An elemental diet is most commonly used to treat Crohn’s disease and Eosinophilic Esophagitis. It is designed to eliminate ALL possible allergens, so usually starts with exclusion of all solid food and inclusion of an amino acid based formula such as Elecare or Neocate. Since the formulas are predigested they are very gentle on the system and easily tolerated, allowing the esophagus and digestive system to heal.
Some children are able to drink all of the formula they need, however in many cases they need a feeding tube to be placed temporarily because they cannot drink enough formula. If your doctor mentions your child needs to go on an elemental diet, here are a few things to think about.
Will my child be able to drink the formula on an elemental diet?
Some children are able to drink the amino acid based formula; however others cannot tolerate the flavor or have swallowing issues due to EE. This means she may need a feeding tube to receive the adequate amount of formula to meet her nutritional needs. To get your child to drink her formula, you may need to use behavioral techniques, and even by doing this she may be unable to drink the amount of formula she needs and a tube may be necessary. The amino acid diet is a difficult one to follow since it is so restrictive. These formulas do not taste good and since the diet is so strict there are not many approved ways to flavor the formulas given and a tube may be the best option.
How long will my child need to follow an elemental diet?
Unfortunately there is no definite answer to this. Your medical team will decide when food can be reintroduced based on her progress and the results of follow up endoscopy and biopsy.
When will she be able to eat regular food?
Once your child’s esophagus is healed, food can be reintroduced on a schedule with strict monitoring. Your child’s gastroenterologist and dietitian will figure out what and when to introduce each food. Your child will be monitored for symptoms of food allergy for every food, and it is important you follow the schedule they give you so that in the end her true allergies are discovered and she is allowed to eat foods that are safe for her.
How strictly does the diet need to be followed?
You need be 100% compliant when on the elemental diet. I know this is difficult, especially if you have other children in the house eating regular food, but letting her cheat is not going to help her. Your child has probably been in pain for a long time and this diet cures 95% of cases! That should be a huge incentive for you to enforce the rules and make sure she only receives her formula and any food that her team feels is safe for her (sometimes sugar and oils are OK). Chances are you have been on a long and painful road thus far, now that you finally have a diagnosis and treatment.
Any suggestions on how to make the elemental diet a little more fun?
Let’s face it; this diet is not a fun one. I know it’s hard to think of a period where your child will not be able to eat anything, especially since you have probably spent much of her life trying to get her to eat something!
Since she will not really be able to eat anything besides water and formula, work with that. Make water in all its forms: Ice, ice chips, shaved ice, cold water and hot water. Different ice shapes can make it a bit interesting. The formulas come in different flavors and can be blended with water to make an Elecare or Neocate shake, and EO28 splash is fruit flavored and comes in a juice box so is socially acceptable to go out with.
A few final words...
The most important thing you can do for your child is have a positive outlook on this diet. Do not make a big deal out of it and explain she needs to do this to feel better. Enforce the diet with well meaning grandparents, the aunts and uncles who spoil her and her siblings as well. The diet is most effective if it is perfectly followed.
If your child regularly goes into the refrigerator or cabinets you may need to put locks on them, or at least signs reminding them not to eat. You may want to avoid buying your child’s favorite foods so they aren’t in the house, and in the beginning try not to go to social functions where food is involved (which is very difficult, since all social situations have food). Keep reminding yourself this is not a long term diet and she will get better if the diet is followed closely. You are doing what’s best for your child, and that is the most important thing.