What is an elimination diet trial?

• An elimination diet answers the question, “Is this food (or foods) causing my child’s symptoms?”
• For a short time, your child will avoid one or more foods to see if symptoms get better or go away.
• Your child will need to avoid the food in all meals, snacks, and drinks.
• The dietitian can help choose nutritious foods to eat during the trial.

When is an elimination diet trial useful?

You can try an elimination diet when you and your healthcare provider think:

• Your child might have a food allergy, which is an immune reaction to a food.
• Your child might have a food intolerance, which means they are less able to digest, tolerate, or use a nutrient or food.
• The trial can confirm positive test results.
• The trial helps when no test exists, which is true for most food intolerances.

How long should we follow an elimination diet trial?

• Elimination diet trials should be short-term, usually about 2 weeks.
• Sometimes extra time is added when:
  • A child gets sick.
  • A child accidentally eats the food.
  • Symptoms improve, but do not go away.

What happens at the end of the diet trial?

It is time to check in with your healthcare provider and dietitian. Tell them your child’s symptoms during the trial. Let them know if your child ever ate the food they were avoiding. Tell them about other things that could be affecting how your child feels, such as illness or teething. Together you will decide on the next steps:

• Symptoms are the same: If the food was fully avoided, add it back into your child’s diet.
• Symptoms are gone! Now it is time for a food challenge. That’s when you add the food for a short time to see if eating it causes symptoms again.
  • If you avoided more than one food, do a separate challenge for each food.
  • If symptoms return, continue to avoid the food.  
  • For some food intolerances, your child might be able to eat a smaller amount of the food or less often than before.
• Symptoms are better…or I’m not sure? You might need to continue to avoid the food for another week or longer before trying the food back in the diet.

Are there any risks?

• Your child could have a reaction when a food is added back to the diet. Ask your healthcare provider if the challenge should be supervised or what precautions you should take.
• Some children get a big part of their calories and nutrients from common food triggers like milk and wheat. When they avoid these foods, they could be at risk for poor weight gain, weight loss, and nutrient deficiencies.
• Children who already eat few foods or limit their food intake will have trouble meeting nutritional needs during a trial. They may start to avoid more foods. An elimination diet trial might not be safe for these children.
• Children can feel left out or sad when they cannot eat the same foods as friends and family, especially during holidays and parties.

How should my family prepare for an elimination diet trial?

• Meet with your healthcare provider or dietitian:
  • Before you start the trial, so they can check your child’s growth and current diet.
  • They will look out for any risk factors, help you choose foods to avoid, and make a plan to help meet your child’s nutritional needs.
• Put it on the calendar:
  • An elimination trial only helps if you can avoid the food for the whole time.
  • Look for a time when you can plan, shop, and prepare foods that fit the diet before you start.
  • Try to avoid times when your plans include travel, special events, birthdays, and medical procedures.
• Plan ahead:
  • Make a list of meal ideas to use during the trial.
  • You might be able to use some favorites or look for new recipes.
  • Plan meals and shop for food each week so that you will have the right ingredients on hand.
• Shop and organize:
  • To give your child options, buy a variety of foods that are allowed during the trial.
  • Some of the safest foods to use are fresh foods and especially “single-ingredient” foods like fruits, vegetables, plain meats, whole grains, and nut and seed butters.
  • Try to remove foods that your child is avoiding from the kitchen.
  • If other family members will eat foods that are not allowed, label these items or store them on separate shelves or storage bins. Place them out of reach, if you can.
• Prepare for school and special events:
  • Pack your child’s meals and send a supply of snacks to keep at school.
  • Ask your child’s teachers if they use foods for art projects or in other ways.
  • Look at restaurant menus before you go, to find foods your child can eat.
  • Always carry safe snacks with you.
  • Ask about the menu before parties. Bring a treat your child can enjoy.
  • Ask your dietitian for help changing a favorite recipe or finding a special food that your child can enjoy.
• Ease into it:
  • Make changes one meal at a time and work up to the whole day.
  • The trial starts on the day you follow the diet at every meal and snack.
• Stick with your schedule:
  • Your child will feel better if they eat regular meals and snacks and drinks enough water.
  • Continue your usual schedule and do things your child enjoys.
• Form a team:
  • It is easier for children to make changes when they can do it with their family.
  • Try to adjust your family meals and snacks so that your child can eat all the foods you serve.
  • Look for similar foods when your child cannot eat the same foods others are eating.
  • Invite your child to help plan meals and choose foods.
  • Try new foods together.
• Remember, it will get easier:
  • The first few days could be hard. You will learn new ways to cook and shop, and your child will get used to new foods.
  • Many children are happy to continue the diet because they feel better.

Additional resources

• Food as Medicine podcast
• Integrative Medicine - Primary Care Perspectives Podcast