Children's Hospital Colorado

Food Intolerance and Elimination Diet Tips for Parents

A array of foods including rice, dried cranberries, corn kernels, almonds, kidney beans and flaxseed.

The practice of cutting a food from your child's diet might be more complex than parents realize, says Kelly Klaczkiewicz, registered dietitian in the Gastrointestinal Eosinophilic Diseases Program at Children's Hospital Colorado.

Parents will generally know if their child is allergic to a food because their child will react immediately and often severely. But a food intolerance can be subtler and more difficult to identify.

A pediatric allergist can guide you through a trial elimination diet to determine if there is an intolerance and how severe it is, while a registered dietitian can offer nutritional recommendations if your child must eliminate or reduce a food in their diet. If you suspect your child has a food intolerance, contact their pediatrician.

What is a food allergy?

When your child has a food allergy, their body has a severe reaction to the protein in that food. An allergic reaction is often immediate, can affect multiple organs, can cause a range of symptoms and can often be severe or life-threatening. Allergy specialists will always make this diagnosis. Caregivers use an allergy-free or food allergy diet to manage a food allergy.

What is a food intolerance?

A food intolerance in children is generally less severe and often limited to digestive problems. Usually, there is something in the food such as a carbohydrate, food additive or something non-specific that causes symptoms in your child's body; it is not a reaction to the protein in the food.

Caregivers typically use an elimination diet to diagnose and manage a food intolerance. Kelly Klaczkiewicz, RD, recommends that families only conduct an elimination diet when recommended by a physician, and under the guidance of a registered dietitian.

What is an elimination diet?

Providers most often employ elimination diets to manage a food allergy, or to diagnose or manage a food intolerance. In recent years, however, parents have been conducting elimination diets on their own to try to self-diagnose a child's food intolerance. But while that might work for an adult, who might go carb-free or dairy-free, it's different for a growing child.

"The biggest misinformation about elimination diets is that they are 'healthier,' but they are not necessarily safe for kids," Klaczkiewicz says. "Cutting out a major food group can significantly impact a child's total nutrient intake and inhibit growth."

She recommends parents enlist the help of a registered dietitian to ensure their child is replacing the nutrients lost by cutting out a major food.

Is a registered dietitian the same thing as a nutritionist?

"The thing about the word 'nutritionist' is that anyone can use it," says Jan Hangen, MS, RD, a registered dietitian at Children's Hospital Colorado. "You could just hang a shingle and start treating people — and bill for it. A nutritionist does not necessarily have credentials."

A registered dietitian, on the other hand, does. In Colorado, dietitians need a bachelor's degree from a school accredited by the Academy of Nutrition and Dietetics. They also complete supervised practice and pass a formal exam. A nutritionist might have training, too — but might not.

The impact of elimination diets on kids

It can be tough for kids to refrain from eating a certain food. Klaczkiewicz says it's important to help them stay positive by focusing on the foods they can eat.

In many cases, a registered dietitian might recommend that a child take a multivitamin to help supplement the nutrients lost by eliminating a food. But not all multivitamins are created equally.

In particular, parents may want to give their child gummy "multivitamins" because they are kid-friendly. But because "multivitamin" gummies only contain vitamins and zinc, but no other minerals, Klaczkiewicz instead recommends children take a complete multivitamin with mineral supplement containing iron. You can find these as a liquid, hard chewable or tab.

Replacing nutrients during elimination diets for children

In addition to taking multivitamins, you can help your child replace nutrients lost during elimination diets with certain foods.

Here, Klaczkiewicz compares different types of elimination diets to show how they can lead to nutrient deficiencies:

Gluten-free diet for celiac disease

Food eliminated for a gluten-free diet
Grains that have gluten in them, such as wheat, barley and rye, and their derivatives

Nutrients lost during a gluten-free diet
Fiber, Iron and B vitamins

How to replace nutrients lost during a gluten-free diet

  • Gluten-free whole grains, fruits, vegetables, meat, eggs and legumes
  • Gluten-free, complete multivitamin and mineral supplement that contains iron

Dairy-free diet for dairy allergy

Food eliminated for a dairy-free diet
All milk and dairy products from cows and other animals because the protein in those milks are similar

Nutrients lost during a dairy-free diet
Calcium, vitamin D and possibly protein too

How to replace nutrients lost during a dairy-free diet

  • Dairy alternatives such as almond milk, soy cheese or non-dairy yogurt
  • Calcium supplement with vitamin D (vitamin D helps kids absorb calcium)

Lactose-free diet for lactose intolerance

Food eliminated for a lactose-free diet
Eliminate or limit dairy products that have lactose (milk sugar)

Nutrients lost during a lactose-free diet
Calcium and vitamin D

How to replace nutrients lost during a lactose-free diet

  • Lactose-free milk, such as Lactaid, or other calcium-fortified non-dairy milk alternatives
  • Small amounts of cheese and yogurt, if your child can tolerate it
  • Lactaid or Dairy-ease enzyme supplements to help digest lactose when eating dairy (discuss with physician first)

Diet for kids with multiple food allergens

Food eliminated for kids with multiple food allergens
Most common: milk, soy, eggs, wheat, peanuts, tree nuts, fish, and shellfish

Nutrients lost during diets for kids with multiple food allergens
Common: iron, calcium and vitamin D; depends on allergy

How to replace nutrients lost during diets for children with multiple food allergens

  • Complete multivitamin with mineral supplement containing iron
  • A registered dietitian can help you more accurately determine how to replace lost nutrients

Vegetarian/vegan elimination diet based on preference

Food eliminated for vegetarian diets for kids
Animal products, most often meat; vegans avoid all animal products.

Nutrients lost during vegetarian diets for kids
Common: protein, iron, calcium and B vitamins; depends on animal products eliminated

How to replace nutrients lost during vegetarian diets for kids

  • Non-animal sources of protein and fortified grains
  • Complete multivitamin with mineral supplement with iron
  • May need additional supplements, depending on level of restriction

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