Clara is 17 months old. At birth she was breastfed, but 2 weeks later cow’s milk-based formula was introduced, which she did not appear to tolerate. Each feeding resulted in diarrhea and vomiting. The pediatrician recommended that her mother switch to a partially hydrolyzed casein infant formula, which Clara seemed to tolerate. However, at age 4 months she developed eczema that was treated with steroid creams. Cow’s milk was introduced when Clara was 12 months of age. Her skin symptoms increased remarkably. When eggs and later peanut butter were introduced, she experienced immediate wheezing; watery, swelling eyes; hives; increased itchiness; and diarrhea. Clara’s parents are unaware of how to look for egg or peanut sources; thus Clara has experienced several trips to the emergency room. The last reaction was much more intense. Her family physician suspects egg and peanut allergies and has sent her to see a board-certified allergist and a registered dietitian.
Nutrition Diagnostic Statements
• Food and nutrition-related knowledge deficit by parents related to food sources of eggs and peanuts as evidenced by serious reactions in their daughter following ingestion.
• Intake of unsafe foods related to ingestion of egg- and peanut-containing foods as evidenced by serious reactions to foods.
Nutrition Care Questions
• How many food allergen suspects are there, and what are they? Why? •
What measures will her parents need to take if Clara is to lose sensitivity to any of the food allergens?
• What other circumstances may arise that may warrant special instructions to caregivers?
• How often should Clara be checked for sensitivity changes?
• What would you tell Clara’s parents to look for on food labels?
• What nutrient substitutions must be considered?