Why might my child need a special diet?

Your child might need a special diet for various reasons, such as:

• a metabolic condition they are born with
• a condition they may develop, such as coeliac disease or diabetes
• food allergies
• your cultural or religious beliefs

No matter the reason for the special diet, it’s important that your child has the nutrients and energy they need:

• to be healthy
• to grow and develop properly

If your child does not need a special diet, give them a variety of foods from the five food groups. Be sure to avoid fad diets for children.

How do I know if my child needs a special diet?

Many conditions that have special dietary requirements are screened for when your child is a newborn. This is called neonatal screening.

At around 6 months of age, you should start introducing your child to foods including allergy foods.

If you think your child may have an allergy, see your doctor. Your doctor can confirm a food allergy with tests such as:

• skin prick test
• blood test

Food intolerances can be diagnosed by a doctor, by:

• checking your child’s symptoms
• checking for other conditions
• suggesting an elimination diet to see if certain foods are causing symptoms

What do I do if my child needs a special diet?

If your baby is born with a genetic condition that affects their ability to deal with a particular nutrient, they will need a special diet for life.

Your child may also develop allergies that may require changes to their diet. Most children will outgrow their food allergies.

Speak to a qualified dietitian. They are best qualified to help you manage your child’s special dietary requirements so that your child can:

• enjoy healthy foods
• get the nutrients they need
• avoid foods that will cause them problems

What changes may be needed in my child’s diet?

Your child’s special dietary requirements will depend on:

• what condition they have
• what allergy they have
• what beliefs you have

Coeliac Disease

Coeliac disease is an immune disease. When gluten is eaten, the gut becomes inflamed due to damage caused by the immune system. This prevents the body from absorbing nutrients properly, and can cause:

• an upset tummy
• weight loss
• tiredness
• skin problems
• anaemia

If your child has coeliac disease, they will need to eat gluten-free foods at all times.

Phenylketonuria (PKU)

In Australia, all babies are tested at birth for PKU, or phenylketonuria. Babies with PKU lack an enzyme needed to break down one of the amino acids (phenylalanine) in protein. High levels of the amino acid can lead to problems with development of their brain.

If your baby tests positive for PKU, they will need to eat a special diet for life that has:

• low protein
• foods with low levels of phenylalanine

Glutaric acidaemia (GA1)

Another genetic disorder, GA1, occurs when there’s not enough of a specific enzyme. This leads to a build-up of 3 amino acids:

• lysine
• hydroxylysine
• tryptophan

High levels of these amino acids can damage the brain. A child with GA1 will need to eat a high calorie, low protein diet, and avoid these 3 amino acids.

Maple Syrup Urine Disease (MSUD)

Maple syrup urine disease is a rare genetic condition where there’s not enough of the enzyme that breaks down:

• leucine
• isoleucine
• valine

These are 3 amino acids that can cause brain damage if they build up. MSUD is treated with a low protein diet, and supplements for other amino acids.

Galactosaemia

Babies with galactosaemia lack an enzyme needed to break down the sugar galactose, which is found in:

• breast milk
• milk from cows, goats and sheep

This genetic condition can cause vomiting, liver problems and intellectual disability.

People with galactosaemia must avoid foods made with milk or milk products for their whole life.

Soy and chickpea products should also be avoided, as they can contain some galactose. Some cheeses are allowed.

Food allergies

The most common food allergies are to:

• eggs
• peanuts
• nuts that grow on trees
• shellfish
• sesame seeds
• wheat
• soy
• milk

Your child will need to avoid foods that trigger a reaction.

Food intolerance

Unlike allergies, food intolerances don’t involve the immune system and generally don’t cause severe reactions. The most common intolerance is to lactose — a protein found in milk.

If your child has a food intolerance, they may need to avoid that food.

Vegan and vegetarian diets

You may wish to feed your child a vegetarian or vegan diet due to your beliefs.

Vegetarian diets usually avoid meats such as:

• red meat
• fish
• poultry

Vegan diets exclude meats and also foods such as:

• milk
• cheese
• yoghurt
• eggs
• honey

Animal products are high in:

• vitamins such as B12
• protein
• iron
• zinc

This means that vegetarian or vegan diets may be low in these nutrients. Check with an accredited practising dietitian that your child’s diet provides all the nutrients they need for healthy growth.

You might need to give your child vitamin or mineral supplements to cover any shortfall.

A well-balanced vegetarian diet shouldn’t cause any nutritional problems and can have health benefits. The nutrients found in animal products can be gained from:

• legumes
• tofu
• seeds
• nuts
• leafy green vegetables

Vitamin B12 is only found in animal products. To get this vitamin, your child can:

• drink vitamin B12 fortified plant-based milk
• take a vitamin supplement

A vegan diet needs careful planning for children.

Children should be given full fat dairy until they are 2 years old.

How do I manage my child’s diet outside of the home?

It can be difficult to explain to children that they need to stick to a special diet. But it’s important that they understand this as early as possible.

You can help them stick to their diet when they’re not at home. Try writing them a simple list of foods they can eat and what they can’t. You can:

• give a copy to your child’s childcare or school
• share it with your child’s friends and their parents
• use a smartphone app to help them identify problem foods

When you’re eating out, there are steps you can teach your child to stay safe:

• Tell the waiter about your child’s dietary requirements.
• If you are not sure what is in a food, ask the waiter.
  • If the staff are unsure, eat somewhere else.
• Avoid self service areas as they could be contaminated.
• If your child has an adrenaline auto-injector (EpiPen) for their allergy, take it with you.

Resources and support

Speak to your doctor or child health nurse for more information on allergy foods.

'Nip Allergies in the Bub' is an initiative from the National Allergy Strategy that has information for both parents and health professionals.

Learn more about allergies from the Australasian Society of Clinical Immunology and Allergy.

Read more about avoiding food allergies in babies from the Royal Australian College of General Practitioners.