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Elemental Diet

An elemental diet may be recommended if a child has severe symptoms, if all food allergy testing was negative or if previous treatment options have been unsuccessful. When following this diet, all regular foods and beverages are removed from the child’s diet and special formulas are used to meet the child’s nutritional needs.

Elemental formulas contain proteins that have been completely broken down into their simplest form, amino acids. The formulas are designed to meet the full nutritional needs of the growing child without triggering the child’s EoE symptoms. At CHOC Children’s, we recommend the following formulas to our patients: Neocate Infant, Neocate Junior (unflavored, vanilla, chocolate and tropical), EO28 Splash, Neocate Nutra (semi-solid), Elecare and Elecare Jr (unflavored and vanilla).

Although it may be difficult to follow, research published in the American Journal of Gastroenterology and Clinical Gastroenterology and Hepatology has shown the majority of children (95-98%) get better on the elemental diet. Patients stay on the elemental diet for approximately six weeks. If a repeat endoscopy shows that the esophagus has healed, food can be reintroduced. Learn more about food reintroduction.

We understand that the thought of putting a child on an elemental diet may seem daunting, but the entire team at the CHOC Children’s Eosinophilic Esophagitis Clinic are with families every step of the way and have put together the following resources:

Challenges Facing Children on Elemental Diets and Their Families

An elemental diet is one in which all regular foods and beverages are removed from a child’s diet and replaced with a special formula that meets all of the child’s nutritional needs. This diet allows us to remove all of the potential food allergens causing a patient’s eosinophilic esophagitis (EoE) symptoms, thus allowing the child’s esophagus the chance to heal. An elemental diet is an alternative to medical management.

Elemental diets are not easy on the children or their families. Children, especially if they are older, may feel depressed or angry about having food taken away. Younger children may feel frustrated in not being able to eat the things their friends are eating and may not be able to comprehend why they have been put on the diet.

Parents and family members of children on elemental diets deal with a full range of emotions, as well. They often feel worried about how the child will feel and be accepted by others. Some caregivers feel sad or guilty for having to take foods, especially those the child enjoys, away. Other feelings caregivers experience often also include stress or anxiety, as well as hope for a cure of the child’s eosinophilic esophagitis.

The most common challenges faced by children on elemental diets and their parents include:

Tips for facing elemental diet challenges:

The most important thing a family can do to help the child on the elemental diet is to stay united and supportive. By being careful of what is eaten in front of the child and changing the way the entire family relates to food—as nutrition instead of a means of celebration or emotional support—life on the elemental diet will be easier for both the child and the family.

Food Reintroduction Following an Elemental Diet

Once a patient’s eosinophils have cleared, foods are typically reintroduced in stages starting with those least likely to cause EOE. Below is a sample food progression. Foods are reintroduced one at a time starting with stage one and progressing to stage four.

Below is a sample food progression published in Gastroenterology Clinics of North America.

Stage One

Stage Two:

Stage Three:

Stage Four:

Long Live Childhood

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