Episode 64: Understanding Food Allergy & Intolerance in Babies and Children

Episode 64: Understanding Food Allergy & Intolerance in Babies and Children

Today we’re tackling one of the most confusing – and often misunderstood – topics in children's nutrition: the difference between food allergy and food intolerance. As a paediatric dietitian, I’ve seen too many families left in the dark, feeling exhausted and overwhelmed, just trying to figure out what’s upsetting their baby’s tummy.

In this episode, I help you untangle the facts from the fear. Whether you’re dealing with a fussy eater, concerned about your little one’s bloating or tummy pain, or unsure how to approach a potential food allergy, I’m here to walk you through it.

You’ll also hear real-life stories from families I’ve helped, and how making the right diagnosis – and nutritional swaps – can make all the difference.

Links
https://nourishwithkarina.com/feedingbabies
https://nourishwithkarina.com/membership

Highlights:

Introduction (00:00.96)
Understanding Food Allergies vs Intolerances in Babies and Children (00:30.382)
Food Allergy vs Intolerance: Understanding the Signs and Supporting Your Child’s Gut Health (02:48.736)
Is It an Allergy or an Intolerance? A Parent’s Guide to Understanding Food Reactions in Kids (05:08.142)
Understanding Food Allergies and Intolerances in Babies and Children (07:17.996)
Gut Health, FODMAPs, and Food Intolerances: What Every Parent Should Know (09:42.072)
Gut Health, FODMAPs, and Food Intolerances: What Every Parent Should Know (09:42.072)
Nutritional Gaps in Allergy-Friendly Diets: What Parents Need to Know (14:13.91)
Meeting Nutritional Needs on Allergy-Friendly Diets: From Fiber to Calcium (16:38.336)
Navigating Common Food Allergies: From Eggs and Soy to Onion, Garlic, and Lactose (18:57.688)
Lactose Intolerance, Plant Milks & Food Labeling: What Parents Need to Know (21:20.044)
Understanding Food Intolerances: What Parents Need to Know About Fructose, Lactose & More (23:40.5)
Managing Food Allergies and Intolerances in Kids: Diagnosis, Substitution & Support (26:03.0)

Show notes

READ TRANSCRIPT

Show Notes

You’ll also hear real-life stories from families I’ve helped, and how making the right diagnosis – and nutritional swaps – can make all the difference.

What we cover in this episode:

1. Allergy vs Intolerance – What's the Real Difference?
We break down the science and symptoms of each, and how to tell them apart.
2. Why Gut Health is the Game-Changer
Learn how a calm immune system and nourished gut can reduce reactions and support your child’s development.
3. What Symptoms to Look For
From chronic tummy aches to skin flare-ups – how allergies and intolerances can show up in unexpected ways.
4. The Hidden Risk of Nutrient Deficiencies
If your child is avoiding foods like dairy, wheat, or egg, I explain what nutrients may be missing and how to safely replace them.
5. Diagnosing Correctly Without Over-Restricting
Why it's so important to get the right support, so your child isn’t missing out on nutritious foods they could actually tolerate.

Show Notes:

More about Karina and Nourishing Kids!

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Karina's popular Nourishing Kids lifts the "food stress" load, giving mums a clear plan to get kids trying new healthy foods and guidance on how to feed their family more easily! Learn more here https://nourishwithkarina.com/nourishingkids

Her Podcast The Easy Feed dives into popular topics - check it out here https://podcasts.apple.com/au/podcast/the-easy-feed/id1710594874

Karina is a regular on Channel 7, Sunrise. Check out her segments here: https://nourishwithkarina.com/press

For online consultations & personalised support. Click here https://nourishwithkarina.com/nutrition-consultation

Karina's popular Kids Food Reviews are here https://nourishwithkarina.com/food-reviews

If you have a Fussy Eater, register for Karina's online training and learn the 3 Essential Steps required to end fussy eating. https://nourishwithkarina.easywebinar.live/endfussyeating

Introduction (00:00.096)
You're listening to the Easy Feed Podcast, episode number 64, Understanding Food Allergy and Intolerance in Babies and Children. Hi there, I'm Carina Savage and with over 20 years experience feeding children, including my own, I've learnt all the secrets that busy mums need to get their children eating better and actually enjoying healthy foods. So a huge welcome to the Easy Feed Podcast.

Understanding Food Allergies vs Intolerances in Babies and Children (00:30.382)
Welcome back. hope you're well. Today I want to talk about understanding the difference and clarifying a little about food allergy and intolerance in babies and children because it's such a confusing area for so many people. Doctors included 100 % respect doctors, but sometimes it's a tricky area for doctors to navigate because they just don't have the time to really

dig deep into the history of your child and to really understand what's going on and make an accurate assessment. Look, they have to be a jack of every single trade. When you go to the GP, you know, whether you've got a blister on your foot or something in your skull, like from literally head to toe, they have to be an expert in everything and insight as well, looking in your ears and your throat and your nose and whatever else.

So I'll leave it there. They have to be an expert at everything. And sometimes diagnosing food allergies and intolerances or even guiding you in that area can be a challenge. And of course, doctors will refer on to allergists and whatnot, but I find so many times, especially in parents of babies, that they just go on this journey of not knowing what's going on, not able to fix it. So these...

poor babies and these poor parents just month after month remain sleep deprived. The poor baby's irritable. They just can't see the light at the end of the tunnel. And it's just because they're not given the right advice. And it's so heartbreaking when you stumble across parents and I've stumbled across many in the last week where they have had this journey.

And I just wish that I'd met them when their baby was eight, 12 weeks old, when this was all unraveling. Now look, food allergy and food intolerance isn't specific to any age. We have babies with both. We have children and teenagers with both. But what we typically see is that allergies will often present in infancy and early childhood and intolerances. So food intolerances will often present from toddlerhood.

Food Allergy vs Intolerance: Understanding the Signs and Supporting Your Child’s Gut Health (02:48.736)
right through to being elderly. So it's slightly different in terms of when it's generally presented, the allergy versus the intolerance. Having said that, I will say there is one kind of outlier there and that is lactose intolerance and babies can definitely suffer from lactose intolerance, especially as a result of an irritated gut from food allergy or a bad gastro virus or something like that. So we do often see.

allergies more in the younger kids and food intolerance from toddler age up. There's those exceptions to the rule. So I do want to unpack a little bit about the difference between food allergy and food intolerance because as I said, it's a minefield and it's quite confusing to try to work out what is going on with your child. And that's where I step in and help families navigate this and come up with a plan to improve their child or their baby symptoms.

and improve their gut health because once we can quieten the immune system and quieten the response, we can actually heal the gut and then the gut actually becomes less agitated and it's not on high alert all the time. And so it's a much calmer environment and is much more able to digest and absorb nutrients more easily without creating a full blown response ready to fight another food protein. So it's not as

agitated and on alert when we calm the immune system down, everything works better and there's much less likelihood of other allergies developing or other conditions, autoimmune conditions developing. So, you know, again, if you've got a child or a baby with suspected food allergy or intolerance, then please reach out to me because specialised in this area, I work with paediatric gastroenterologist and I can definitely help you because it is a really tricky area to navigate.

But look, let's start with understanding food allergies. Now food allergies can present at any age from birth right through to after the age of one. Food allergies are immune mediated. So that is different to a food intolerance because they are usually involving the digestive system rather than the immune system.

Is It an Allergy or an Intolerance? A Parent’s Guide to Understanding Food Reactions in Kids (05:08.142)
So there's the nuance, the difference there. Okay. So let's start by talking about the difference between allergies and intolerances or food allergy and food intolerance. So food allergy involves the immune system. It's immune mediated. So your child's or your baby's immune system overreacts to a certain food protein. Okay.

It reacts to the food protein as if it were a harmful invader and the response typically causes a release of chemicals, which can cause allergic symptoms. Now, even a tiny amount of the food protein can trigger an allergic reaction. And these reactions can range from anything from lip swelling, coughing to hives, to vomiting.

to anaphylaxis, is when you you're struggling to breathe or there's the gut mediated allergy. So this is still an allergic reaction where you can have profuse vomiting, you can have blood in the poo, you can have really soft mucousy poos. So these are gut mediated allergies, but they are still allergies involving the immune system. And this is where it can get a little tricky because food intolerance involves

the digestive system and can present with very similar symptoms. So food intolerance on the other hand, is not involving the immune system, so to speak, allergies do. Food intolerance really relates to an inability to tolerate certain foods, mostly carbohydrates in the gastrointestinal tract.

And look at maybe related to an inadequate amount of the enzyme to digest the carbohydrates. So for example, in lactose intolerance, or it could be related to gut inflammation. Like sometimes we see when you get a bad gastro virus, you can then become lactose intolerant or with babies with milk allergy, often then they can become lactose intolerant because their gut is just not calm. So when your gut has been inflamed by something, you can.

Understanding Food Allergies and Intolerances in Babies and Children (07:17.996)
then get worse intolerances. I see it a lot in teenagers and adults that have had a really bad parasite infection. They've had a really bad Giardia or some other bad bug and it's really destroyed their gut health and their immune health. And then that's caused this sort of secondary, irritable bowel and food intolerance. So food intolerances can include bloating. They can include diarrhea. They can include.

chronic tummy pain, but they're typically not life threatening. Like you're not going to end up in hospital, unable to breathe. It's not like an anaphylactic food allergy, but it is still quite debilitating. I see so many children who miss weeks and terms of school because they have ongoing tummy pain. I only spoke to a mum yesterday who said they've been to emergency. They've done all the tests. I've been to the specialist.

And yet they still can't identify why their 10 year old child is just crippled, bent over in pain because, you know, something is tripping them up. Something is causing their gut issues. I had a similar case a couple of weeks ago in a subsequently fix this child within one 60 minute consultation by taking the time to understand the history, understand what was going on, diagnose what the food intolerance was, and then guide the parents appropriately.

But you really need to understand the difference between food allergy and food intolerance, and then really take the time to understand what foods are potentially causing these symptoms to then try to work out how to fix symptoms of food intolerance. With food allergy, you really need to eliminate the entire protein. So with food allergies, it could be related to milk.

It be egg, it could be soy, it could be wheat, it could be nut, it could be fish, it could be sesame. They're very common ones. It could be shellfish. So they're your most common food proteins that children, babies and children and adults will be allergic to. And skin prick testing won't always show the food allergy. had a patient yesterday, as I said, skin prick test only showed peanut, but we know the child's got a milk allergy and probably a soy allergy as well.

Gut Health, FODMAPs, and Food Intolerances: What Every Parent Should Know (09:42.072)
but it's gut mediated. So it's not going to be picked up on a skin prick test, but it is still a food allergy. So there is that distinct difference between food allergy and food intolerance, but the symptoms can sometimes cross over, especially in babies. I see a lot of children with what you call toddler diarrhea, where they just can't have a formed bowel action. They're always running to the toilet.

urgent loose bowel actions, or they actually struggle to train into outer nappy. So they struggle to toilet train because their bowels are so loose. And this is what they used to call toddler diarrhea, but really it's carbohydrate intolerance. And you might also hear the terminology carbohydrate malabsorption. And that is really the same thing. So basically malabsorbing it, not absorbing it causes the intolerance, causes the symptoms. So the carbohydrate malabsorption causes.

carbohydrate intolerance and you just need to identify what is going on and then you can work out how to help. Now with food intolerance, it could be a whole host of different carbohydrates. And there is a collective name for a number of these carbohydrates called FODMAPs. The collective name is actually lengthened to fructo, oligo, di, mono and polysaccharides. And basically that's all different types of carbohydrates.

grouped together and that's because all of those groups could potentially cause those food intolerance symptoms. Now there are factors that will increase the risk of food allergy or increase the risk of food intolerance. With babies, definitely there are many factors which influence

the risk of food allergy and it's directly related to how the immune system develops over the first 12 months or the first thousand days really, which starts when you're in, your baby's in utero. So really the development of the gut microbiome is crucial in determining how badly or whether your baby's going to develop food allergies because that gut microbiome will either

How Birth, Antibiotics, and the Microbiome Shape Food Allergies and Intolerances in Children (11:53.546)
Increase or dampen the reaction to food proteins. And we know that babies born preterm or born via C-section or given a whole lot of antibiotics in the first year or raised in a really sterile environment with any other siblings or dogs or cats or anything around, not playing in dirt. There's so many factors that will influence the development of a child's or a baby's microbiome, which then directly impacts.

their risk of developing food allergy, when solids are introduced and how they're introduced. Again, another thing that I talk to parents about all the time, because it's important to as much as possible get it right so that we reduce the risk of your child developing food allergy. Because once they've got it, then the immune system's already off and running and it's heightened. And then we have to do what we can to try and calm it down and dampen the immune response and really create what we.

called in the scientific medical world, oral tolerance. That oral tolerance is what's so important to develop the tolerance for these proteins so that we don't have these allergic reactions. With food intolerance, same thing. I see so many little ones that have been smashed with antibiotics because they've needed to, because they've had your staph infection, they've had all sorts, but the antibiotics, whilst it's killing one bug,

The bad bug is also killing good bugs and it can impact their gut health, their microbiome and therefore it can increase the risk of food intolerance and therefore symptoms related to that food intolerance. And as I said, those symptoms could be bloating, it could be being doubled over in pain, cramping. It could be diarrhea. Sometimes it's constipation. There's this new area of lactose intolerance emerging where they're realizing that

You can actually get constipated from lactose as well, traditionally we always thought it was just the loose mucous POOs. So if your little one is allergic to one or more food proteins, it is important that they are meeting their nutrient requirements because when you're taking out milk, soy, wheat, egg, nut, one or more of those, it can compromise certain nutrients.

Nutritional Gaps in Allergy-Friendly Diets: What Parents Need to Know (14:13.91)
Now look, we can easily substitute for dairy free with, with other protein and calcium rich foods. And most of the time, the formula or the milk's source that we move them onto, the milk substitute will have calcium. But it's about making sure that substitute protein and calcium is found in those other foods. Same with if you are egg free or wheat free, definitely with the wheat free, basically gluten free, you need to make sure that we are

substituting with other foods that are going to provide a good source of whole grain and fibre because that's often a nutrient that might be compromised when you're wheat out. Also, we need to factor in iodine and folate and thiamine because these three nutrients are fortified in all of our wheat in Australia because they identified that we don't get enough of these. And so it's mandatory that

All of our wheat in Australia, so our bread, our pasta, everything that's made in Australia has been fortified with folate, thiamine and iodine. So those following a wheat-free or gluten-free diet need to be mindful of this because especially thiamine when they've studied adults on a gluten-free diet, that's the nutrient that was most at risk. And that is B1, vitamin B1, thiamine. If there's a fish or shellfish allergy, then we need to factor in amigas, making sure that there's a substitute, amiga.

source, whether that's flaxseed, chia, walnuts, or supplements there. I see plenty of families that have little ones with multiple food allergies. And in that situation, it's incredibly important that you do seek help from someone like myself, a pediatric dietician, which can put it all together for you. I can go through your day, your baby's day, I should say, and look at all the different foods that the baby's having in conjunction with the milk that they're having in the sauce.

whether it's a plant milk or a formula, often it's an allergy formula and make sure that all the protein, the iron, the zinc, omegas, everything is covered. And that's so important for the developing baby. The same goes for toddlers and children with food intolerance and allergies, of course. So what I just said about babies with allergies, same goes for children. But with food intolerance, same thing. If we are wiping out big chunks of carbohydrate groups, it's important to make sure that we are still

Meeting Nutritional Needs on Allergy-Friendly Diets: From Fiber to Calcium (16:38.336)
meeting their requirements for fiber, for vitamins. Look, I see some kids that eat no fruit or vegetables and they don't necessarily have food intolerance, but vitamin C is at risk in that situation. And look, you don't need to have bucket loads of it. In fact, you don't want to have too much in a supplement form, but it is important that you are getting your vitamin C requirement and also making sure that you're getting enough plant rich food because fiber is the most amazing fuel source for the gut microbes.

It's what they survive on and they must have fiber to stay healthy so that the gut microbiome is well populated with a good amount of good bacteria and the immune system can be calm and work highly effectively. So sure we can use supplements sometimes and I certainly talked to parents about that if we need to, either in my one-on-one online consultations or when we catch up in our private calls inside nourishing kids, but

At the end of the day, it's better if you can supplement with natural food sources. For example, yesterday in the chat inside Nourishing Kids, in our private chat group, one of our mums said, look, we're completely dairy free. I just want to make sure that my little one's getting enough calcium. And we were talking about all the calcium rich foods and she popped up one of the, she posted one of the calcium supplements that she'd been recommended. And I gave him my thoughts on that. We talked about how much is needed and whether.

You go for the EAR, which is the Estimated Average Requirement, or whether you go for the RDI and just those sorts of conversations we have all the time. And it was, yeah, it was really good to show her how you can definitely meet calcium requirements being dairy free. You just have to substitute the right foods. And the same goes for soy. Soy, think you can get away with avoiding.

more easily, unless you're a vegetarian, then that leaves a big hole. Hopefully there's not too many people who are vegetarian that have to avoid soy because of allergies, because soy is such a beautiful protein for vegetarians. It's amazing and it's adaptive. You've got your edamame, you've got your tofu, you can do so many different ways, whether it's scrambled or fried, it's Akadashi tofu. Yum. Just be aware that soy is often in most breads, soy powder. You can definitely get milk in.

Navigating Common Food Allergies: From Eggs and Soy to Onion, Garlic, and Lactose (18:57.688)
soy free bread, but most bread has soy in it. But soy is one that if you were to avoid, you are less likely to be at risk of nutritional deficiency. Unless you're a vegetarian or vegan. Eggs is a tricky one. Eggs are pain in the butt because with eggs, it's used in baking. It's used in so many different dishes or glazing sausage rolls with egg, or it's used as a binder in things like meatballs and

Egg is used in a lot of things, zucchini slice, French toast and of course the regular scrambled eggs to state the obvious there. But it's something that is, can, if you're eating other protein rich foods, even if you're a vegetarian and you're having plenty of soy and tofu and nuts and seeds and grains, absolutely you can replace the protein, but it's just more the challenge to avoid it from a food allergy perspective because it is everywhere.

And there's actually great egg replacers that you can get in supermarket now to substitute for egg. You can also use the liquid in tinned kidney beans and chickpeas, it's called aquafava. That's a good substitute for egg. Or you've got chia or you've got avocado, you've got banana. They're also good substitutes for egg in baking or cooking. Eating out can be a real challenge, especially with food allergy, but also with food intolerance because

Often, especially if it's onion and garlic, I find it's more the teenagers that have intolerances to onion and garlic rather than little ones. But onion and garlic's in everything. Lactose is another one that can be a bit of a challenge. Trying to find lactose free products in Japan when we went in January was time consuming to say the least. And then I think I've actually wrapped my head around it because my son tolerated milk so well over there.

And then I was Googling it and I feel like a lot of Japan are lactose intolerant. So I'm actually just wondering whether more of the milk is actually low lactose over there anyway. I'm even using Google translate. couldn't get this information. Didn't say lactose free, didn't say 80 % reduced lactose or anything. But I came to this conclusion myself because he tolerated it well, but even lactose intolerance can be quite challenging.

Lactose Intolerance, Plant Milks & Food Labeling: What Parents Need to Know (21:20.044)
because not a lot of places have lactose free milk. It really depends on whether you're in the main city or even some main cities, the cafes tend to have oat or almond or soy. And I think it is getting more and more common in cafes, especially as we recognise that lactose intolerance is everywhere. So hopefully it will become easier for people to choose that because it's a challenge.

Having said that, I think it's better just to go to plant milk anyway. The reason we are all lactose intolerant is because we weren't meant to milk at this age anyway. You've probably heard me rant on about this before, but it's actually the reason why we often don't tolerate lactose because it's milk made for baby cows, not for baby humans. And so we don't tolerate it past weaning. We're the only species that consumes milk past weaning. And we're actually not even drinking breast milk, we're drinking another

animals breast milk. So it's the reason why there's so much lactose intolerance. And I think that's why you'll see more and more lactose free products on the shelf, lactose free yogurt, lactose free cream, lactose free milk. And you'll see it more and more in cafes. with the labeling with food allergies, I think it's really up to personal preference with how strict you are. And look, it's still a minefield in terms of the manufacturers can still just put on the product.

may contain traces of nuts, may contain dairy when they don't need to clarify the real risk, which hopefully in the future changes, but at the moment it's not. And so I think it really depends on the severity of the food allergy. If your child is anaphylactic, then of course you would probably avoid the may contain products as well. But if your child might just have a vomit or have a sloppy poo.

then it might be fine to include the may contain because there's every chance that they are okay. It's just that it's a risk. Okay. So at end of the day, the food companies are doing it to cover their butts. The same thing with may contain gluten. They're just doing it to cover their butts so that they don't get sued. And it's likely to be okay. If you've got a child with severe food allergy, then I would definitely still avoid the may contain. But if it's manageable, then I would just go ahead and use it.

Understanding Food Intolerances: What Parents Need to Know About Fructose, Lactose & More (23:40.5)
unless you could find an alternative that didn't say may contain the protein that your child is potentially allergic to. Food intolerances. It's harder to avoid by reading the food packet because it's really these carbohydrates are grouped into food types. So you've got fructose, which is high in some fruits. You've got lactose, which is in milk. You've got sorbitol, which is in

some fruits, other foods such as avocado, which is technically a fruit. Then you've got Manitou, which is mostly in vegetables. And then you've got fructans, which is in wheat, rye, onion, garlic. And then you've got galactans or gos, which Galacto oligosaccharides is the technical nerdy name for it. Sorry, I shouldn't have even said that. That's what it is. If you say gos, that's what it means. And that is things like legumes. So you've got all these different groups. There's really six groups and it's not like you're going to read

necessarily, you might read fructose on there, but you're not going to read fructans on there. You'll read onion or you'll read garlic. So it's a little trickier to navigate the food intolerance world on your own, unless you really know, A, what the food intolerance is and then B, the foods that sit under that group that you, your child or you may be intolerant to. And that's where I come in. So.

Look, both areas, allergies and intolerances are very challenging to navigate at times. And I think two most important things is one is that you are accurately diagnosing what is going on was actually three. So one is you actually diagnosing what's going on, whether it's a food allergy or food intolerance. Number two is you actually understand what the problem is and how many food allergies or food intolerances there are.

So that you're not avoiding too many so that you're not just restricting eight different things when your child only needs two things restricted. And not that you would do this intentionally, but I've definitely seen situations where this happens. And then three, is it making sure that the foods are substituted appropriately? Because if we're not substituting appropriately, that's when whole food groups and nutrients.

Managing Food Allergies and Intolerances in Kids: Diagnosis, Substitution & Support (26:03.0)
can get lost and missed, and then there's an increased risk of nutrient deficiency. So it's really those three things. It's having a proper, accurate diagnosis, whether it's a food allergy or intolerance, knowing exactly what the food allergies and intolerances are and not having avoiding too many, only avoiding the ones you need to. And then three is substituting appropriately. And that is really key because that's where your child's nutrition could be at risk.

And we always want to be monitoring a child's growth, weight, height, bowel actions, bowel health, because they're good indicators of the child's overall health. Now I've got a number of parents inside nourishing kids in my membership where we talk about a lot of this stuff because it's very common, food allergies, one in 10 kids. So it's a great supportive environment where I can help you with these questions around nutrients.

adequacy, like the question about calcium yesterday and the little one that's avoiding dairy. If it was for a full new assessment and plan, then that requires a one-on-one consultation. But if you're just needing ongoing support throughout the journey, then absolutely, Narration Kids is a great opportunity to connect with me. We have Fortnite League Q &A calls and it's just a really supportive.

environment where you have professional guidance along the journey. So reach out to me. Find me on Instagram at nourishwithcarina. me a message or send me an email. Hello at nourishwithcarina.com. K-A-R-I-N-A. Please leave me a review on this podcast episode. I'd love to hear from you, hear what you think about this podcast and let me know what you're loving about it. I will wrap it up there. Until next time, friends, take care. Bye for now.