Food Trial – How To Do It The Right Way
Once you have gone through the Total Elimination Diet and the symptoms your little one was experiencing have resolved, it is now time to reintroduce foods back into the diet through a food trial. You will have to decide how you will reintroduce these foods: (1) you will reintroduce foods into your diet if exclusively breastfeeding, (2) you can reintroduce the food into yours and your baby’s diet if breastfeeding and your little one is on to solids, or (3) you will reintroduce foods into just your little one’s diet if you are no longer breastfeeding.
The Total Elimination Diet is a labor of intense love. It is hard on you, hard on your little one, and hard on your family, too. It’s 100% worth it, though, to see your little one healthy and feeling good! That being said, the reintroduction of food into the diet is a very important next step. Food trials come with their own set of challenges, and the best way forward will be different for each family, but there are some common threads that can help to make it easier to get started on the right foot.
Helpful Hint
If you are introducing food back into your diet and your baby’s diet, start by introducing the food to your baby, rather than on yourself. When I first started doing food trials with my little one, I made the mistake of introducing the food into my own system first, thinking that having a food diluted through breastmilk would be the best approach. I was wrong. What I learned is that if I ingested the food and it was a fail, I then had to wait two to three weeks (!) for the food to clear from my system and then ANOTHER two weeks after that to clear from my baby’s system. This meant up to five weeks of painful symptoms before her system could start to heal and another two weeks of healing before we could try another food trial. This meant that we were only introducing a food every two months! I eventually figured out that if you only introduce the food to your baby, you have a much shorter time of potential symptoms and you can move past the failed trial much more quickly.
(1) What food do I trial first?
(i) AVOID foods from the major trigger groups, as statistically these are more likely to be problematic.
(ii) AVOID foods that you suspect your child was reacting to prior to the Total Elimination Diet.
(iii) AVOID foods from food families that your child previously reacted to. For example, if your child reacted to soy, lentils would not be a good choice for an initial food trial.
(iv) DO consult your healthcare team to see if they have any specific recommendations for you to consider.
(v) DO consider nutritional content. Total Elimination Diets can have negative impacts on one’s nutrition, so choosing a food that packs as much of a nutritional punch as possible is always good.
(vi) DO think about what foods your baby is already tolerating, if any. I know for some of us, this list is slim to none in the beginning. If your baby does have a safe food(s), consider introducing a food from the same family.
(vii) DO take into consideration whether your little one will eat the food. Some children develop oral aversions which can further complicate food choices.
(viii) You may want to consult the FPIES Food Survey when thinking about ideas for what to trial. This survey was given to over 280 children with FPIES and each food was that was trialed was given a pass or fail status for that child. It only provides one data point among many, though, as each child is different.
(2) How do I perform a food trial?
(i) How much food do I introduce?
Food should be introduced in a small amount that gradually increases. For example, a common starting amount is 1 teaspoon. If no reaction is suspected after 24 hours, then on the second day the amount is increased to 2 teaspoons. This pattern continues for 6 days (which will add up to 6 teaspoons). The 7th, 8th, and 9th days NONE of the food being trial is given to your little one. This is because for many MFPI and FPIES babies, symptoms will appear chronic (mucous in the poop, sleeplessness, etc) while the food is being ingested, but after re-ingesting the food, symptoms can become acute (repeated vomiting, diarrhea, shock, etc). A food is not truly a “safe” food until it has been ingested, stopped, and then re-ingested. On days 10 – 14, continue with the 6 teaspoons amount unless symptoms occur or are suspected to occur. If you pass the 14 days you are likely in the clear. *high five*
(ii) How often do I give the food?
Once a day only. Most people prefer to give the food first thing in the morning as symptoms can be delayed many hours (or even days), and it’s much easier to keep a close eye on your little one during the day then it is in the middle of the night.
(iii) How frequently can I perform a food trial?
This will depend a lot on your child and the type and severity of symptoms experienced. At most you could perform two food trials per month, if the first one is a pass. If the food trial is a fail, it’s advisable to wait until all symptoms have resolved again before performing another food trial. If your child’s symptoms are mild and tend to resolve quickly, you may be able to trial another food fairly quickly. On the other hand, if your child’s symptoms are severe or take a long time to resolve, you may not be able to perform another food trial for some time. My personal experience has been that we are only able to perform a new food trial every 6 to 8 weeks because we have had a lot of fails and symptoms take a long time to resolve. Food trials are a marathon experience for most of us, and one that goes at a snails pace. In the end, though, slow and steady really does win the race.
Helpful Hint
If you have had 3 or more food trial fails in a row, it is time for “gut rest”. This is a 4 – 8 week period where only safe foods are eaten while the gut heals from the trials. If the gut does not have time to heal before the next food trial, you may get false failures. This is because the gut is experiencing inflammation and intestinal hyperpermeability, plus the immune system is on high alert and primed to react. Some people have found probiotics to be helpful during gut rest to help the healing process. Personally, we have not found any that work well for us, so I can ant recommend any. If you have a brand that works well for you, please share!
(iv) If a food fails a trial, how long before I should try to trial that food again?
If a food has failed a food trial, you should wait at least 6 months before trialing that food again.
(v) What counts as a symptom?
There are the usual symptoms, of course, that probably led you to discovering that your child has MFPI / FPIES in the first place, such as reflux, diarrhea or constipation, high levels of gas or stomach cramps, sleeplessness, irritability or anxiety, vomiting, rashes, etc.. But any change that occurs after beginning a food should be noted and considered a possible reaction. It is strongly recommended that you keep a food and symptom journal and record any physical or emotional changes that you notice.
Helpful Hint
If there is ANY possibility of an anaphylactic reaction to a food that you are trialing, the first exposure to that food should be performed in a medical office. Your healthcare team should be advising you on whether this is a possibility or not.
(3) Anything else I need to know?
(i) Trial only single food ingredients (i.e plain white potatoes, as opposed to mashed potatoes) and use only fresh ingredients instead of pre-packaged foods.
(ii) When you do feel safe to introduce multiple ingredient foods and / or pre-packaged, read the labels carefully for possibilities of cross-contaminants. These are usually marked clearly on packages with verbiage along the lines of, “Manufactured in a facility that makes products containing soy.”
On a personal note, I found food trials to be even harder than the Total Elimination Diet. The anxiety of waiting to see if a reaction would occur was very difficult for me, and yet, so was waiting weeks until we could try again. After the first few months, though, it got easier. If you want to drop me a line letting me know how it’s going, I’d love to hear from you. Best of luck!