Knowing when to abandon trialling a new or previously failed food is one of the most difficult tasks of non-IgE allergy parenting. The evidence informing food re-introduction in particular, is scarce, contradictory and inconclusive at best. Sadly, the advice of the professionals assisting our children is no more consistent.
Before you begin contemplating food trials, it is essential that your child is at their baseline. This phrase simply means that your child is in full health (this includes colds, post immunisation woes and teething), with their reflux under control, is sleeping as would be expected for any other child their age and is not approaching or currently experiencing a developmental milestone which would compromise their sleep. Please don’t feel under pressure to rush into food trials while any of these other factors is at play. You won’t gain any new information about the food under these circumstances and will only add to your own frustration and exhaustion.
Another consideration before beginning any kind of food trial, is making sure you have a comprehensive list of symptoms experienced by your child during a reaction. Non-IgE reactions and FPIES reactions are umbrella terms. This simply means that they cover a great number of symptoms and types of reactions. Unless your child has non-IgE anaphylaxis or acute FPIES, the chances are you won’t have a formal care plan and that you are the only real expert when it comes your child’s symptoms. There is no substitute for your expertise in these cases and, for your own sanity, it will really pay to write all your child’s reaction symptoms down before you begin food trials.
Every failed food trial will be a set back for your child’s growth and development. Time they spend unwell as a result of consuming foods they can not tolerate must be weighed up against the benefits that food could potentially bring for them if successfully introduced. For this reason, it is often best to target single foods which together could make a simple but balanced diet. For example, one source of carbohydrate such a grain or potato, a fat, a vegetable, a protein and a fruit. Ultimately, the decision about which order you approach the food groups is up to you and your healthcare team. It is worth remembering that during times of difficulty for your child (teething, reflux flares and ill health) you may need to return to this simplified diet to weather the storm. For this reason, many allergy parents opt to start with a carbohydrate, a fat and then a protein as the quantities of these foods required to sustain a growing child can be hard to achieve with formula alone.
The final stage of food trial preparation is to use your list of symptoms to decide exactly when you are going to stop the trial if things go awry. If your child experiences a rash for example, this could be a clear cut indicator to stop the trial and try again at a later date. Early symptoms such as a reflux flare may be a natural stopping point for another child. Others may experience stomach cramps and mucus diarrea as their first clearly defined symptom and this would prompt the parent to stop the trial.
Before you begin trialling any food, it is very important to decide how far you are willing to go with an adverse reaction. As the reaction becomes more severe, you are offered more clarity about whether the food is a problem but you are also increasing the time it will take for your child’s body to recover from the trial. As a rule of thumb, you will need to rest your child’s gut (not introduce new foods) for three times as long after a more severe fail than a mild fail.
To summarise, before you start a food trial:
1. Make sure your child is in good health.
2. Make a complete list of their reaction symptoms.
3. Choose the food you are going to trial.
4. Draw your line in the sand. When you see this symptom you will stop the trial.
5. Trust yourself and your instincts.
As there is no text book answer for when to stop a food trial, it is of the utmost importance that you decide your limit based on your individual circumstances. And then adhere to your convictions if symptoms begin.
It’s always best to decide how to handle food trials together with your dietician and health professional. But in reality, this isn’t always possible and you know your child and their reactions best. Trusting in your own expertise is the key to feeling in control during food trials- whether the trial proves a success or not. You are Mama and you know best!
Xx Allergy Mama
Want some tips about quantities and frequency when weaning children with non-IgE allergies and FPIES? Check out our weaning series on the Non-IgE Baby blog