Treating a child with eosinophilic esophagitis (EoE) is a journey with both ups and downs. From allergy testing and endoscopies to trying food eliminations and elemental formula diets, the CHOC Children’s Eosinophilic Esophagitis Clinic team works with patients and their families to narrow down each child’s EoE triggers.
After an endoscopy shows that the eosinophils have gone away, our team works with the patient’s family to reintroduce foods. The foods are selected according to previous allergy testing, nutritional quality, the child and family’s preferences and the expertise of the team. Foods are slowly reintroduced one at a time beginning with those negative on testing and/or least likely to cause a reaction. During this time, it is important for caregivers to monitor the patient for allergic reactions or EoE symptoms. Symptoms are usually similar to those that led to the child’s initial diagnosis and can range from mild reflux and food impaction to cramping, vomiting and difficulty swallowing. If there is known or suspected risk associated with the food, the reintroduction may be done under the supervision of the child’s healthcare team.
After a few foods have been reintroduced, patients undergo another endoscopy to see if the eosinophils have returned, even if the patient does not have obvious EoE symptoms. If there are no eosinophils, the child can continue eating those “safe foods.” If the eosinophils have returned, those foods are again removed. The food reintroduction process continues until the EoE team is able to determine the food(s) causing the allergic reaction. Once the team figures out which foods cause the child’s EoE symptoms, those foods are permanently eliminated from the patient’s diet.
Has your child been on an elemental diet?
Learn more about the food reintroduction process for children who have been on an elemental diet.
Food reintroduction can be exciting and overwhelming for patients and their families.
The challenges of food reintroduction
After all of the hard work, it may come as a surprise to patients’ families that reintroducing foods into a child’s diet may not be the celebration of success they had imagined. Difficulty reintroducing foods into a child’s diet can happen for a number of reasons.
Negative feelings for food
Over time, it is not uncommon for children who have had EoE to develop negative feelings toward foods—especially when they realize how much better they feel with foods being partially or completely eliminated from their diets. Because it is difficult to pinpoint foods causing EoE immediately, we often eliminate foods with the purpose of reintroducing them later to see if there is a change in eosinophils. Children who have experienced the six-food elimination diet or a customized food elimination diet, may be nervous to incorporate food back into their diet that they were once told may harm them.
For children who have been through the diets and end up on the elemental formula diet, food reintroduction can be particularly difficult. Children who are used to consuming formula as nutrition often become so used to this way of life and feeling good without the need of foods that they may refuse the idea of eating regular foods all together.
Under or over sensitivity to tastes, smells or textures of foods
While on a restricted diet, a child’s sensitivity toward the textures, tastes and smells of foods can change. This sensory change is particularly true for children who have been on an elemental formula diet—whether they receive their nutrition by mouth or a feeding tube.
Elemental formula has a very distinct taste. Because it isn’t a taste that children particularly love, they often drink it while it is very cold, very quickly. Over time, they can become used to the formula’s taste and find it difficult to enjoy the tastes and smells of regular foods—even those they once enjoyed.