During her Sunday shopping at Giant Eagle, Maria Murphy reaches for a box of her son's favorite granola bars and gets ready to toss it into her cart when something stops her. She examines the box closely and realizes that although the packaging is identical, this is a new flavor and it contains peanut butter.
Her son, Tommy, a senior at Hawken School, is allergic to nuts. Eating a granola bar with peanut butter could cause a reaction so severe it could cut off his breathing.
She quickly returns it to the shelf and finds the type he can eat.
For the Cleveland Heights mother of two, shopping is a marathon of label reading, even after 18 years of dealing with Tommy's allergy.
It has become slightly easier since the Food and Drug Administration changed packaging labels in 2004 to call out the key allergens, but Murphy remains vigilant as she moves through the store.
In one aisle she finds peanut butter-filled pretzels. Although they're clearly labeled, she turns the see-through plastic jar to show that they look like any other pretzel nuggets.
"Imagine being at a party and thinking they're regular pretzels and eating one," she says. She pauses, and you know what she's thinking: That pretzel could kill him.
Tommy was diagnosed as an infant after not being able to keep his formula down. He is among a growing number with food allergies so serious they can lead to anaphylactic shock and death.
Most of his reactions to peanut butter have been caught quickly and treated immediately with Benadryl. "My throat closes, and it becomes hard to breathe," he says. "I get hives on my face."
Fifteen million people in the United States suffer from food allergies, according to Food Allergy Research and Education, a nonprofit working to find a cure for food allergies. Among children, food allergies have increased 50 percent from 1997 to 2011, according to the Centers for Disease Control and Prevention.
"We don't know why that is," says Dr. Julie Sterbank, an allergist and immunologist at MetroHealth System. "It's probably for a variety of different reasons."
While experts seem to agree that there's a genetic component that predisposes certain people to allergies, genetics alone doesn't fully explain the staggering numbers.
"There is some environmental interaction that makes some children who carry those genes have a reaction," says Dr. Leigh Ann Kerns, an allergist and immunologist at University Hospitals Rainbow Babies and Children's Hospital.
While these triggers are the subject of much research, there's little consensus.
Some have cited changes in the American diet as a possible cause. "We eat a lot more processed foods than we did 20 or 30 years ago," says Dr. Rajeev Kishore, director of the division of allergy and immunology at Akron Children's Hospital.
Others suggest improved hygiene has stunted our immune system development.
"Because we don't have as many infections to mature the immune system initially," says Sterbank, "the immune system seems to get bored and feels like it needs to attack
In food allergies, the body makes an antibody to a protein in the specific food. When it attacks that protein, the reaction can range from hives to vomiting to swelling of the lips, tongue or throat.
In addition, individual sensitivities to allergens can differ widely. Some people with egg allergies, for example, don't get symptoms from baked foods because the heat changes the egg's molecular structure. But others react seriously to those baked items.
"True allergic reactions happen quickly, within 15 minutes to 45 minutes," Kishore explains. "And they will be repetitious and are not quantity dependent."
Those characteristics distinguish a food allergy from food intolerance, although people often use the same vernacular for both. People with lactose intolerance, for example, don't have the enzyme that breaks down the sugar in milk, causing symptoms such as upset stomach, bloating and diarrhea.
"[Intolerance] tends to be dose related," says Kerns. "The more the patient takes in, the more severe the reaction."
Because allergic reactions can happen so quickly and harshly, it has become a critical issue for families and schools.
"Diagnosis of food allergy is a big life-changer for everyone in the family," says Kerns. "Food is a very integral part of our social activity."
Cleveland attorney Paul Shipp has two sons Owen, 6, and Colin, 4, with peanut and dairy allergies. "When certain foods can kill you that are safe to the majority of the population, you look at things very differently," he says. "We saw danger everywhere: day care, school, in the care of friends or family, birthday parties, restaurants, Halloween."
As a toddler, Owen was accidently exposed to dairy by a child care worker. He developed hives, vomited and had severe swelling of his face, eyes, lips and tongue.
To keep the boys safe, Shipp and his wife, Emily, have embraced milk and peanut butter alternatives, such as soy nut butter and rice or soy milk. On the rare occasion they have something in the house that contains dairy or peanuts, they label it with prominent letters and store it in a high cupboard.
While food allergies tend to run in families, it doesn't mean everyone in a household has the condition — which can make the normal stresses of family life even more difficult.
Take the Gill house, where mom Susie has a severe egg allergy and son Riley, 14, has a milk allergy so extreme that even eating beef is risky.
However, 13-year-old daughter Kelsey likes only cow's milk on her cereal — she's tried many other kinds — so they keep milk in the house. "We haven't adjusted the whole family's diet around the allergens," says father Brad Gill, director of Hawken's lower school.
It puts additional pressure on Riley.
"What my son needs to understand is that the only person he can absolutely trust is himself," says Gill. "So if he's unsure of something, he shouldn't have it. He needs to make really good decisions."
For many, dealing with allergies outside the home comes with an entire other level of concern, awareness and isolation. It can mean avoiding restaurants, declining invitations from friends if food is beings served or bringing along premade food for the kids.
"We don't want to put anyone out or trouble them to prepare food that our kids can eat," Shipp says. "The answer is usually that we don't take our kids to other people's houses — just family."
Restaurants can pose a greater risk, since cross-contamination can happen easily in a busy kitchen. Using one spatula to flip a pancake containing milk and eggs and then the same utensil to turn sausage, for example, could cause a person allergic to those ingredients to become violently ill from eating the sausage.
"My wife has been refused service on more than one occasion," says Gill. "She'll explain what her allergy is, and they'll come back and say, •We cannot absolutely guarantee your food preparation will not be cross-contaminated.' "— — — — —
That's the same reason why Riley, a freshman, does not eat at the Hawken cafeteria salad bar. "Anyone could pick up a piece of cheese and then put the tongs into the salad," Gill says.
Food Allergy Research and Education estimates that one in every 13 children — or about two per classroom — suffer from food allergies.
That number is much higher in Katie Atherton's first-grade classroom at University School's lower campus in Shaker Heights. Six of the 18 boys in her classroom have serious allergies, ranging from nuts to sunflowers to dairy, egg and wheat.
"Personally, for me, it's terrifying," she says. "As a school, we've looked at our policies because these parents are trusting us with their boys' lives. They're at school more times during the week than they're at home."
Atherton has become a passionate advocate for her students by developing a culture of safety in her classroom. Boys wash their hands after lunch and even wipe off their desks after snack time. A poster next to her desk shows how to recognize the signs of an anaphylactic reaction. She even minds the labels on any products, such as lotion or beauty aids, she uses at home that follow her into the classroom.
University School's lower school has a nut-free policy. And in her classroom, parents must give 24-hours notice before sending in a treat and list all ingredients on anything homemade. Even a drop of almond extract in a large batch of frosting can trigger a reaction in an allergic child, she says.
Because signs can start subtly, allergy training is important. On a field trip to the West Side Market, for example, Atherton kept a close eye on a boy with food allergies. While he didn't eat anything he wasn't permitted, afterward he told her he "felt funny" and started clearing his throat.
Recognizing it as a sign of an airway becoming restricted from an anaphylactic reaction, she immediately checked his stomach and found hives. The nurse administered a hefty dose of Benadryl, which stopped the symptoms, although his EpiPen was ready if the situation turned into an emergency.
Normally only available by prescription, the EpiPen gives a quick dose of epinephrine, which relaxes the muscles in the airways and tightens blood vessels. In April, however, Gov. John Kasich signed a law that allows schools and camps to stock and use, in the case of an emergency, an epinephrine auto-injector that isn't specifically prescribed.
Hawken's lower school has 550 students, Gill says, and 80 have prescriptions for EpiPens, most for food allergies.
"It's a whole new world for us and our kitchen staff," he says.
Hawken has instituted a peanut-free policy for the school and all events. The kitchen staff even meets with families of allergic students and provides personalized meals.
The peanut-free policy has given Murphy and her husband, Jay, a sense of comfort for Tommy, who attended a Catholic grade school without such a schoolwide policy. He sat at a nut-free table every day, and only others who followed the policy could join him.
"He had a good group of pals who he would sit with during lunch," Murphy says. "When they brought peanut butter to school, they knew they had to sit elsewhere."
While lunchroom policies differ throughout Northeast Ohio, schools require an Allergy Action Plan of all students stating restrictions and whether an EpiPen is stored with the nurse or carried by the student.
Still it's almost impossible to account for everything. And as kids get older, especially as teenagers and young adults, it becomes more difficult to watch over them.
"They're finally out, they're with friends, they don't want to ask about food allergies," says Dr. Sandra Hong, an allergist and immunologist at the Cleveland Clinic Strongsville Family Health and Surgery Center. "It can be extremely difficult."
The Murphy family is about to face such a transition.
Recently while visiting colleges, mother and son noticed a huge bowl of peanut butter sitting out uncovered next to some apples in one of the school's dining halls. It served as a simple reminder of being vigilant.
"I'm already getting slightly anxious about college," Murphy says.
Tommy has done well on his own before, though, playing on a competitive summer baseball team that traveled out of state. Occasionally, his parents couldn't make the trip.
"Tommy had to make the choice on what to eat and where to eat and to always carry his EpiPen," Murphy says. "Thankfully, he was absolutely fine."
Emily Shipp's sons, Owen, 6, and Colin, 4, have peanut and dairy allergies. So she substitutes soy nut butter and soy-, nut-, and dairy-free chocolate chips in her buckeyes recipe.
Mix melted butter with soy nut butter and powdered sugar using a mixer. Roll into balls. Place on cookie sheet covered with wax paper. Refrigerate 1 hour until solid. Melt chocolate until smooth. Put toothpicks in balls and dip into chocolate. Refrigerate until chocolate sets.
Plate GainGet your kids to eat healthier with these easy, fun strategies.
Like many children their age, John Selick's three kids love to make pictures. But when his 8-year-olds, Michael and Hannah, and 6-year-old Hadley want to get creative, Selick doesn't break out the paints or crayons.
Instead, the head chef at University Hospitals Ahuja Medical Center rolls out a sheet of puff pasty, spreads it with ricotta cheese and lets his children decorate the pizza with vegetables he cuts into shapes.
"They'll get together and do a landscape," Selick says. "They'll tell me how they want the peppers cut — green, red, yellow peppers."
The first time he made the recipe with his kids, Michael — whose favorite food is macaroni and cheese — said he only liked pepperoni pizza. "I took my little circle cutter and cut red peppers like pepperoni," Selick says. "He knew it wasn't pepperoni, but the kids were laughing and making jokes, saying it was special pepperoni."
And although Michael insists he doesn't like vegetables, he ate it.
"I was a picky eater when I was a kid," Selick confesses. "All I ate was hot dogs."
That's why he's creative in introducing vegetables and healthy nutrition to his own kids and those at Warrensville Middle School, where he stocks a donated salad bar and creates innovative fare such as quinoa salad as part of partnership between the hospital and the school.
As a graduate of Collinwood High School, Selick understands firsthand that learning to eat nutritiously starts with exposing kids to healthy foods. So occasionally he talks to classes about nutrition and once even brought in a whole salmon for a demonstration.
Here, nutrition experts discuss that and other tips for keeping your family healthy.
Don't give up
Exposure needs to start at a young age and be ongoing, says Dr. Reema Gulati, a pediatric hepatologist who specializes in obesity at MetroHealth System.
"Tastes are influenced a lot by early feeding," says Gulati. "It can take 10 to 16 attempts, especially with younger kids, to get them to eat a new food."
So, ask your child to try those pesky Brussels sprouts at least a dozen different times before you give up.
Eighty-six special requests
"The parent's job is to offer healthy foods, at regular times, in appropriate amounts for a child to eat," says Janet Kramer, a clinical dietician at University Hospitals Rainbow Babies and Children's Hospital. "The child's job is to decide how much to eat of the food being offered."
If your child doesn't eat, be matter-of-fact about it and let him or her know the time of the next scheduled meal or snack, but don't get up and make something different. It's likely that what your child wants isn't as nutritious as what you're offering.
Fats are OK
The American Academy of Pediatrics recommends healthy children between the ages of 1 and 2 drink whole milk, because the fat aids brain development. But that's not new.
What might be new is that experts now know that it's not healthy to eliminate all fat from a child's diet. It's just important to know which are the good fats and which are the bad ones.
"Fat has a lot of roles in the diet," says Kramer.
Some vitamins, including D and K, must be dissolved in fat to be used by the body. Also, since it's calorically dense, fat allows you to feel full longer, preventing you from filling up on refined carbohydrates such as cookies and chips that provide little nutritional value.
The bad press that fat received happened because transfats added to processed foods had a bad effect on blood cholesterol levels, which contributes to poor health, including early heart disease and kidney failure, says Gulati.
"Many people are realizing it was a mistake to say no to fat when eaten in moderation," she says.
Good fats include natural fats found in foods such as avocado or oils such as olive and coconut oil. In fact, Gulati not only praises the benefits of coconut oil to her patients, but also cooks with it at home for her children.
Disband the clean plate club
"Children know when they're full," says Jennifer Willoughby, a pediatric registered dietician at the Cleveland Clinic.
But when parents insist that children clean their plates, it overrides children's natural hunger cues, which can lead to overeating and weight gain.
Willoughby recommends a focus on variety. "We take bites of every single food," she says. "We try everything on the plate. Then, if we're full, we may not need to clean the plate necessarily."
Make treats a treat
Desserts and other sugary treats can be a source of tension between parents and kids. It's important to establish boundaries early and keep sweets as a special thing.
"Dessert should not be a regular thing because kids view it as a prize at the end of dinner," Willoughby says. "They might just be forcing foods that they don't like just to get to dessert."
Save the cakes, cookies and ice cream for special occasions, and serve cut fruit at the end of the meal instead.
It's also important to not keep treats in the house. Rather than gallons of ice cream in the freezer, take the kids out for a single scoop every now and then.
"My children love doughnuts," Gulati admits. "So we take them out."
Each child gets one doughnut, in the smallest size, and nothing more.
"They are so happy they have their doughnut that it doesn't even strike them that we're not bringing the doughnut box back home," she says.
Discover other milky ways
A grocery store's dairy aisle isn't what it used to be. Milks made from soy, rice, almonds, coconuts, cashews and other nuts and grains have moved in on the cow's turf.
But how does a parent decide? Sometimes, milk allergies or lactose intolerance makes it critical to switch a child over the age of 2 to a milk alternative. Other times kids just like the taste better. (For kids under age 2, don't do anything without consulting your pediatrician.)
But it's important to read the labels, says Kramer. Milk is a good source of calcium and vitamin D, and most milk alternatives are fortified with both.
"What they lack is protein," Kramer warns. While a cup of milk has 8 grams of protein and soy milk has about the same, almond milk has only 1 or 2 grams.
The lack of protein can be made up from other sources in your child's diet, but it's important to be aware.
Take the bite out of juice
The No. 1 mistake parents make is to think that juice is healthy, so kids can drink unlimited amounts. "We're meant to eat our fruit, not drink it," Kramer says. "Even with 100 percent fruit juice, they're drinking a lot of fluid with sugar."
She suggests switching to water, which has health benefits beyond just reducing calories from sugar.
"We get confused between thirst and hunger, and we try to quench our thirst by eating something," Gulati says. "Mindfully drinking water throughout the day will take away hunger pains. Drink enough water so your body can differentiate when it's thirsty and when it's hungry."
For teenagers and adults, that means eight glasses a day. Young children need less, but they should drink water about every two or three hours throughout the day.
Set a good example
It doesn't make sense to a young child for you to say he or she can't drink pop when you're holding one in your hand. So one of the keys to getting your children to eat healthy is to do it yourself.
But recent studies also show that parenting style makes a difference in how children eat. Parents should set clear expectations, but also involve children in grocery shopping, food preparation and making choices between healthy options, asking "Should we have broccoli or asparagus tonight?"
"While they're setting expectations for their child, they're also responsive to their child," Gulati says.
Grow a garden
Some kids don't even realize how food is produced, says Vicki Jenkins, marketing director for Veggie U based in Oberlin.
"They're very surprised when you pull a carrot out of the soil," she says. "You see their eyes light up because it's almost magic."
Veggie U brings educational programs into Northeast Ohio schools to teach children about nutrition and offers recipes and activities for families to do together on their website.
Chef John Selick volunteers with the organization, bringing his puff pastry recipe into classrooms. But teaching his own kids about nutrition is closest to his heart.
"We grow a potted garden together," Selick says. "If they're touching the food at a raw stage, and then they see it come out of the oven, I think they're more likely to eat it."