What to ask/tell paediatrician?

[vvviola]

DD2, aged 1, allergic to dairy, egg & peanut.
System here (NZ) seems to be they try to refer you to immunology team first, who will refuse the referral if the case isn't serious/complex enough. If this happens you are then referred to the general paediatric team - who can refer you on if required, or just manage the case themselves. This is what has happened to DD.

We got the date for her appointment (2 weeks away), and I'm trying to figure out what I should be asking, and what things I should specifically bring to their attention. Unfortunately I'll have DD1 with me (school holiday) so I'll really need a list of things so that I can make sure I don't forget anything.

Does anyone have any ideas? Hints? Experience?

Thanks!

[Weta]

I'm originally from NZ but now live in Luxembourg, and I know we found the whole system extremely frustrating when DS1 was first diagnosed with dairy allergy.

How serious are your DD's allergies?

I would take a very detailed list with you of every reaction she has had (trigger, symptoms, how it was treated, how long it lasted etc).

I guess the main issues for me would be finding out how serious the allergies are (if you don't know already) ie by doing skin prick and/or blood tests (I think the blood tests give more info), and making sure you have the right treatment. Depending on how serious the allergy is, you may want to ask for an emergency medical kit - we were not given this in NZ but as soon as we moved to France (when DS1 was 18 months old) they gave us the equivalent of an epipen, plus steroids, antihistamine and ventolin inhaler to keep with us at all times. I don't know how difficult it is to get one in NZ - we didn't ask because we didn't know about them.

Another issue to discuss may be childcare if you are planning to use any in the near future - the precautions you need to take and whether the childcare setting should have medications available for your daughter.

I would also discuss diet and ask to see a dietician who will monitor your DD's food intake and make sure she isn't missing out on essential nutrients (and maybe suggest ways of replacing them). One idea for replacing calcium which they didn't mention in NZ but did in France was to give bottled mineral water with a high calcium content.

What kind of milk is she on at the moment? this is another thing to discuss with the doctor, as you may be able to get hypoallergenic formula (eg Pepti Junior, Nutramigen, Neocate, depending on severity). Though to be honest they weren't keen on paying for it in NZ and told us to use rice milk or soy milk (personally I would investigate both of these before you go, as rice milk has relatively high levels of arsenic and it is now advised that it not be the main drink for children under 5, and soy milk has some issues with phyto-oestrogens which mimic the effects of oestrogen - nothing seems to be proven exactly but in France the advice was to avoid it is a main drink for young children, especially boys).

sorry if this sounds a bit negative about NZ, though I imagine you are coming up against the funding issues already anyway - and I think you are from the UK (based on Living Overseas threads!) so it may be similar there too.

[vvviola]

Weta thanks so much for your post! Gives me lots to consider.

DD has had skin prick & blood tests done, so we have some idea of the severity (GP said she's "seen worse" but that it's fairly serious). I think the GP wanted her referred more for management and possible food challenges, although I'm concerned there may be a few allergies we haven't come across yet. I'm also concerned about what she's eating - so good to know we could get a referral to a dietician.

She's still exclusively bf, with the exception of the occasional bottle of soy formula that I send into crèche with her - which she plays with and takes the occasional swig from, but generally prefers to wait for me to come get her .

I'm happy enough with the process so far... I've been in the Belgian system and the Irish system, and haven't found the GPs as responsive as they are here (but it could be I've been very lucky with my GP!)

It's hard to know whether to push for an epipen etc or not (we were given the antihistamine fairly quickly after her first big reaction). I don't like the idea, but the thought of not having one if it was needed... (I fully admit to overthinking all of it )

[Weta]

No harm in raising the subject of food challenges, see what they say. And also other potential allergens and whether you should delay introducing certain foods eg peanuts.

You're not overthinking at all, you have to work out what's best for you. In our case DS1 had a clear systemic (and hence anaphylactic) reaction with breathing problems so (in France at least!) the epipen was a no-brainer. You could post another thread specifically on that issue, might help you to work it out.

Glad you are finding the system good in NZ so far and that you've found a good GP. It's true that some aspects of it are great, and I think our GP may well have saved DS1's life when he had his first reaction as a baby, thanks to a clear protocol and a swift adrenaline injection. And France is definitely the other extreme as in my view they tend to overmedicate for everything and have a huge social security deficit as a result - it's just that we found the allergy referral process very long at a difficult and worrying time, and we also had problems with asthma management (more of an issue for us at the time) and found the French system much better for that.

And things may have changed since then anyway as DS1 is now nearly 9 :)

[vvviola]

Interesting you've found the asthma management better in France. In Belgium (which has a similarly over-medicalised system) I had huge problems getting docs to even consider asthma for DD1. Whereas here & Ireland much more willing to investigate.

(Can I just say, your name gives me a little shudder every time I see it. scary little beggars those wetas - DH neglected to tell me about them before we moved )

[vvviola]

Just bumping this up in case anyone else has any suggestions - the appointment is on Tuesday.
(I've thankfully managed to sort childcare for DD1 so I have more chance of actually being able to have a proper conversation with the doctor without being interrupted every 5 seconds!)

[vvviola]

A final (slightly desperate , as I'm afraid I'll forget something totally obvious) bump before tomorrow's appointment. Have spent the evening writing timelines of symptoms etc...

[Weta]

probably too late but just to say good luck! don't think I have any more suggestions... hope it all goes/went ok, am sure you'll be fine :)

[vvviola]

Thanks Weta, it went quite well. We have a referral to a dietician, and tests for a few more possible allergens. No epipen needed, but we're to go straight back if we're concerned about any reaction.

I was hugely impressed with the time she took with us - over an hour taking details, discussing options & giving advice. And getting plenty of reassurance that we have the right measures in place.

Phew

Thanks again!