they keep him from eating junk food.  The American College of Asthma, Allergy, and Immunology states that only 5% of kids under the age 5 have a food allergy.  Now how many families do you know who tell you their kids are "allergic" to some foods?  It would be easy for me to say Ben was allergic to foods rather than stubborn, but that's far from the truth.

Allergies change very frequently up through about age 5 years, especially for wheat, cows milk, egg, and soy allergies.  If your child has previously been diagnosed with an allergy, ask if they can be retested at their annual physical.  It is true that it's common for children to grow out of allergies, so even if they have a rough start, have hope!

He prefers his food on the floor rather than in his belly.....sigh.

And the last bit of wisdom....it is ok for your child to be diagnosed and treated for food allergies at your primary care pediatric office.  As a parent, of course you want to see the specialist, but in all honesty you're going to wait a long time, and/or pay more to receive the same information in most cases.  If your child is diagnosed with multiple or high grade (4 or 5 out of 5) a follow up can easily and quickly be arranged at the allergist.  A good provider does communicate with these specialists and a phone consult on our side is often far more effective for all involved.