Q: My 10-year-old daughter is allergic to tree nuts and shellfish. As a result, she is suspicious of trying new foods. Her diet consists of bread (homemade); chicken fingers (if we dine out); potatoes (baked, and the occasional french fry); eggs (scrambled); steak; pasta (no sauce); and Lucky Charms cereal.

While I want her to be cautious in deference to her allergies, I would like her to eat more nutritiously. I don’t want to start a food battle, which is where we’re headed. — Via email

A: You’re right to try to avoid food battles, which parents can’t win.

You might start by addressing the allergies generally. Ask your daughter’s pediatrician about your consulting a pediatric allergist.

Occasionally allergies diminish as a child matures. In some instances, the allergist may consider a re-exposure test — exposing the child to the allergens to see if the reaction still occurs. Note: Do not try to test on your own. It must be conducted in a clinic or hospital where emergency equipment is available if needed.

Readers may wonder why this test would ever be worth the trouble. But parents of children with allergies that can trigger life-threatening reactions know how unsettling it is to live under such conditions, and how difficult it is to avoid the trigger foods. Even foods supposedly free of dangerous ingredients may be contaminated with trace amounts in food-processing plants.

The allergist can review for you exactly what the risks are. A clear emergency plan will reassure the whole family.

A child this age should always carry her own self-injectable epinephrine shot and should know how to administer it. Extra self-injectable epinephrine should also always be available wherever the child is — at home, school and camp. At least one adult should also be trained to administer the shot.

Everyone needs to know what the earliest signs of an allergic reaction are, and how to respond with an epinephrine shot immediately, followed by a trip to the emergency room.

As for your daughter’s diet, it sounds as if vegetables, whole grains and fruit are missing, and could be safely added — particularly if they aren’t processed. Chicken, eggs and steak are good sources of fat and protein. (Sugary cereals aren’t a healthy choice, but skim milk would add protein and calcium.)

Since she likes eggs, you might offer an omelet with a bit of cheese, green peppers, tomatoes, or spinach. Give her a choice, and if she’s not ready to try, don’t make an issue of it.

To vary her diet, you can try pasta made out of rice, quinoa (with amino acids that help build proteins), or Jerusalem artichokes. Check the labels to be sure these foods contain no tree nuts or shellfish, and that they are made in plants free of those ingredients.

Since you make your own bread, you might want to mix in bananas, zucchini, or other fruits and vegetables. Start with a tiny amount. Try using flours made from a variety of different grains — again, checking to be sure they aren’t processed in plants that handle tree nuts. One way to reduce the fear of processed foods is to make as much food as you can from scratch — for example, tomato sauce.

Such precautions will help to make mealtimes relaxing and sociable. Unfortunately, eating may have become associated with anxiety and a sense of danger. If you all know the food on the table is safe, everyone can relax and enjoy each other’s company. It may take a while, but once your child has learned to look forward to meals as a chance to be together, she may be less hesitant to depart from the usual menu.

You may have to present a new food many times before she takes a bite. It’s important to remain patient and not rush her. With food allergies, at least half the battle may be to avoid food battles.

Questions or comments should be addressed to Dr. T. Berry Brazelton and Dr. Joshua Sparrow, care of The New York Times Syndicate, 620 Eighth Ave., 5th Floor, New York, N.Y. 10018. Questions may also be sent by email to:

nytsyn-families@nytimes.com

 

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