Food Challenge – Infant and Young Children

Food Challenge – Infant and Young Children

Food challenges are used to exclude allergy to a food. They can be carried out for several reasons and your child’s consultant or nurse should have explained the reasons for challenging your child.

Your child will be given the food in a controlled way, in hospital. Increasing amounts of the food is given over 5 steps with close observation of your child at all times. We aim to given a certain amount of food so that we know it can be tolerated. This is usually the same amount of protein for every food, or a typical portion size for the age of your child.

Benefits of a food challenge

• To safely find out if your child can eat a food that has previously been avoided
• Making family life easier by reducing the time spent checking labels and making eating outside the home easier
• Reduce the worry of having an allergic reaction
• Recognise the signs of an allergic reaction and how to treat it if your child reacts while having the food challenge

Risks of a food challenge
Your child may have a reaction during the food challenge which is why it is carried out in hospital where reactions can be assessed, reported and treated. Symptoms might include:

Your child will be closely observed throughout the procedure and any symptoms will be detected quickly and appropriate action will be taken. Depending on the symptoms experienced, the challenge will either continue, be halted temporarily, a stage repeated or stopped. We will discuss these decisions with you throughout the challenge. Medication will be given if necessary. Cetirizine will be given for mild/moderate reactions and an adrenaline injection into the thigh will be given for any reactions where your child’s airway, breathing or conscious level has deteriorated.

Preparation of your child prior to the challenge
Unless your child is too young to understand you should tell them:

• why they are coming to hospital
• that they will be given increasing amounts of some food and that it is important that they eat this even if they don’t like the taste
• explain that the procedure may help your child to get to eat a wider variety of foods
• encourage your child to talk about the procedure and ask questions

Things to know before the challenge

• Your child should not eat for 2 hours before the challenge. The challenge will usually commence approximately 30minutes after you arrive at the Children’s Clinic
• Please eat a light breakfast
• Your child will be able to drink during the challenge so please bring squash with you if they prefer this.
• You will need to bring the food with you for the challenge; please ensure this is in a form that your child will eat. For example, if your child is being given nuts you may wish to bring whole nuts or nut butter. You will be advised which form we would recommend and how much to bring.
• As well as the food for the challenge you may also want to bring a food with you that we can use to disguise the taste of the food being challenged or may make it easier to help your child eat the food (i.e. bread to eat with peanut butter). Please make sure this is a food that your child has eaten before and is known to eat and tolerate.
• Your child must be well with no cough, cold or recent infections. If they have asthma or eczema this must be well controlled or stable.
• Antihistamines should be stopped for 5 days before the challenge as these can give us a false negative result.
• Please bring all your child’s medication with them. If they are prescribed Adrenaline Autoinjectors (Jext/Epipen) these must be present. We may not be able to proceed if you do not bring all your medication with you.

What will happen on the day of the challenge?
On arrival your child will be weighed and measured and have some observations done; pulse, respirations, blood pressure and temperature.

A skin prick test will be performed for the food we are going to challenge. Where possible we will also do a “prick-to-prick” test for the food we are about to challenge as well as the solutions that your child may have also been skin prick tested to before.

The team (doctor or nurse) will ask various questions to ensure that you and your child understand the procedure and will answer any questions that you may have. We will ask you to sign a consent form.
Once the challenge commences an increasing amount of food will be given at intervals that is decided by the medical staff and your child will be closely monitored in the day case area throughout the entire test.

After the challenge
If no reactions occur and the challenge is completed your child will be observed for a further two hours and will then be discharged. If a reaction has occurred, we will ensure your child is treated and well before discharge.

The nurse will discuss the outcome of the challenge with you and amend your child’s Allergy Action Plan accordingly. You will be advised whether the challenge was successful or not and the implications of this.

Important -if the challenge is successful, we encourage your child to eat the food ideally 3 times per week to ensure that their body knows that this food is something that should be eaten. This is particularly important for young children. If this is something that you are going to be reluctant to do, please speak to a member of staff who will explain the importance of this. If you know you are not going to give the food regularly, we may not be able to carry out the challenge.

Follow up after a challenge
You will be advised on the day of the challenge whether your child needs to be seen in Clinic for a follow up appointment with the team. This will depend on several factors including; the result of the challenge and other allergies/conditions that your child has.

Contacts
If you have any concerns or questions after reading this information you can contact:

Allergy Specialist Nurse for Children and Young People – Phoebe Moulsdale
Mobile number – 07564 848463
Extension number – 30178
Paediatrics Allergy Department
Email: wah-tr.paediatricsallergy@nhs.net

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:
The PALS telephone lines are open Monday to Thursday from 8.30am to 4.30pm and Friday: 8.30am to 4.00pm. Please be aware that a voicemail service is in use at busy times, but messages will be returned as quickly as possible.

If you are unable to understand this leaflet, please communicate with a member of staff.

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