How to read food labels and meet nutrition needs on restricted diets
By Alexis Fissinger, clinical dietitian at CHOC
So, your child has been diagnosed with food allergies . . . or maybe your child has befriended a child with food allergies. Either way, the already daunting task of feeding a child becomes immediately more challenging.
Where do you even start when it comes to making sure their food is safe?
And what about their nutrition? If they cannot eat a major food (or foods), won’t they be missing out on certain nutrients?
These are questions that I get asked frequently as a pediatric dietitian working with food-allergic families.
In this article, you will find the answers to these questions, as well as lifesaving resources and practical tips that you can use immediately to make sure that your child remains safe and nourished.
How to read food labels for allergens
The first and most important thing that you can do to protect your child is to get familiar with reading food labels of packaged foods . . . and don’t ever stop! The more practice you get, the better (and quicker) a detective you will become. Plus, ingredients used in packaged foods often change. Just because you read the label and it was safe last time, does not mean you can assume the product is safe this time.
Thanks to the Food Allergen Labeling and Consumer Protection Act (FALCPA), the nine most common food allergens must be clearly labeled on all packaged foods and vitamins that are regulated by the Food and Drug Administration (FDA). While there are various names for many of these allergens, this act enforces clear labeling of the most common names for milk, soy, egg, wheat, peanut, tree nuts, fish, shellfish and sesame. Furthermore, the type of nut and fish must be specified.
FDA-regulated packaged foods must list the common name for the allergen in at least one of two ways:
- A “Contains” statement near the ingredient list. Example: “Contains milk, soy and egg.”
- No contains statement? Then when we must review the full ingredient list, look for your allergen’s common name which is often noted in parenthesis right behind a potentially trickier name for the allergen. Examples: flour (wheat), whey (milk) and natural flavoring (soy).
Not all allergens may be included on ingredients lists
Unfortunately, not all foods are regulated by the FDA, thus the above guidelines may not be sufficient to ensure your child’s food is safe. It is important to know which foods this act applies to and which it does not. While it is recommended that all foods be labeled in accordance with this act, it is not mandatory for the following:
- Foods regulated by the United States Department of Agriculture (USDA) such as meat, poultry and certain egg products.
- Foods served at restaurants, street vendors, festivals/events, fast food establishments and even some locally-made foods.
- Kosher labeling.
- Other non-food items, prescription or over-the-counter drugs, most alcohol and pet nutrition.
In these situations, it is best to read the ingredient list more thoroughly, making sure you understand what each ingredient is. You will have to be on the lookout for all the many names that your allergen(s) may be called. Visit Kids with Food Allergies for a full list.
Similarly, any food allergen that falls outside of the top nine most common food allergens, does not have to be as clearly labeled. It may even be disguised as “natural flavoring” or other vague ingredients, without specifically listing the allergen. The best thing to do would be to speak to your allergist and a registered dietitian that specializes in food allergies. They can help you learn more about these ingredients. Additionally, it may be best to call manufacturers of food products that have certain vague ingredients.
For all packaged foods, FDA-regulated or not, always read the actual ingredient list and look for the contains statement instead of relying on the marketing on the front of packages. Certain front-label phrases may not actually mean what you think they mean. For example, “non-dairy” and “plant-based” do not mean that the product is 100% free of milk.
Replacing missed nutrients for kids with food allergies
So here’s the fun part. Knowing what foods your child can have is just as important as knowing what they can’t. That’s how we make sure that nourishment is achieved for proper growth and development.
Children with food allergies may be at higher risk for nutrient deficiencies, especially if they have more than one allergy or if the child is going through a picky-eating phase.
Luckily, each essential nutrient that a child needs to grow and develop, can be obtained from more than one food, it’s just about knowing which food to replace with! Knowledge is the first step, and ongoing exposure is the second. The chart below can help you make food choices for your family, to ensure that you present a variety of sources of certain nutrients that may be missing in the diet due to a food allergy.
Allergen replacement chart for kids with food allergies
|Allergen||Main nutrients of concern||Other good sources|
|Milk||Protein, Vitamin B12||Beef, fish, poultry, eggs|
|Calcium, Vitamin D||Fortified* dairy-free milks (oat, nut and soy if not allergic), specifically fortified* orange juice|
|Vitamin A, Vitamin B12, Phosphorus, Riboflavin||Fortified* cereals and dairy-free milks, orange and dark green veggies, beef, eggs|
|Eggs||Choline, Riboflavin||Beef, fish, poultry, dairy, soybeans, fortified* foods|
|Wheat||B vitamins, iron||Fortified alternate grain products (particularly if whole grain wheat-free), beans, lentils, nuts, meat, poultry, fish|
|Peanuts and tree nuts||Magnesium||Beans, dairy, potato, brown rice, fortified*cereals|
|Riboflavin||Beef, fish, poultry, eggs, fortified * cereals|
|Fish and shellfish||Niacin||Poultry, brown rice, nuts, fortified*cereal, whole wheat bread|
Some common themes regarding allergen replacement for kids:
- Fortified breakfast cereals are often an excellent source of a variety of micronutrients that growing bodies need. Plus, they are usually kid-approved! It might be a good idea to include one serving in the daily routine.
- If your child does not eat any animal proteins, there is a greater risk of nutrient deficiencies, and you should work with a registered dietitian.
- A multivitamin can cover a majority of vital nutrients, but not all. If your child has multiple food allergies and is unable to consume the food variety required to make up for lost nutrients, get a multivitamin on board (but check the label!) and consult a dietitian. Calcium, protein, fiber and iron are all nutrients not typically added to multivitamins and may require special attention.
For even more information about managing your child’s food allergy, please visit www.kidswithfoodallergies.org. There you will find a host of reliable resources and topics to help your child live a happy and healthy life. Included are recipes, resources for school and allergen cards for your child and caregivers, and much more!
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At CHOC, we specialize in providing a full continuum of pediatric nutrition services, including inpatient and outpatient services, depending on our patients’ needs.