⚠️There are two primary sources of 𝐕𝐢𝐭𝐚𝐦𝐢𝐧 𝐀.
✅𝐏𝐥𝐚𝐧𝐭 𝐬𝐨𝐮𝐫𝐜𝐞, or 𝘱𝘳𝘰𝘷𝘪𝘵𝘢𝘮𝘪𝘯 𝘈:
▶️All mammals get two-thirds of carotenoids from beta carotenes.
▶️Yellow, red and green (leafy) vegetables (spinach, carrots, sweet potatoes and red peppers)
▶️Yellow fruit (mango, papaya and apricots)
✅𝐀𝐧𝐢𝐦𝐚𝐥 𝐬𝐨𝐮𝐫𝐜𝐞, or 𝘱𝘳𝘦𝘧𝘰𝘳𝘮𝘦𝘥 𝘝𝘪𝘵 𝘈:
▶️Fortified low-fat spreads
▶️Milk and yoghurt
▶️Liver and liver products such as liver pâté (don’t eat more than once a week, and pregnant women should avoid them altogether)
❇Examples of low concentration of Vit A (𝘪𝘯 𝘮𝘪𝘤𝘳𝘰𝘨𝘳𝘢𝘮𝘴 𝘢𝘯𝘥 % 𝘰𝘧 𝘥𝘢𝘪𝘭𝘺 𝘷𝘢𝘭𝘶𝘦).
➡️Peppers, sweet, red, raw, ½ cup (117/13)
➡️Mangos, raw, 1 whole (112/12)
➡️Black-eyed peas, boiled, 1 cup (66/7)
➡️Apricots, dried, 10 halves (63/7)
➡️Broccoli, boiled, ½ cup (60/7)
➡️Pistachio nuts, dry roasted, 1 ounce (4/0)
➡️Egg, hard-boiled, 1 large (75/8)
➡️Salmon, sockeye, cooked, 3 ounces (59/7) ➡Yoghurt, plain, low fat, 1 cup (32/4)
➡️Tuna, light, canned in oil, drained solids, 3 ounces (20/2)
➡️Chicken, breast meat and skin, roasted, ½ breast (5/1)
‼️Though most get their Vit A from plant sources, in reality, its absorption is not great.
🔸️When we eat beta carotenes, only 𝟺𝟶 𝘵𝘰 𝟼𝟶% 𝘢𝘳𝘦 𝘢𝘣𝘴𝘰𝘳𝘣𝘦𝘥.
🔹️In contrast, between 𝟾𝟶 𝘵𝘰 𝟿𝟶% of retinol from animal proteins will be absorbed.
❗To make the matter a bit more complicated, 𝘥𝘦𝘧𝘪𝘤𝘪𝘦𝘯𝘤𝘺 𝘪𝘯 𝘻𝘪𝘯𝘤, 𝘱𝘳𝘰𝘵𝘦𝘪𝘯 𝘢𝘯𝘥 𝘧𝘢𝘵 𝘢𝘣𝘴𝘰𝘳𝘱𝘵𝘪𝘰𝘯 (conditions like abetalipoproteinemia) affect carotenoid absorption.
❎𝐂𝐚𝐫𝐨𝐭𝐞𝐧𝐨𝐢𝐝𝐬 are 𝘱𝘪𝘨𝘮𝘦𝘯𝘵𝘴 𝘧𝘰𝘶𝘯𝘥 𝘪𝘯 𝘱𝘭𝘢𝘯𝘵𝘴.
▶️They are the reason for the bright red, yellow and orange colours you see in plenty of fruits, vegetables, algae and bacteria.
▶️Their importance is related to their ability to help absorb light so that photosynthesis can be done.
They are also antioxidants.
You can take supplements, if you can't eat any of the above.
As we spoke before, 𝐕𝐢𝐭𝐚𝐦𝐢𝐧 𝐀 is 𝘧𝘢𝘵-𝘴𝘰𝘭𝘶𝘣𝘭𝘦.
⚠️We don’t eat Vit A, even in supplements.
When we consume 🍎fruits, 🥕vegetables or 💊supplements, in reality, we are taking something called “𝘳𝘦𝘵𝘪𝘯𝘺𝘭 𝘦𝘴𝘵𝘦𝘳𝘴” (also known as preformed Vit A) or 𝘱𝘳𝘰𝘷𝘪𝘵𝘢𝘮𝘪𝘯 𝘈.
✅One way or another, they suffer alterations to become 𝘳𝘦𝘵𝘪𝘯𝘰𝘭𝘴. This is simply because those are easier absorbed in the small bowel.
❎As they are absorbed, small molecules called “𝐜𝐡𝐲𝐥𝐨𝐦𝐢𝐜𝐫𝐨𝐧𝐬” will transport them into the Liver.
❎If the Liver has reached its full capacity of Vitamin A, other small molecules called 𝐕𝐋𝐃𝐋 (𝘝𝘦𝘳𝘺 𝘓𝘰𝘸-𝘋𝘦𝘯𝘴𝘪𝘵𝘺 𝘓𝘪𝘱𝘰𝘱𝘳𝘰𝘵𝘦𝘪𝘯𝘴) will transport it (often already changed into retinyl palmitate) to other tissues.
✴Those tissues are mainly:
1️⃣Adipose tissue (AKA fat)
❎Another group of molecules called 𝐋𝐃𝐋 (𝘓𝘰𝘸-𝘋𝘦𝘯𝘴𝘪𝘵𝘺 𝘓𝘪𝘱𝘰𝘱𝘳𝘰𝘵𝘦𝘪𝘯𝘴) might also do that transport.
‼️𝐕𝐞𝐫𝐲 𝐢𝐦𝐩𝐨𝐫𝐭𝐚𝐧𝐭 𝐭𝐨 𝐤𝐧𝐨𝐰:
▶️VLDL and LDL are what is called “bad cholesterol”
▶️HDL is what is called “good cholesterol”
✴Bear in mind any disease affecting the bowels (and I am referring to the 𝘴𝘮𝘢𝘭𝘭 𝘣𝘰𝘸𝘦𝘭) will affect fat absorption capacity. In turn, this will affect Vitamin A absorption as well.
❓Remember we spoke about Vit A being fat soluble?
✅Conditions that affect Vit A absorption:
➡️Inflammatory Bowel Disease
➡️Cholestasis (conditions preventing bile passing to the bowel, from the Liver)
➡️Small bowel bypass surgery
➡️Significant parasitic infestation
➡️Low fat in the diet
⚠️People with any of these conditions should take 𝐕𝐢𝐭 𝐀 𝐬𝐮𝐩𝐩𝐥𝐞𝐦𝐞𝐧𝐭𝐬.
When Vit A is not absorbed, it will be excreted in stools.
The one that becomes inactivated in the bloodstream will be excreted in the urine.
✴The big problem is that our body absorbs Vit A better than it destroys it.
⛔This can lead to excessive accumulation and 𝐕𝐢𝐭 𝐀 𝐭𝐨𝐱𝐢𝐜𝐢𝐭𝐲.
Also known as Retinol or Retinoic Acid.
Those names derive from an area in the back of the eye.
It was the first 𝘧𝘢𝘵-𝘴𝘰𝘭𝘶𝘣𝘭𝘦 but not the first Vitamin to be discovered.
🇪🇬It all started with the 𝘌𝘨𝘺𝘱𝘵𝘪𝘢𝘯𝘴, as they found that some types of 𝘣𝘭𝘪𝘯𝘥𝘯𝘦𝘴𝘴 could be cured by 𝘦𝘢𝘵𝘪𝘯𝘨 𝘭𝘪𝘷𝘦𝘳.
🔶️This Vitamin plays a vital role in 👁𝘷𝘪𝘴𝘪𝘰𝘯, 𝘨𝘳𝘰𝘸𝘵𝘩, 𝘤𝘦𝘭𝘭 𝘥𝘪𝘷𝘪𝘴𝘪𝘰𝘯 and 𝘪𝘯𝘵𝘦𝘨𝘳𝘪𝘵𝘺 (mainly 𝘢𝘪𝘳𝘸𝘢𝘺𝘴, 𝘶𝘳𝘪𝘯𝘢𝘳𝘺 𝘵𝘳𝘢𝘤𝘵 and 𝘨𝘶𝘵), 𝘳𝘦𝘱𝘳𝘰𝘥𝘶𝘤𝘵𝘪𝘰𝘯 and 𝘪𝘮𝘮𝘶𝘯𝘪𝘵𝘺. We cannot forget how important it is for foetal development.
🤰But beware, pregnant women DO NOT need a Vitamin A dose higher than the daily recommended dose.
✅Due to this, many believe it is 𝐭𝐡𝐞 𝐦𝐨𝐬𝐭 𝐞𝐬𝐬𝐞𝐧𝐭𝐢𝐚𝐥 𝐕𝐢𝐭𝐚𝐦𝐢𝐧 in animal life (not just humans).
🔻When there is a deficiency, it can lead to:
➡️Low immune response
➡️Dry skin and hair
✴𝐍𝐨𝐭𝐞 𝐨𝐟 𝐜𝐚𝐮𝐭𝐢𝐨𝐧: If you use creams containing Vit A, do not go on long sun exposures, leading to skin cancer development! On the other hand, sun exposure decreases skin Vit A.
✳𝗪𝐡𝐚𝐭 𝐭𝐨 𝐝𝐨?
Use it after sun and/or at nighttime.
❓Is there a connection between Vitamin A and allergies?
🔸️The only relationship found so far is between lack of it and increased risk of allergic asthma and allergic rhinitis (hayfever).
‼️There is a hypothesis saying that Vit A might help prevent an adverse reaction when eating different kinds of food.
❌Too much Vitamin A can also lead to problems. Such as:
➡️Pain in the joints and bone
They are bacteria that can lead to benefits to the large bowels when taken in an appropriate amount.
❓But are all Probiotics good?
📝For me to have a better idea about that, I went to find the evidence behind it.
✴There are over 2.5k articles focusing on 22 different probiotics.
✴From those articles, I found 249 RCTs (𝘳𝘢𝘯𝘥𝘰𝘮𝘪𝘻𝘦𝘥 𝘤𝘰𝘯𝘵𝘳𝘰𝘭𝘭𝘦𝘥 𝘵𝘳𝘪𝘢𝘭𝘴), with most of them being sponsored by the company selling them.
✔So take their conclusions with a pinch of salt…
✅The most effective use for them is diarrhoea, IBD (𝘐𝘯𝘧𝘭𝘢𝘮𝘮𝘢𝘵𝘰𝘳𝘺 𝘉𝘰𝘸𝘦𝘭 𝘋𝘪𝘴𝘦𝘢𝘴𝘦) and IBS (𝘐𝘳𝘳𝘪𝘵𝘢𝘣𝘭𝘦 𝘉𝘰𝘸𝘦𝘭 𝘚𝘺𝘯𝘥𝘳𝘰𝘮𝘦).
⚠️This image shows the conditions for which probiotics are helpful and the evidence's strength.
(𝘊𝘩𝘰𝘰𝘴𝘪𝘯𝘨 𝘢𝘯 𝘢𝘱𝘱𝘳𝘰𝘱𝘳𝘪𝘢𝘵𝘦 𝘱𝘳𝘰𝘣𝘪𝘰𝘵𝘪𝘤 𝘱𝘳𝘰𝘥𝘶𝘤𝘵 𝘧𝘰𝘳 𝘺𝘰𝘶𝘳 𝘱𝘢𝘵𝘪𝘦𝘯𝘵: 𝘈𝘯 𝘦𝘷𝘪𝘥𝘦𝘯𝘤𝘦-𝘣𝘢𝘴𝘦𝘥 𝘱𝘳𝘢𝘤𝘵𝘪𝘤𝘢𝘭 𝘨𝘶𝘪𝘥𝘦. 𝘩𝘵𝘵𝘱𝘴://𝘥𝘰𝘪.𝘰𝘳𝘨/𝟷𝟶.𝟷𝟹𝟽𝟷/𝘫𝘰𝘶𝘳𝘯𝘢𝘭.𝘱𝘰𝘯𝘦.𝟶𝟸𝟶𝟿𝟸𝟶𝟻 𝘋𝘦𝘤𝘦𝘮𝘣𝘦𝘳 𝟸𝟼, 𝟸𝟶𝟷𝟾)
❇This means, not all probiotics have any evidence based effect on your health.
➡️And the helpful ones are disease specific.
❗At least, from all of them, we know there are no absolute contraindications to their use.
✅Other benefits found are that they:
▶️Stimulate the immune system
▶️Can decrease the inflammatory response
▶️Can improve vaccine response
✅Where are they found:
▶️Fermented milk drinks
▶️Examples: kefir, kombucha, sauerkraut, pickles, miso, tempeh, kimchi, sourdough bread, some cheeses (Cheddar, Parmesan, and Swiss cheeses are soft cheeses that contain a decent amount of probiotics. Gouda is the soft cheese that delivers the most probiotics of all)
✅How to take them:
▶️There is scant evidence comparing which type of formulation may be more effective.
▶️The choice of formulation may be based on shelf-life, in that lyophilized capsules maintain high concentrations longer than probiotics in dairy products and enteric-coated capsules show higher survival rates than non-enteric coated capsules.
▶️Probiotic capsules requiring refrigeration are heat-dried (not lyophilized) and thus not stable at room temperature, limiting their portability.
▶️Besides, if the patient is lactose-intolerant, yoghurts or other types of fermented dairy products may not be advisable.
‼️Careful with quality control, some will have less than stated.
⚠️Sometimes, when having an 𝐚𝐥𝐥𝐞𝐫𝐠𝐢𝐜 𝐫𝐞𝐚𝐜𝐭𝐢𝐨𝐧, it can become a more severe reaction.
✳The most severe allergic reactions are called 𝐀𝐧𝐚𝐩𝐡𝐲𝐥𝐚𝐱𝐢𝐬.
📝The definition of 𝐀𝐧𝐚𝐩𝐡𝐲𝐥𝐚𝐱𝐢𝐬 is not uniform worldwide.
For you to have an idea, the WAO (𝘞𝘰𝘳𝘭𝘥 𝘈𝘭𝘭𝘦𝘳𝘨𝘺 𝘖𝘳𝘨𝘢𝘯𝘪𝘻𝘢𝘵𝘪𝘰𝘯), the WHO (𝘞𝘰𝘳𝘭𝘥 𝘏𝘦𝘢𝘭𝘵𝘩 𝘖𝘳𝘨𝘢𝘯𝘪𝘻𝘢𝘵𝘪𝘰𝘯), the AAAAI (𝘈𝘮𝘦𝘳𝘪𝘤𝘢𝘯 𝘈𝘤𝘢𝘥𝘦𝘮𝘺 𝘰𝘧 𝘈𝘭𝘭𝘦𝘳𝘨𝘺, 𝘈𝘴𝘵𝘩𝘮𝘢 𝘢𝘯𝘥 𝘐𝘮𝘮𝘶𝘯𝘰𝘭𝘰𝘨𝘺), the EAACI (𝘌𝘶𝘳𝘰𝘱𝘦𝘢𝘯 𝘈𝘤𝘢𝘥𝘦𝘮𝘺 𝘰𝘧 𝘈𝘭𝘭𝘦𝘳𝘨𝘺 𝘢𝘯𝘥 𝘊𝘭𝘪𝘯𝘪𝘤𝘢𝘭 𝘐𝘮𝘮𝘶𝘯𝘰𝘭𝘰𝘨𝘺) and the ASCIA (𝘈𝘶𝘴𝘵𝘳𝘢𝘭𝘢𝘴𝘪𝘢𝘯 𝘚𝘰𝘤𝘪𝘦𝘵𝘺 𝘰𝘧 𝘊𝘭𝘪𝘯𝘪𝘤𝘢𝘭 𝘐𝘮𝘮𝘶𝘯𝘰𝘭𝘰𝘨𝘺 𝘢𝘯𝘥 𝘈𝘭𝘭𝘦𝘳𝘨𝘺), all have slightly different definitions.
✴The one I like the most is actually the ASCIA one:
"𝘈 𝘳𝘢𝘱𝘪𝘥𝘭𝘺 𝘦𝘷𝘰𝘭𝘷𝘪𝘯𝘨, 𝘨𝘦𝘯𝘦𝘳𝘢𝘭𝘪𝘴𝘦𝘥 𝘮𝘶𝘭𝘵𝘪-𝘴𝘺𝘴𝘵𝘦𝘮 𝘳𝘦𝘢𝘤𝘵𝘪𝘰𝘯 𝘤𝘩𝘢𝘳𝘢𝘤𝘵𝘦𝘳𝘪𝘴𝘦𝘥 𝘣𝘺 𝘰𝘯𝘦 𝘰𝘳 𝘮𝘰𝘳𝘦 𝘴𝘺𝘮𝘱𝘵𝘰𝘮𝘴 𝘰𝘳 𝘴𝘪𝘨𝘯𝘴 𝘰𝘧 𝘳𝘦𝘴𝘱𝘪𝘳𝘢𝘵𝘰𝘳𝘺, 𝘤𝘢𝘳𝘥𝘪𝘰𝘷𝘢𝘴𝘤𝘶𝘭𝘢𝘳 𝘢𝘯𝘥 𝘰𝘵𝘩𝘦𝘳 𝘴𝘺𝘴𝘵𝘦𝘮𝘴 𝘴𝘶𝘤𝘩 𝘢𝘴 𝘵𝘩𝘦 𝘴𝘬𝘪𝘯 𝘢𝘯𝘥/𝘰𝘳 𝘎𝘐 𝘵𝘳𝘢𝘤𝘵."
Given this, how do we know it is 𝐀𝐧𝐚𝐩𝐡𝐲𝐥𝐚𝐱𝐢𝐬 or not
⬆️Have a look at the image above.
❓What to do if you think you, or your child, are having an anaphylactic reaction?
▶️If you are sure it is, give 𝐀𝐝𝐫𝐞𝐧𝐚𝐥𝐢𝐧𝐞.
▶️If you are unsure it is, STILL GIVE 𝐀𝐝𝐫𝐞𝐧𝐚𝐥𝐢𝐧𝐞.
▶️If you are sure it is not, ONLY in this case, give 𝐀𝐧𝐭𝐢𝐡𝐢𝐬𝐭𝐚𝐦𝐢𝐧𝐞𝐬.
‼️In ALL circumstances (or if you don't have an Adrenaline AutoInjector), 𝐜𝐚𝐥𝐥 𝟗𝟗𝟗 and ALWAYS ask for 𝐡𝐞𝐥𝐩.
✅(𝘵𝘩𝘦 𝘢𝘭𝘨𝘰𝘳𝘪𝘵𝘩𝘮 𝘐 𝘩𝘢𝘷𝘦 𝘶𝘴𝘦𝘥 𝘰𝘯 𝘮𝘺 𝘪𝘮𝘢𝘨𝘦𝘴 𝘪𝘴 𝘵𝘩𝘦 𝘯𝘦𝘸 𝘥𝘳𝘢𝘧𝘵 𝘰𝘯𝘦, 𝘸𝘢𝘪𝘵𝘪𝘯𝘨 𝘵𝘰 𝘣𝘦 𝘱𝘶𝘣𝘭𝘪𝘴𝘩𝘦𝘥)
🔶️It is important to know that 𝐀𝐧𝐚𝐩𝐡𝐲𝐥𝐚𝐱𝐢𝐬 is a 𝐫𝐚𝐫𝐞 𝐞𝐯𝐞𝐧𝐭, and most times, it 𝐃𝐎𝐄𝐒 𝐍𝐎𝐓 𝐥𝐞𝐚𝐝 𝐭𝐨 𝐝𝐞𝐚𝐭𝐡.
🆕️In fact, recently published research said there had been a significant increase in hospital admissions with Anaphylaxis, but a decrease in deaths.
This seems like a contradiction, but it is not.
⁉️Why is that?
✅On the one hand, we know there is a significant increase in the incidence of allergies, so naturally, the number of Anaphylactic cases will increase.
✅But on the other hand, the health care professionals awareness has increased, leading to better recognition and prescription of appropriate medication.
I will put my hands down, and agree with whoever tells me what is done, is still not enough.
The bottom line is:
➡ ️𝐑𝐞𝐜𝐨𝐠𝐧𝐢𝐬𝐞 it Fast.
➡️Have your 𝐦𝐞𝐝𝐢𝐜𝐚𝐭𝐢𝐨𝐧 with you AT ALL TIMES!
🆘️Ask for 𝐇𝐄𝐋𝐏!
⚠️Recently publication showed there are significant 🥜peanut proteins in 🏡household dust.
But what is the relevance of this study, and how does it apply to the development of 🤧allergies?
🔸️It is known that during the 👶first year of life, exposure to allergens will lead to the development of either tolerance or allergy.
🔸️With the loss of the natural skin barrier, the presence of eczema increases the risk of developing sensitization to the allergen that gets in contact with the skin.
The best course of action to deal with eczema, and potentially prevent the development of 🤧allergies, should be:
➡️Apply moisturizers as often as you feel the skin is dry to touch.
➡️If that is not solving the problem, speak to your doctor as the child might need topical steroids as well.
➡️Consider the possibility of an allergy leading to eczema and consider an exclusion diet. That should be guided by a paediatric allergist and a paediatric allergy dietitian.
🔜(In due course, I will publish more information regarding eczema and the best way to take care of it.)
(Main article – “Mass spectrometry confirmation that clinically important peanut protein allergens are in household dust”; Helen A. Brough, Elizabeth Naomi Clare Mills, Kerry Richards, Gideon Lack, Philip E. Johnson; 04 October 2019)
A US study suggests that, though camps will accept 🧒 children with allergies, most are not prepared to act if something happens as often they don’t have or request individualized action plans.
🏕It seemed camps that had faced anaphylactic events in previous years were better trained and able to recognize it than others who didn’t.
Despite that, one-third of camp leaders did not think most staff would be able to act appropriately.
Though this study was not done in the UK, I would suggest👫 parents need to be aware of the possibility of the same happening in summer camps here or any other country where they might send their children to.
⚠️The main lessons to take from this study are:
🔹️Enquire if the staff at the summer camp is trained to deal with allergic conditions, mainly anaphylaxis.
🔹️See what policies and emergency measures they have in place, e.g. contacts for local ambulance service, GP or Hospital.
🔹️Provide action plans specifically for your child. If you don’t have one, ask your Paediatric Allergist to provide a BSACI action plan.
🔹️See if your child’s medication did not expire and take them to the camp, in a clearly marked container, potentially with a photo of your child outside it.
🔹️You don’t stand to lose anything by asking if the food your child is allergic to is excluded from the camp, and other children cannot bring it with them there.
🏫As more and more nurseries/schools are becoming nuts free, it would not be a bad idea for summer camps to follow suit.
(Many Summer Camps Unprepared for Allergic Campers - Medscape - Dec 10, 2019)
🤧 It is a reaction from our immune system to something we got in contact with that the immune system did not recognize as "safe".
This can happen to a multitude of substances, with the best known being 🥘foods, 🐈pet dander, pollen, house dust mites, 🐝bee or wasp venom. But chemicals can also lead to those reactions.
The substance that causes such a reaction is called an "allergen".
Allergens can be found all around us.
In 🥘food, 🍵drinks, environment, being them airborne (which can be either 💦droplets or minuscule solids) or solids we get in contact with.
The primary reaction that will happen is the immune system trying to destroy that "invader" (allergen), and for that, it uses a significant amount of the immune mediators.
The outcome is an allergic reaction that can come in all sorts of presentations and severity.
Saying that not all allergens we get in contact with will make our immune system react.
Some are relatively harmless, depending on each individual's immune system and, often, prior exposure to that substance.
What are the most common allergens in children?
🔸️ Tree nuts
How does it affect 👶children:
🔸️Increased risk of developing allergies if one/both 👫parents are atopic
🔸️33% with moderate/severe eczema may present with a food allergy
🔸️There is a close relationship between asthma, 👃allergic rhinitis and food allergy in school-age
🔸️Food allergy is associated with severe asthma
The outcome of the allergies depends on the food the child is allergic to.
🔸️ Milk and egg - usually resolved by teenage years
🔸️ Wheat and soy - those are transient allergies of childhood
🔸️ Peanut and tree nut - typically starts in childhood and only 20% resolve
🔸️ Fish - it is often lifelong
Milk, soy, egg and wheat - are the most common foods involved in non-IgE mediated food allergy.
𝐆𝐚𝐬𝐭𝐫𝐨𝐞𝐬𝐨𝐩𝐡𝐚𝐠𝐞𝐚𝐥 𝐑𝐞𝐟𝐥𝐮𝐱 (GOR) is likely one of the most common causes of concern for 👫parents of infants/newborns.
⁉️Signs can some time be hard to understand, as not in all cases you will see the feed coming out. This is what is commonly called “𝘴𝘪𝘭𝘦𝘯𝘵 𝘳𝘦𝘧𝘭𝘶𝘹”.
🔶️There are common behaviours that can be used to make that diagnosis, though all need to be put into context as not always it means the child has reflux.
❓So what are they?
▶️Unsettled when lying flat
▶️Need to wind in an upright position for long periods
▶️Need to fall asleep upright
▶️Frequent hiccups (stimulation of phrenic nerve by acid in the oesophagus)
▶️Frequent feeding (feeding leads to release of endorphins, decreasing pain caused by acid reflux – if not treated, can lead to food refusal)
❓Do all need investigation and/or treatment?
🔹️Not at all.
🔹️In reality, most cases just need conservative measures.
⚠️When GER becomes severe (leading to GERD - GastroEsophageal Reflux Disease), there are several aspects we need to worry about, and appropriate action is required.
➡️The following are the complications to pay attention to:
✅Failure to thrive
✅Acute life-threatening events
✅Oesophagitis (endoscopy needed to make a diagnosis)
✅Haematemesis (vomiting blood)
𝐈𝐧𝐯𝐞𝐬𝐭𝐢𝐠𝐚𝐭𝐢𝐨𝐧𝐬 𝐟𝐨𝐫 GER
▶️Oesophageal pH study and/or impedance study
▶️Upper GI (gastrointestinal) endoscopy
‼Do bear in mind that a significant proportion of GER in infants might be associated with a🥛 milk allergy:
🔸️204 infants (<1yr) with GER
🔸️40% respond to cow’s milk exclusion (hydrolysate)
🔸️Responders typically had other GI symptoms and atopic features (eczema) (𝘐𝘢𝘤𝘰𝘯𝘰 𝘦𝘵 𝘢𝘭 𝘑 𝘈𝘭𝘭𝘦𝘳𝘨𝘺 𝘊𝘭𝘪𝘯 𝘐𝘮𝘮𝘶𝘯𝘰𝘭 𝟷𝟿𝟿𝟼; 𝟿𝟽: 𝟾𝟸𝟸-𝟽)
If you are worried and see any of the symptoms described above, go to your GP, and he/she will address those issues and eventually refer to a 𝐏𝐚𝐞𝐝𝐢𝐚𝐭𝐫𝐢𝐜𝐢𝐚𝐧, a 𝐏𝐚𝐞𝐝𝐢𝐚𝐭𝐫𝐢𝐜 𝐀𝐥𝐥𝐞𝐫𝐠𝐢𝐬𝐭 or 𝐃𝐢𝐞𝐭𝐢𝐭𝐢𝐚𝐧.
⚠️Do not try a Lactose Free formula if there are worries of a milk allergy! Lactose is the sugar in milk, not a protein.
⚠️Do not try medication for colic, as evidence suggests they are of no use. Often, it is either coincidental improvement or even the placebo effect on parents, as they feel something is being done.
⚠️Simple Food Protein Induced Enterocolitis Syndrome (𝐅𝐏𝐈𝐄𝐒) or Food Protein Induced Proctocolitis (𝐅𝐏𝐈𝐏) is often mistaken for a viral infection causing vomiting and diarrhoea, with occasional blood in stool.
‼️Often, and not wrongly, it may be diagnosed as a 𝘯𝘰𝘯-𝘐𝘨𝘌 𝘢𝘭𝘭𝘦𝘳𝘨𝘺, with the most common being CMPA.
✅This is because it normally tends to have mild symptoms.
⁉️Important to note that severe 𝐅𝐏𝐈𝐄𝐒 is relatively rare and less common than Anaphylaxis!
✴𝐅𝐏𝐈𝐄𝐒 most common triggers:
▶️But can be associated with a long list of food proteins
🧒👧Most children will be able to tolerate the food causing the reaction by the age of 2 or 3 years old. In some cases, it may persist throughout life.
❗Children with recurrent episodes may suffer from poor growth and weight loss - failure to thrive.
✅Usually children will recover very fast from an episode of 𝐅𝐏𝐈𝐄𝐒, as long as appropriate diagnosis and treatment is made.
🔴For severe cases, the best treatment is fluid resuscitation.
⚠️What does not work to treat them:
Though you will often see all of them being used due to the worry it is either Anaphylaxis or Sepsis.
✴In the case of 𝐅𝐏𝐈𝐏, most symptoms tend to resolve by 6 months of age (50%) or 9 months of age (95%).
✳The advice is to reintroduce the causing food into the mother's diet after an exclusion period of 6 months or give it to the child when reaching 12 months of age.
⚠️For both cases, if the child is formula fed be aware that:
1️⃣Medical and dietetic advice needs to be sought before a restriction diet is done
2️⃣It might take 2 weeks for improvement to be seen
3️⃣The child will need and Extensively Hydrolysed Formula (EHF - first choice) or eventually an Amino Acid Formula (AAF - second choice)
❗In the case of a breastfeeding mother, a restriction diet needs to be guided by a dietitian.
✅This is to be sure appropriate nutrition (focusing on protein and calcium) is achieved.
‼️For 𝐅𝐏𝐈𝐄𝐒, there seems to be a 30% chance of people involved to develop either 𝘢𝘵𝘰𝘱𝘪𝘤 𝘥𝘦𝘳𝘮𝘢𝘵𝘪𝘵𝘪𝘴 (eczema), 𝘢𝘴𝘵𝘩𝘮𝘢 or 𝘩𝘢𝘺𝘧𝘦𝘷𝘦𝘳 (allergic rhinitis).
Dr Costa is a Consultant Paediatrician and fellow of the Royal College of Paediatrics and Child Health.