Monday, 9 February 2015

Back to the dietitian... a routine visit, for dairy free 'Baby'

'Wow you've grown!'

is what they said to 'Baby' at our most recent appointment! Or words to that effect!

And yes, I must admit, she certainly has!

My purse has been sending me that message for some while, now - I've already had to buy her almost a complete new set of school uniform and she only started school in September!

So that was the good thing about our appointment - confirmation that 'Baby,' despite her milk allergy, is thriving well.

Must admit, there wasn't much else we gained this time, as what with the nature of 'Baby's' allergy being Non-Ige, all 'Baby's' milk challenges are carried out a home - supposedly at six monthly intervals. However, all our attempts to challenge her with baked milk recently, have been frustrated by her frequent unexplained tummy aches (which I am still trying to get to the bottom of) and by her picking up various illnesses from school. 

As I've mentioned before, you have to be well in order to carry out a milk challenge* and as her reactions to milk are mainly delayed gut-related reactions, I've no idea whether these tummy aches have been cause by accidental exposure to milk, or whether she's picked up some bug. If it is an accidental exposure to milk, it would leave her gut needing a break to heal up, and get better... so we keep waiting for a golden window of opportunity to appear! 

So what did we get up to?

1) Each time we go, they check 'Baby's' measurements. 

They weigh her. These days, it requires a much bigger set of scales:

The scales!

And they measure her height, on this height chart:

No, she hasn't reached the clock, just yet!

2) We discuss her food intake. 

This enables the dietitian to see if 'Baby' was getting the right balance of food overall. It also enables her to recalculate 'Baby's' calcium intake - to ensure that she's not missing out. The dietitian might offer some tips, on how to improve intake, if required. This was especially useful in the early days of weaning.

Stupid me, sits there at this stage, 'umming' and 'ahhing' a lot, as I try to cast my mind backwards and think about what we've been feeding our little one. Only after the appointment (DOH!), does it occur to me that next time, I should be more organised and take the following, as I think this would make things a bit easier:

  • a copy of the school's three week lunch plan 
  • a meal plan for a 'normal' week at home
  • a more precise calculation of her daily dairy free 'milk' intake (including how much she has at school)

3) We also discuss her progress (or lack of progress) with the 'Milk Ladder,'* along with any other concerns that we might have.

At the moment, we still need to attempt a baked milk challenge every six months (assuming that 'Baby' is well), but like I said, we're still working on this one.

Originally, when we saw our first dietitian, we went through the same sort of process, but 'Baby' was weighed on a very different set of scales, and, at that time, as a breastfeeding mother, my intake was closely monitored too! We also had appointments quite regularly - at least every 6 months. However, 'Baby' being older now and having moved house to a new area, our appointments have been scaled back to yearly intervals. In fact I got the impression they were not that fussed about seeing us at all! 

I can understand why:
  • She's had all the tests, both blood tests (she wasn't keen on those) and skin prick - (much more harmless)! The tests revealed nothing - except that her allergy is Non-Ige mediated*. That means she's not got the life threatening version (panic over, 'cos at one stage 'Baby's' was having some interesting rashes).
  • We've been managing her dairy free diet successfully at home for a while now, so there's not all that much they can teach us there, now that we've 'learned the ropes,' so to speak! 
  • There are so many children developing food allergies these days and so few allergy professionals (by comparison) that they've got quite patients already!

We only had one thing to test, but it still took up most of her arm!

So, why do we go?

  • We're still hovering around step one of the milk ladder.* We thought we'd achieved this step in the summer, but then, what with various things going on; emptying our old flat for sale, family illness etc. we had a short break and then it seemed that 'Baby' was no longer tolerating the malted milk biscuits. GRRR! As, we're still hoping to work our way up the said milk ladder, I wish to keep my foot in the door (as it were) with the dietitian - in case I need to refer back to her for advice.
  • I want them to keep monitoring her. Yes, we're doing okay with her at the moment, but this may not always be the case! I want to keep her on the books, to make sure she doesn't end up forgotten - like an old teddy bear, deteriorating in a dusty box in the attic.
  • To get updated nutritional advice - the dietitian's handout on calcium sources has significantly more content than last year!
  • Also, just on the off-chance that some new miraculous discovery could advance 'Baby's' ability to tolerate cow's milk, I want to be in there with my appointment already. After all, it took us long enough to get an appointment in the first place!!

Of course, what I really long for, is the day when 'Baby' outgrows her allergy, and a visit to the dietitian is no longer required...

* Glossary:

Milk Challenge - when you try to find out whether an allergic individual is still allergic to milk, by giving them a small amount of milk, in some form. If severely allergic, this will take place within a hospital setting. If not severely allergic, this will take place at home, according to instructions provided by your Health Care Professionals.

Milk Ladder - the term given to a structured approach which is used to reintroduce cow's milk to children with a cow's milk allergy. It is based on the premise that if children can be found to tolerate baked milk (apparently 80% can), they should consume it regularly. Their bodies may then be induced to progress gradually to accept cow's milk in other forms. As a result, they are more likely to outgrow their milk allergy. I have seen several examples of milk ladders. They all work on the same principle. My preferred version has the approach broken down into twelve stages.

Non-Ige mediated food allergy - is one that does not present symptoms immediately. Reactions may occur hours, or even a few days later. This kind of food allergy does not show up in tests but is diagnosed via food elimination, followed by a challenge, in which the suspected allergen is reintroduced.

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