Case Study—Monitoring Growth and Development in a Child with Multiple Food Allergies
Justin is a 24-month-old male with multiple food allergies, including: milk, eggs and peanuts. At six months old a cooking utensil that had been used to cook eggs touched his arm and his mother noticed a significant dermatological response. As a result, Justin’s pediatrician advised her to avoid eggs, cow’s milk and peanuts in Justin’s diet until food allergy testing could be done at two years of age. Fortunately, Justin hasn’t had any negative reactions to soy milk. Food allergy testing has confirmed that Justin needs to continue to avoid cow’s milk and peanuts. His pediatrician plans to conduct food allergy testing annually and advises his mother that Justin will likely be able to outgrow the milk allergy. Justin is referred to a registered dietitian for an assessment of his growth and nutrition intake. His mother reports that he is able to feed himself and she has noticed no problems with chewing and swallowing. A 24-hour dietary recall shows Justin consumed the following foods:
Fortified soy milk (4 ounces), rice cereal, bananas, grilled soy-cheese sandwich, fortified soy milk (4 ounces), green beans, apricots, orange juice (8 ounces), apple slices, almond butter on toast, apple juice (8 ounces) roast turkey, baked potato, green peas, and fortified soy milk (4 ounces).

Questions (from the Growth Assessment section on page 299):
1. Complete the above table. Is Justin’s growth on track? (See http://cdc.gov/growthcharts/ for growth charts).
2. Is Justin’s diet adequate?
3. Are Justin’s eating and feeding skills appropriate for his age?
4. Does the diagnosis affect his nutritional needs?
5. As Justin is getting ready to start preschool soon, what safety concerns do his parents need to be aware of?

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