Tuesday, 23 October 2012

Nutrition Related Problems In Paediatrics, An Interview With Dr Amin Sheikh

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Paediatric gastroenterology registrar says awareness and education is key...

I am delighted to introduce you to my lovely friend Amin.  We met at University where he was a great pillar of support through the geeky but fun years!   It's a funny story actually.  Amin and I shared the same lectures during the first year of university.  I used to notice him notice me all the time.  I am sure that he'll deny it if you ask him.  I even wondered if the handsome doctor possibly fancied me; but no, he was just looking for a friend to study with.  Never mind - a girl can always hope!  So here we are, well over a decade later. The dietitian and the doctor.

Which top 3 nutrition related problems do you frequently treat regularly?
Iron deficiency anemia is one.  Vitamin D deficiency is another important area especially in families with dark skin.  Often mothers who do not realise that they have poor vitamin D status may go onto breastfeed their child who may then have increased risk of vitamin D deficiency.  

Another area of nutritional concern are when children with multiple food allergies are subsequently placed on very restricted diets without the advice from a dietitian.  Sometimes families attempt restricted diets to alleviate the symptoms of eczema, but unfortunately there are a lot of inaccurate information available on the internet which parents can access.  This is not recommended as an alternative solution to seeking necessary medical advice.

What should parents know about vitamin D deficiency or restricted diets?
Iron and vitamin D deficiencies are often picked up when children are first admitted to hospital and when high risk groups are screened.   However, earlier screening or accessing education in the community can help prevent these deficiencies.  To achieve this, we need to support families by increasing awareness of which groups of children may be at increased risk of iron or vitamin D deficiencies.  For example, it can be as simple as reminding a mum with known low vitamin D status, to take her prescribed dose of vitamin D supplements during breastfeeding to reduce the risk of reduced vitamin D status in her baby.

Vegetarian mothers may also wish to seek dietetic advice when she starts weaning her baby over to vegetarian weaning solids to ensure optimal iron intake.

In the area of food allergies, always seek medical advice if these are suspected.  

Families should not feel that they need to manage these allergies or food intolerance on their own as you can run the risk of inadequate intake of various food groups and essential vitamins or minerals.

What burning questions do parents often ask you?
Families often ask me if they need to restrict their child's diet based on a history of food allergy in a sibling.  My current advice in New Zealand is to give any 'suspected' allergen food such as milk, in small quantities in a step by step process.  It is not always probable that a sibling will also develop food allergies even when a family history of food allergy exists.

This advice may vary across the globe, so always check with your medical practitioner about tailored advice for your child.

In a straight forward case of food allergy to peanuts, it has been quoted that there is less than 10% chance that a non-identical twin or a sibling will also develop an allergy to peanuts.  This risk increases to 64% in identical twins as quoted in the Journal of Allergies and Clinical Immunology in 2004.

Vitamin D
If a mother has already been diagnosed with iron or vitamin D deficiency, it is important that the mother seeks medical advice or resources from her general practitioner to ensure that both baby and mum are supplemented as necessary.  

Not all eczema is related to food allergies so it is important that families remember this and manage the eczema as directed by your pediatrician.  Having said that, some children with severe eczema can have this exacerbated secondary to food allergies.

Food allergies are also not necessarily the cause of the eczema, it can simply trigger symptoms.  

Food Allergies
Remember that children do grow out of food allergies so always discuss with your paediatrician or dietitian about when is a good time to reintroduce food groups that are currently being excluded from your child's diet.

Thank you so much to Amin for an interesting chat about nutritional related problems that families may face from around the world.  If you would like to see Dr Sheikh again next month, please feel free to comment below with any questions that you would like him to explore in next month's interview.

Enjoy your day lovely readers.  Remember, the information that you have read on this blog today must not replace any specific medical or dietetic advice that you may have received for your child.

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