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:

  • Acceptance of family and friends of the importance and necessity of the restrictive diet.
  • Learning to say “no” when the child begs for favorite foods.
  • Finding a different way to celebrate holidays, birthdays and other special occasions without making food the center of activities.
  • Shifting the thoughts that food is a source of happiness in every day life and celebrations to it being nutrition to fuel the body.
  • Some children find it difficult to drink enough formula to meet their nutritional needs. A feeding tube may be placed to continue treatment.
  • Many families are surprised to find their child may be hesitant when it comes to food being reintroduced into their diet after the eosinophils have cleared. Learn more about the challenges of reintroducing foods.

Tips for facing elemental diet challenges:

  • Education is the key. Sit down with family members, teachers, friends, coaches and other people important in the child’s life and explain the child’s condition and diet.
  • Be an advocate for the child at school, church, sports or any activity they may be involved in.
  • Join a support group, online forum or talk with someone going through the same situation.
  • Seek out reliable resources such as apfed.org, foodallergy.org and kidswithfoodallergies.org. Please also refer to our list of online resources.
  • Cold formula does not have a strong taste. Make a smoothie out of the formula with ice in the blender.
  • Change family outings to things that are not food related, such as arts and crafts, hiking, swimming, music and games.
  • When preparing meals for the rest of the family, try to stay away from making the child’s favorite dishes.
  • Remove the child’s favorite sweet treats and snacks from the house so that they are not reminded of them. Encourage siblings and family members not to eat the child’s favorite snack or sweet treats in front of them.
  • Let the child pick out his or her own special cup to drink from.
  • Give small rewards for when the child meets his or her nutritional goals.
  • Birthdays may not feel as special without cake. Make the child a “cake” out of something that isn’t edible. This way they can still blow out the candles. Encourage the child’s siblings to select birthday party themes that do not center around food as well.
  • Stay positive. Remind the child how good they are feeling while on the new diet.
  • Encourage the child’s siblings to be supportive of their brother or sister. Be careful not to reward other children with snacks and treats, so as to not upset the child on the elemental diet.

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

  • Non-legume vegetables: carrot, squash, sweet potato, white potato, string bean, broccoli and lettuce
  • Non-citrus, non-tropical fruits: apple, pear, peach, plum, and apricot

Stage Two:

  • Citrus fruits: orange, grapefruit, lemon and lime
  • Tropical fruits: banana, kiwi, pineapple, mango, papaya, guava and avocado
  • Melons: honeydew, cantaloupe and watermelon
  • Berries: strawberry, blueberry, raspberry and cherry

Stage Three:

  • Legumes: lima bean, chickpea and white, black, and red beans
  • Grains: rice, oat, barley and rye
  • Meat: lamb, chicken, turkey and pork
  • Fish and shellfish
  • Tree nuts: almond, walnut, hazelnut, brazil nut and pecan

Stage Four:

  • Corn
  • Peas
  • Peanut
  • Wheat
  • Beef
  • Soy
  • Egg
  • Milk