If your child is having frequent tummy troubles or seems uncomfortable after eating certain foods, your doctor might recommend an elimination diet. This is when you temporarily remove certain foods from your child’s diet and slowly add them back in to see if you can uncover the cause of symptoms.

Elimination diets are commonly short-term and used to identify food intolerances and sensitivities. An allergist can diagnose a true food allergy with a detailed diet history, blood test and/or skin test. If positive, a long-term elimination diet is required.

If you suspect your child may have either a food intolerance or an allergy, contact their primary care doctor before trying an elimination diet. Kelly Klaczkiewicz, RD, a registered dietitian in the Gastrointestinal Eosinophilic Disease Program at Children’s Hospital Colorado, shares what you need to know about allergies, intolerances and elimination diets.

Food allergy vs. food intolerance

There are key similarities and differences between intolerances and allergies in children. Although each can trigger symptoms, food allergies and intolerances work differently in the body and can produce reactions that range from mild to severe.

Recognizing and understanding those differences can help identify causes, symptoms and treatments for your child. Find our chart below for helpful guidance on allergies and intolerances.

Using elimination diets for identifying food intolerances in kids

Elimination diets can be helpful for diagnosing food intolerances. Intolerances typically lead to digestive symptoms such as bloating, gas or stomach pain. By removing the foods and adding them back in, doctors and dietitians can observe how your child’s body responds to identify which foods trigger discomfort.

Using elimination diets to identify and treat food allergies in kids

Food allergies involve the immune system, and symptoms can range from mild itching or hives to severe reactions such as trouble breathing or anaphylaxis. Elimination diets for food allergies are often done alongside skin or blood testing. If your child has a food allergy, it is important and sometimes necessary to strictly avoid the problem food(s).

Can I manage my child’s elimination diet on my own?

No, it’s important that a registered dietitian guides the elimination diet process, especially for children. While an elimination diet might be easier for an adult to manage themselves (such as going gluten-free or dairy-free), it’s a different experience for a growing child who still needs key nutrients replaced after cutting out a major food group.

“The biggest misconception about elimination diets is that they are healthier, but that’s not necessarily true,” Klaczkiewicz says. “They are not safe for kids without guidance. Cutting out a major food group can significantly impact a child’s total nutrient intake and can impact growth.”

It’s incredibly important to find a registered dietitian for this process (instead of a general practitioner or nutritionist). Registered dietitians have increased specialties and accreditations from the Academy of Nutrition and Dietetics to oversee complex processes like food elimination diets.

The impact of elimination diets on kids

Taking away favorite foods, even temporarily, can feel challenging for parents — and confusing for kids who don’t understand why they can’t have an entire food group. Elimination diets may be as short as two to six weeks, but others may be long-term or life long. Either way, it’s important to help your child recognize foods they can have and enjoy throughout the elimination diet.

“Meeting with a registered dietitian can help your child feel more empowered, positive and in control — it’s important for them to be a part of this conversation and education process,” Klaczkiewicz says.

Before starting an elimination diet, you and your child will share their usual eating habits and diet history with the dietitian. This helps the dietitian understand your child’s food preferences and suggest safe, familiar substitutions for foods removed during the elimination diet.

During this time, remember that your language around food matters. Remember not to label food items as “good” or “bad”. Instead, try to remind your child that certain foods are “safe” or “unsafe” for their intolerance.

For young kids, remind them to ask a caregiver or trusted adult before they eat something. While this can feel frustrating for some kids, especially when they can’t eat what they want, working with your child’s registered dietitian can help. They can suggest tasty, safe substitutions your child still enjoys.

Some kids may start to feel anxious about food items being safe or not. If this becomes a problem, it can be helpful to talk to someone, such as a trained psychologist with experience in gastrointestinal disorders or allergies.

How to go shopping for an elimination diet 

Make sure that you involve your child in every step of the process. First, go through items in your fridge or pantry and look at the nutritional labels to recognize foods that do and don’t align with the elimination diet.

Next, take your child grocery shopping to find some yummy and safe foods. 

Mainstream grocery stores carry a lot of great options, so you don’t have to focus on finding expensive or fancy substitutions. For your first time shopping, plan to spend an extra 20-30 minutes at the store. This allows you to focus on finding alternatives.

Fruits, vegetables and unprocessed meats are also great options, and are typically safe from typical food intolerances. This opens up many options for your child’s diet.

As groceries can get expensive, remember fresh, frozen and canned food products are all nutritious. Although canned vegetables tend to have high sodium levels, this is typically not a concern for kids, unless you have been told otherwise by a doctor. For canned fruit, try to choose fruit packed in water, juice or light syrup — not heavy syrup.

Replacing nutrients during an elimination diet

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 vitamins are created equally.

Gummy supplements are kid friendly because they look and feel like candy. If your child needs an individual nutrient, such as vitamin D or calcium, a gummy supplement will work. However, gummy multivitamins only contain vitamins and zinc — no other minerals.

If your child needs more nutritional value, Klaczkiewicz recommends children take a complete multivitamin with mineral supplement containing iron. You can find these as a liquid, a hard chewable or a tablet to swallow.

Here are some of the most common elimination diets, the nutrients they may limit and strategies your child’s care team or registered dietitian may suggest to help replace them.

Elimination diets by age

Toddlers

Caregivers typically control their toddlers’ and younger children’s diets, so elimination diets are normally easier to implement for these kids.

After the age of 1, dairy products provide a lot of nutritional value (protein, fat and calcium) that helps with brain development, growth and bone mineralization. If dairy products need to be avoided in a toddler’s diet, it is good to encourage high-protein milk alternatives, such as soy milk or pea protein milks. Registered dietitians can recommend foods to replace other nutrients, as well.

Toddlers can be picky eaters, so meeting with a dietitian that specializes in food intolerances is helpful in finding alternatives that offer high nutritional value and that the child will enjoy.

Elementary age

Teach your child about their elimination diet as early as possible so that they know what is safe to eat. Encourage them to ask a caregiver before they eat something.

At this age, send safe snacks with your children with they go to school or to a friend’s house. Sometimes teachers or other caregivers don’t understand the complexity behind your child’s intolerance, so it’s best to pack them something safe.

If your child is going to an event, ask what food is being served. This way you can plan ahead so that your child has safe food options.

Tweens and teenagers

It is really important that parents make sure their older kids are educated and on -board with their elimination diet, especially since they are more independent and can make their own food choices.

If your teenager is going out for a meal to a restaurant with their friends, remind them how to safely order and advocate for themselves. You and your teenager can also check allergen information on a restaurant’s website prior to them going to make sure there are safe options. A registered dietitian can also provide examples of safe restaurants for elimination diets.

It is especially important that older kids understand why the elimination diet is needed. In some cases, if an elimination diet is not followed, it could cause damage to their gut or intestines, or trouble breathing/ anaphylaxis with food allergies.

However, if your child is on an elimination diet for more mild symptoms of intolerance, it’s best to follow the diet as closely as possible, but there won’t be any damage if an accidental slip-up happens. That said, it’s still good for your tween or teenager to understand that symptoms may occur if they decide to eat something outside their elimination diet.

Common challenges with elimination diets in kids

Managing your child’s diet can be difficult for a variety of reasons. It is best to talk with a registered dietitian to navigate your child's unique restrictions and symptoms. 

What if my child refuses to eat the substitute foods?

When trying food alternatives, remember that the substitutes may not taste exactly like the original food item. Caregivers are encouraged to try all of the substitutes and alternatives that the child eats or drinks. It's important to do it with a positive attitude. Children often respond to how we react to food, so remember to use encouraging language around food alternatives.

If your child doesn’t like the substitute food, try to figure out what they are missing from the original food group. It might be a specific taste, flavor or texture. You can try different brands of the substitute to find one they like. You can also rotate through alternatives so that your child has some choices. Registered dietitians can often recommend brands that have worked for other kids.

If your child still refuses to eat any substitutions, think about what nutrients they might be missing from the eliminated food group. Most often, supplementing with a complete multivitamin with mineral supplement will be able to meet their needs. However, with milk/dairy elimination, calcium may need to be supplemented separately. If your child’s doctor or dietitian is concerned about other nutrients, they may recommend separate supplements.

It’s also a great idea to consistently offer things like fruits, vegetables, unprocessed meats, and beans or lentils for their diet. These options can help to fulfill your child’s nutritional needs while offering a familiar taste.

How do I manage school lunches and social events with my child’s elimination diet?

With school lunches and social events, preparing in advance is important. For school lunches, homemade meals work best to accommodate all food restrictions. Some schools or school districts can work with food allergies or conditions like celiac disease. Here are some ideas to pack in your child’s lunchbox:

• Leftover food from family dinners can be sent in a thermos to keep the food warm.
• Pick something from each of these food groups from your food or pantry: fruit, vegetable, protein and starch. For example, make a sandwich with meat and a side of an apple and carrot sticks.

For social events at another child’s home, ask what the menu will be like ahead of time. If the menu items aren’t safe for your child, consider bringing alternatives that are similar so that they don’t feel left out. If that’s not possible, bring a food you know they’ll enjoy. If it’s a birthday party, consider packing a safe dessert for them to enjoy.

How can we go to restaurants when my child is on an elimination diet?

Check the menu and allergen information ahead of time to plan what to order. If possible, try to go to the restaurant at a less crowded time. This way, the staff can be more attentive to your child’s needs. Advocate for your child and make sure the staff understands their restrictions. If your child doesn’t want to eat anything on the menu, pack snacks as a backup. 

Moving forward with confidence and support

Elimination diets can feel overwhelming at first, but with the right guidance and support, they can be a powerful tool to help your child feel better and thrive. By working closely with your child’s care team and registered dietitian, you can make sure your child stays nourished, confident and supported every step of the way. Remember, this is usually a temporary process designed to give you answers about your child’s symptoms. Ask questions, take your time and trust that your positivity and patience is helping your child in the long run. You’ve got this!