Addressing Food Allergies: The Role of Texas Health Steps Providers

Early and quick recognition and treatment (of childhood food allergies) can prevent serious health problems or death.

Centers for Disease Control and Prevention, (2022)

Texas Health Steps providers have an important role in educating families about nutrition and guiding them about introduction of foods and identifying food allergies.

The Texas Health Steps Periodicity Schedule for Infants, Children, and Adolescents includes nutritional screening as a required component of all preventive medical checkups for children and youth ages birth through 20 years. Health education and anticipatory guidance also are required components of preventive medical checkups.

The Texas Health Steps Anticipatory Guidance Provider Guide includes these recommendations for families about food introduction:

• 4-month and 6-month checkups: Introduce solids slowly, one at a time.

• 9-month checkup: Slowly increase the choice of solid foods.

AAP’s guidelines for infant feeding include:

• Encourage parents to wait until around age 6 months to introduce their infant to solid food.

• Explain the importance of introducing a wide variety of foods, especially vegetables and fruits, and to expose an infant to a variety of textures.

• Explain that sometimes it takes an infant 10-15 tries over a period of months before they accept a new food.

Remember that anticipatory guidance topics should be individualized and prioritized based on questions and concerns of the parent, caregiver or patient. Base your specific guidance on individual needs as well as findings obtained during the health history and physical exam.

Discussing food allergy concerns

Marcus and Elena have brought their daughter Elissa to your clinic for her 6-month Texas Health Steps preventive medical checkup. Elissa meets all of the expected growth and developmental milestones and seems like a healthy, happy child. But Elena expresses concern that Elissa is a picky eater and “throws up” certain foods and refuses others. She says she is worried her daughter has food allergies.

Here are some conversation starters to help you determine what steps to take next.

“When did you start giving Elissa solid foods?”

Possible response: Whether babies are ready depends on things like whether they can sit up in a high chair, hold up their head and open their mouths when offered food. She may just need a little more time.

“Which foods does she spit out?”

Possible response: Babies need time to get used to different textures and may need to have the same food introduced multiple times. Elissa just may not be used to different textures yet. The AAP’s healthychildren.org web page, Starting Solid Foods, offers helpful tips to use at home.

“How often do you give her the same food?”

Possible response: It is important to introduce a wide variety of foods with different textures and introduce a particular food multiple times over a period of months. That can be what it takes for Elissa to get used to a food and like it.

What kind of reactions has she had to foods?

Possible response: May we talk about what an allergic reaction looks like?

1. If she has not had reactions indicative of atopic disease: Try giving her small amounts of age-appropriate foods that contain peanuts, such as peanut butter, and small amounts of egg.
2. If Elissa has had reactions that may indicate atopic disease: Consider referring her to a specialist who is enrolled in Medicaid for further evaluation and possible allergy testing.

Guidelines for referring patients to a specialist

Consider referring the following patients to a specialist enrolled in Medicaid for further evaluation and possible allergy testing:

• Infants and children of any age who have experienced allergic symptoms (anaphylaxis, urticaria, angioedema, itching, wheezing, gastrointestinal responses) in association with food exposure.
• Infants and children of any age with a diagnosed food allergy (for ongoing specialized guidance).
• Children of any age who experience an itchy mouth from raw fruits and vegetables.
• Infants with recalcitrant gastroesophageal reflux, dysphagia or known eosinophilic inflammation of the esophagus.
• Infants with gastrointestinal symptoms including vomiting, diarrhea (particularly with blood), poor growth and/or malabsorption not readily explained by other causes.

Source: The Children’s Hospital of California at the University of Irvine School of Medicine.

Check the current Texas Medicaid Provider Procedures Manual (TMPPM) Children’s Services Handbook for information about referral requirements. Find approved providers who are enrolled in Medicaid through the online Provider Search.