What to pay special attention to in the preparation of meals in elimination diets

An elimination diet for children attending a nursery or kindergarten can be a challenge for both the person planning meals and the child who begins to notice the differences in dishes and ingredients on their plate.

Understanding the elimination diet is a key element that can positively impact the cooperation between the facility and the parents of a child with special nutritional needs.

As long as the elimination of products or ingredients of a dish does not occur as a result of the parent’s beliefs but as a result of a medical diagnosis – the removal of an allergen (allergy) and/or an intolerant ingredient (intolerance to, e.g. lactose, fructose) from the diet is an important element of balanced nutrition for children and prevention of an allergic reaction or anaphylactic shock after contact with the allergen.

The impact of an allergen, i.e. substances that cause a specific hypersensitivity reaction in a child, can manifest itself through, among others, rash, itching, skin lesions, sneezing, excessive nasal discharge (the so-called runny nose), in the worst case anaphylactic shock. Many allergens can be found in the food we eat – directly as a dish, e.g. a dish with fish, or as an ingredient of a dish, e.g. eggs, as an addition to the mass when making meatballs, pancakes or cakes.

Therefore, every facility where meals are served must provide a menu with indicated allergens so that the parent can make a safe choice of meals for the child.

In practice, we most often encounter the need to eliminate cereals containing gluten, eggs, milk and milk products, nuts, and fish. Less often, we encounter the need to eliminate celery or sesame.

So, what is worth paying special attention to.

Planning. When planning the menu, it is important to remember about interchangeable groups for ingredients that are allergenic or that are intolerant to the child. In the case of gluten-free diets – a substitute for gluten groats, bread, and pasta made of durum flour – substitutes in the group of cereal products will be cereals naturally containing gluten: buckwheat, millet, quinoa, and rice. As part of breakfasts, we will offer children buckwheat, rice soups, milk soups with gluten-free noodles (soy, rice, gluten-free flour), and bread baked from gluten-free flour. Certified gluten-free products have a crossed-out grain symbol.

If cow’s milk protein is eliminated, products from the legume group will be substitutes. Calcium-fortified plant-based beverages (except soy drinks). We increase the amount of protein-rich foods: meat pastes, poultry, rabbit, pork, fish, and eggs, if tolerated, as well as hummus. Kale, broccoli, parsley, or sesame are good sources of plant-based calcium.

A substitute for eggs will be aquafaba, the liquid from under-boiled chickpeas, ground linseed, mashed banana, and apple mousse – depending on the dish we need to use the egg for.

In the case of a swap for scrambled eggs, you can offer your children plant-based tofu prepared like traditional scrambled eggs with the addition of curry to obtain the colour of the egg.

A portion of fish can be substituted for a portion of poultry, eggs, or legumes (natural tofu)—although they will not provide omega-3 fatty acids in any way. A plant-based source of omega-3 is ALA, which can be converted into EPA and DHA in the body. It is a kind of substitute for fatty acids obtained from fish. That is why it is worth adding linseed and linseed oil.

 

When planning and undertaking elimination diets in a facility, it is worth talking to parents to find out what products and dishes have already been introduced into the diet. It is important that the team preparing meals has technological work in compliance with GMP and GHP. The whole team must understand the need to maintain careful production to avoid contamination of the food with an allergen.

I encourage you to include fresh, local and seasoned ingredients on the menu, avoiding processed foods. When choosing substitute dishes, let’s take care of their similar appearance and consistency to a conventional diet (children love to look at each other’s plates).

Keep in mind that each child may have different dietary preferences and restrictions, so it’s essential to be flexible and tailor meals to each child’s individual needs.