Althéra Recipe folder Tips and advice for those who have been prescribed Althéra Nestlé HealthCare Nutrition supports the WHO code which states that breast milk is the best nutrition option for babies NOURISHING PERSONAL HEALTH
Contents Cow s milk protein allergy 3 Symptoms, treatment, lactose intolerance 4 Tips and advice 5 Calcium requirement in cow s milk protein allergy 6 Althéra for children with cow s milk protein allergy 7 Tips and advice about Althéra, storage and shelf life 8 Cow s milk protein allergy Allergies are becoming increasingly common, especially in children. Allergy to cow s milk is caused by an immunological reaction to cow s milk protein. It usually becomes noticeable early in life; often when the child first comes into contact with cow s milk, for example in porridge, gruel or other infant foods. Approximately 2-3% of children have an allergy to cow s milk protein, but most outgrow it before starting school. There is currently no good answer as to why allergies occur and why they are increasing in the Western world, even though some factors that affect the development of allergies have been identified (see figure below). Recipes with Althéra 9 My own recipes 14 Food allergies occur when the immune system reacts to common substances in the environment. Genetic background Exposure factors Foods Environment (e.g. dust, dust mites, pets, pollen) Sensitization of the immune system Allergy symptoms (e.g. eczema, asthma, hay fever) 3
Symptoms The most common symptoms are rash (eczema and hives) and gastrointestinal problems such as colic, diarrhea, vomiting and nausea. Other common symptoms are loss of appetite, general discomfort and poor growth. Treatment If the child has been diagnosed with cow s milk protein allergy, all products containing cow s milk protein must be excluded. If you are a breastfeeding mother, you may need to exclude all dairy products from your diet. If the baby is receiving formula, this must be replaced with an alternative that is completely free from cow s milk protein. Dietary supplements introduced later on must also be free from cow s milk protein. Note that milk from other animals, such as sheep and goat, is equally badly tolerated and should therefore also be excluded from the diet. Lactose intolerance It is important to distinguish between cow s milk protein allergy and lactose intolerance. Lactose intolerance involves a complete or partial lack of the enzyme (lactase) that breaks down milk sugar (lactose). Most people with lactose intolerance can tolerate hard cheese (which contains only small amounts of lactose) or smaller amounts of milk, soured milk and yogurt. People with cow s milk protein allergy need to exclude these products completely. Breast milk is naturally high in lactose and lactose intolerance normally develops later in life. Since milk is a staple food and is included in many other foods, you should consult a dietitian or doctor for specific advice. Tips and advice for those advised to avoid cow s milk protein! Do not use products that include the following in the list of ingredients: Sour cream, crème fraîche Powdered creamer Casein/caseinate/sodium caseinate/ calcium caseinate Lactose * Milk chocolate Margarine (if not milk-free) Soft whey cheese, whey cheese Milk albumin Milk, soured milk, yoghurt, cream Caseinate Cheese, cottage cheese, quark Butter Skimmed milk powder Powdered milk Whey/whey powder * Except for Althéra which contains purified lactose. Always read the list of ingredients carefully. Bear in mind that ingredients can be changed in a product that you regularly buy. Note that the following products may contain milk protein: Bread baked with milk or margarine that contains milk. The bread may also have been glazed with milk. This same applies for pastries, cakes and biscuits Stock cubes, liquid stocks and seasoning mixtures Meat products such as sausages and liver paté Cocoa powder Sweets and chocolate (including dark chocolate) Processed and semi-processed products such as powdered sauces or fish cakes Meringues may be baked with milk protein instead of egg Muesli, cereals, breadcrumbs and batters Sorbet 4 5
Calcium requirement in cow s milk protein allergy As the child gets older, the need for calcium increases. Calcium is primarily found in milk and dairy products. Althéra provides for calcium requirements during the first 6 months. The recommended intake of calcium for children over 1 year is 600 mg per day. 100 ml Althéra gives 41 mg of calcium. For children older than 1 year, Althéra can be seen as the child s alternative to regular milk, and can be combined with other foods to meet the child s calcium needs. The following is an example of a day s menu that meets nutritional requirements, including calcium, for children aged 1-3 years. Daily menu Morning: 200 ml premixed Althéra or Althéra gruel (see recipe) Althéra for children with cow s milk protein allergy Althéra from Nestlé HealthCare Nutrition is a formula that is completely free from cow s milk protein and has the same nutritional content as a regular infant formula. It has been tested in clinical trials and is a safe, nutritionally complete and good-tasting choice of formula for small children. Althéra can be used as the sole nutrition from birth up to 6 months, and later as a dietary supplement. The proteins in Althéra are broken down (hydrolyzed) into smaller units that the body does not react to. Althéra contains purified lactose (milk sugar), which is guaranteed to be free from cow s milk protein and gives Althéra its tasty flavor. Note that the child should not eat other foods containing lactose, as few producers can guarantee that the lactose is free from cow s milk protein. Nestlé HealthCare Nutrition supports breastfeeding and believes that breast milk is the best nutrition option for babies. Breakfast: Snack: Lunch: Snack: Dinner: 1 serving oat porridge with 100 ml premixed Althéra and stewed fruit or 1 serving fruit porridge 1 banana 1 serving turkey stew with rice and vegetables 100 ml enriched oat drink 1 sandwich with milk-free margarine and ham. 150 ml Althéra 1 serving fish stew with potato, 100 ml enriched oat drink Evening meal: 1 serving Sinlac porridge with fruit puree 6 7
Tips and advice about Althéra If the child is under 6 months The child can be given breast milk in combination with Althéra. If the child received formula before the diagnosis, you can gradually move to using Althéra for a few days, giving the child time to get used to the new taste. When it s time for first food In accordance with the recommendations of the Swedish National Food Agency, very small first taste portions should be introduced when the child is four to six months old, at the earliest, while continuing a complete breastfeeding/formula routine. At about 6 months it s time to start getting the child used to eating solid food. Continue to breast feed or give formula during this period.start with a teaspoon or so in the first few days, gradually increasing the amount. There are no rules as to what foods to start with. The most important thing is that the food is soft so that the child does not choke. You can, for example, mash some boiled potato or root vegetables, rice, boiled chicken, fish, mince, lentils or beans. Add a little breast milk or formula to get the consistency of soft mash. For mashed banana, apple and pear, simply scrape the peeled fruit with a spoon. It s also a good idea to add a little neutral oil to the food in order to increase its energy content (e.g. rapeseed oil). Avoid all milk and dairy products. In recipes that include milk, you can replace it with the same amount of premixed Althéra. Althéra is easily soluble when mixed with water. Storage and shelf life Only prepare one meal at a time. Warmed or left over mixture should always be thrown away. Opened Althéra cans should be stored at room temperature and used within 3 weeks. Unopened cans keep until the best-before date, and should be stored at room temperature. Recipes with Althéra The recipes on the following pages are suggestions for ways to use Althéra in food for children. Porridge and gruel Althéra gruel 1 serving 5 scoops Althéra powder 2 tablespoons milk-free oat flour Bring water and oat flour to the boil while stirring. Boil for 2 minutes and whisk in Althéra powder. Corn gruel 1 serving 2 teaspoons cornflour 5 scoops Althéra powder Mix the water and cornflour, bring to the boil and simmer for a few minutes. Allow to cool and whisk in the Althéra powder. Tips: In recipes that include milk, replace with the same amount of premixed Althéra. Preparing Althéra Powder Water Premixed amount 3 scoops (13.2 g) 90 ml 100 ml 4 scoops (17.6 g) 120 ml 130 ml 5 scoops (22 g) 150 ml 170 ml 6 scoops (26.4 g) 180 ml 200 ml First wash your hands. Immerse the bottle, teat and cap in hot water. Boil them for 5 minutes. Keep them covered until use. Boil tap water for 5 minutes. Allow to cool (40 C ). Pour the exact amount of cooled water into the bottle (see table). Add the given number of level scoops of powder. Shake the bottle until the powder has completely dissolved. 8 9
Buckwheat gruel 1 serving 1 tablespoon buckwheat flour 6 scoops Althéra powder Mix the water and buckwheat flour. Bring to the boil and simmer for a few minutes. Remove the saucepan from the heat and mix in the Althéra powder. Allow to cool before serving. Corn porridge 1 serving 150 ml water 4 scoops Althéra powder 2 tablespoons polenta Mix all the ingredients and simmer for about 5 minutes. Allow to cool to the right temperature for eating. The porridge can be flavored with 50 ml of fruit puree or half a mashed banana. Rice pudding 1 serving 150 ml water 4 scoops Althéra powder 6 tablespoons PAMA Instant Rice Mix water and Instant Rice and simmer for 2-3 minutes. Mix in the Althéra powder and allow to cool to the right temperature for eating. Eventually, the rice pudding can be flavored with 50 ml mashed banana or fruit puree (blueberry, mango or other). Semolina pudding 2 servings Fruit porridge (large serving) 5 scoops Althéra powder 100 ml rolled oats or spelt grain 50 ml stewed fruit or berries 50 ml fresh or frozen berries Mix water and grains and boil to make a porridge, about 3 minutes. Mix in Althéra powder followed by the berry or fruit puree. Purees and taste portions Potato puree 1 serving 50-100 ml premixed Althéra Around 150 g peeled, boiled and mashed potato 1 teaspoon milk-free margarine Use newly boiled and mashed potato. The amount of Althéra can be increased in the beginning, to give the puree a looser consistency. Vegetable puree 1 serving 50-100 ml premixed Althéra 100 g potato 50 g carrot/parsnip 1 teaspoon milk-free margarine Boil and mash the vegetables. Add the Althéra mix and margarine. The amount of Althéra can be increased in the beginning, to give the puree a looser consistency. 200 ml premixed Althéra 2 tablespoons semolina Simmer for four minutes and allow to cool. Mix with e.g. fresh or frozen berries, fruit puree or Nestlé Frutti. Serve cold. 10 11
Snack Small oat pancakes 2 servings 1 egg (or egg replacement such as No Egg ) 200 ml premixed Althéra 75 ml wheat flour 75 ml rolled oats Milk-free margarine for frying Mix 100 ml Althéra with the flour and oats. Whisk until smooth. Add the egg and the rest of the Althéra. Fry small pancakes. If using egg replacement, follow the instructions on the package. Pancakes 1 serving 1 egg (or egg replacement) 200 ml premixed Althéra 100 ml wheat flour Salt if required Milk-free margarine for frying. Mix 100 ml Althéra with the flour, and whisk lightly. Add the egg and the rest of the Althéra. Fry in a small frying pan until golden brown on both side. Serve with favorite fruit conserve. Apple rice 4 servings 400 ml water 150 ml pudding rice 3-4 apples, peeled and sliced 1 2 tablespoons sugar (optional) Boil the water. Add the rice and apple, and simmer for 20 minutes on low heat. Add sugar to taste, and simmer for a few more minutes. Serve with premixed Althéra. Smoothie 2 servings 200 ml cold premixed Althéra. Mix with one of the following: ½ banana and 2 tablespoons fruit juice ½ conserved/stewed pear half 2 tablespoons blueberries and 2 tablespoons raspberries (preferably frozen) 1 small jar Nestlé fruit puree or Nestlé Frutti For a thicker smoothie, add more fruit or reduce the amount of Althéra. Oat smoothie 1 serving 150 ml premixed Althéra 2 tablespoons rolled oats 1 small banana or 100 ml fruit puree Mix all the ingredients to a smooth consistency. Serve! Sauce Bechamel sauce 2 tablespoons wheat flour 1 tablespoon milk-free margarine 50 ml premixed Althéra Quickly whisk the flour into cold water in a saucepan. Bring to the boil and simmer for 5 minutes. Remove from the heat and add the margarine and Althéra. Cooking with Althéra Althéra is well suited for cooking. At 70 C some nutrients, e.g. vitamins, may be reduced. 12 13
My own recipes My own recipes 14 15
Do you have any questions about Althéra and cow s milk protein allergy, or would like to order materials? Please contact our registered dietician, or your own doctor or dietician. Nestlé HealthCare Nutrition Customer service: +46 (0)20 78 00 20 healthcarenutrition@se.nestle.com www.nestlenutrition.se My dietician/doctor s name: Tel.: Your notes: NHS/mar/12 Nestlé HealthCare Nutrition PO Box 6026, SE-102 31 Stockholm, Sweden. NOURISHING PERSONAL HEALTH