Chang Lucy Liu November 16th, 2012 ID: 4201733 FSCN 3612: Nutrition Makeover Assignment 1.

Background information on the subject(s): I interviewed a mother about her eight month old child. The mother is 26 years old, Caucasian, lives in a comfortable home in Minneapolis with her son and husband. The infant is male, born a term baby at forty weeks and one day. Brown defines term in her Nutrition Through the Life Cycle textbook as from thirty-eight to forty-two weeks after conception (Brown, 88). His diet consisted of only breast milk from his mother until semi-solid foods were introduced at six months. She works mostly from home and had friends and family that were supportive of her breastfeeding. The baby is described as an easy baby, generally happy and mild, and easy to take everywhere. He caught his first and only cold at six months. Growth and development have been normal. 2. Problem: When asked to describe any issues perhaps related to diet that the infant have had, the mother said that she was grateful that there had hardly been any diet related problems. The only one that the baby has had was from birth to four months when he would arch his back after feedings and was sometimes inconsolable. In the first two months of his life he would cry for three to four hours after being fed. The mother experiences slight irritation to dairy so her doctor told her to take dairy products out of her diet for two weeks. The baby stopped arching his back and fussing after two weeks of no dairy in the mothers diet. When she added dairy back in to her diet, he reacted again with the arching. The

mother tried adding dairy into her diet once a month. At four months, the baby did not seem to arch his back at all anymore or have any problems after the mother had included dairy in the diet. Her doctor attributed the responses of the baby to breast milk after mother had ingested dairy to reflux. 3. Action to take: Although reflux could explain the babys symptoms to being fed breast milk in the first two months, I thought it could be more than just that. In our textbook, one common food allergen or food that infants have intolerance to is stated to be cows milk (Brown 213). Gastroesophageal disease, or the reflux that the babys doctor had attributed the crying and seemingly painful responses the baby had experienced to, is described as a condition in which the contents of the stomach leak backwards from the stomach into the esophagus (Gastroesophageal, par. 2). These contents can irritate the esophagus and cause pain (par. 2). One article I found stated that gastroesophageal reflux and cows milk allergy are often tied together (Salvatore par. 1). In a high proportion of infants with cow milk allergy, gastroesophageal reflux is not only associated with cow milk allergy but also found to be induced by cow milk allergy (par. 1). Furthermore, besides those infants with milk typical cow milk allergy symptoms, the symptoms of gastroesophageal reflux associated with cow milk allergy are the same as those observed in infants with just gastroesophageal reflux without cow milk allergy. So I can see how my subjects doctor could infer that the baby has just gastroesophageal reflux in response to dairy in the mothers diet. Cows milk allergy is the most common food allergy in children under two years of age, and affects approximately 2% of this age group (Hein, par. 2). It is reported to

affect 0.3% to 7.5% of infants, with 82% of the symptoms reported within the first 4 months of life (Salvatore par. 6). Cows milk allergy is defined as an immunologically mediated adverse reaction to cows milk proteins (Heine par. 2). In the case of my subject, who was breastfed, the cows milk proteins from dairy products ingested by the mother must have transferred into the breast milk, for him to have cows milk allergy. And there is increasing evidence to show that ingested cows milk are secreted into human milk, and can potentially sensitize the breast-fed infant (Heine, par. 18). However, this is not confirmed, as some research findings seem to prove the opposite (par. 18). Infants who are breastfed have been found to have a lower risk of developing a milk allergy than those who are formula fed (Milk, par. 5). The link between which infants do develop such an allergy is believed to be genetic (par. 5). This would make sense in our case, as the mother also has an irritation to dairy, although even if she didnt, this still could be genetic since many infants with intolerance to milk protein build tolerance to it later on, as explained in the following paragraph. A large majority of infants with cow milk allergy, 85% to be exact, develop tolerance to cows milk protein by age three (Heine, par. 33). This seemed to have already happen with my infant subject. So, it does seem to be safe for the mother to eat dairy products and breastfeed her child. However, there are other risks to be considered. Increased sensitivity to other allergens and earlier development of atopy is found to be associated with cows milk allergy (Heine par. 2). The mechanisms behind these hypersensitivities are poorly understood (par. 3). However, some studies show that decreased exposure to such allergens (typically pollen, foods that are often allergens, dander, and insect venoms) can reduce the risk for developing such hypersensitivities

(par. 2-3, 18, 40). My only advice for this mother and her child is that because this is a significant risk, she should reduce her infants exposure to common allergens. 4. Assessment of the Makeover: At first, I felt slightly uncomfortable about this assignment because I misunderstood it to be that I had to counsel someone about a nutrition related problem and that that person had to carry what I suggested out. I didnt feel qualified to do this, which is because I am not qualified to do this. I didnt want to be responsible for someone elses health when I didnt have the knowledge or experience to do so. That is what I initially understood the assignment to be. Once I understood that I just had to think of some way to counsel the subject without actually needing the subject to implement my advice, I felt much better. It was an interesting assignment, more complex than I had expected, and in many ways enjoyable.

References Brown, Judith E. Nutrition Through the Life Cycle. Wadsworth Cengage Learning 2011. Gastroesophageal Reflux Disease. PubMed Health. U.S. National Library of Medicine. 2012 <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001311/>. Heine, Ralf G, et al. "Cow's milk allergy in infancy." Current opinion in allergy and clinical immunology 2.3 (2002):217-225. Milk Allergy in Infants. KidsHealth. October 2011. Reviewed by Mehta, Archana, MD; Stewart, Sheelagh M, RN, MPH. Salvatore, Siliva, MD; Vandenplas, Yvan, MD, PhD. Gastroesophageal reflux and cow milk allergy: Is there a link? Pediatrics [0031-4005], 2002 vol:110 iss:5 pg:972 -84.