A parent in my caseload recently told me that her child – in addition to getting an autism diagnosis – had just been given a diagnosis of eosinophilic esophagitis, or “EE”. Both diagnoses are not unusual in kids in my caseload, and they frequently show up together. So it didn’t surprise me to hear this from this parent. The part that surprised me was the play-dough birthday cake.
Having EE means many food proteins become intolerable, and can’t be eaten. This family had been given such a dismal outlook on how to feed this child in the context of EE that, for birthday time, they made a prop birthday cake out of play dough. Candles were real, cake was fake – just a prop to pretend with. The cake was not to be eaten, just looked at, and used as a vehicle for birthday candles. No one had found a way to recover the child’s tolerance for even a few foods.
One of the best things about my job is hearing anecdotes like this. They are certainly motivating. In my view, when expert medical teams around the country leave children with props for cakes more than once or twice in a lifetime, something is awry. First question: Why can we not do better? Second question: Why are these children getting EE in the first place – a condition that is regarded as recent in pediatrics?
It’s tragic that EE is now so common that moms’ groups and list serves exist to support families needing tools to create a non-cake. For now I’ll skip opinion and analysis of why EE (much less autism) has emerged among this generation – that’s a whole other blog. It’s also tragic that, as was true in this case, once the doctor finds this, no referral was made to a professional who can work on effective solutions: Safe foods, formulas, recipes, the right probiotics, or bowel microflora corrections that can support growth, gain, learning, and development. I hear this all too often.
EE is a fancy long name for too many white blood cells in the walls of throat tissue. White blood cells show up when they think there is a job to do, like fight an infection. But in EE, the culprit is often allergy or sensitivity, not infection, so the white blood cells keep showing up for no reason. They can eventually damage the throat (esophagus). The eosinophils (white blood cells) are much like those that are too active in kids with inflammatory conditions like asthma, skin rashes, or chronic sinus infections.
EE is painful. It often occurs with reflux, which exacerbates the EE and pain. This is especially challenging for kids who are non-verbal, because they can’t tell you when they are in pain. They usually act out; it’s their only way to communicate pain and frustration. These are the kids in my practice who grab food away from family members, because they don’t want their siblings or parents to have pain. They think food causes pain for everyone, that pain with eating is just part of life. I’ve also met kids who take pain out only on themselves, with self injurious behavior. Tragic part: Seeing them medicated for “behavior” rather than screened and treated for a painful GI condition.
The good news is children with EE may be able to improve the health of the esophagus and GI tract with some out-of-the-box measures, along with the tried and true. Work these into your child’s routine and expect improvement after 4-6 months, to allow time for tissue repair.
– Use elemental protein sources. These are specialized formulas that come in various formats: Ready to drink in a juice box and straw that your child can bring to school or pack to travel; powdered, mixed as one does for infant formula; or modular – that is, just pure powdered amino acids (these replace food protein) that can be mixed in anything, from spaghetti sauce or apple sauce to smoothies or gravy. Brand names are Elecare, Neocate Infant, Neocate Junior, or Splash EO28. These are covered by insurance for EE in some states.
– For an elemental protein source for kids who hate the taste of formulas above (I get it – I’ve tried them all and my own son used some of these for years), try Nutricia North America’s amino acid mixes, usually made available for modular feeding in G-tubes. Blend into safe foods for you child to use orally. I have used this tactic often with good success; you will need a dietitian’s or doctor’s authorization to order this yourself. Though amino acids don’t taste good, finding ways to flavor smoothies is a possible – think odd combo’s like avocado and bittersweet cocoa powder (dairy/casein free). For recipe ideas, visit FoodSensitivityJournal.com.
– Get food allergy (IgE) and food sensitivity (IgG) screening. These screenings can describe two different ways that the immune system may be reacting to foods. Prioritize the worst offenders by removing them, rotate the rest. Removing all food protein is an extreme measure that is usually unnecessary and unsuccessful, even in kids with multiple allergies and sensitivities.
– Treat intestinal fungal (yeast or Candida) infections. Candida species can worsen reflux, disrupt normal digestion and absorption, and trigger painful constipation if allowed to flourish at the expense of beneficial bacteria in the human gut. Untreated bowel infections are a top finding in my practice, for children whose treatment for EE failed at their major medical centers.
– If grains are an issue – and gluten in particular – there are still ways to make a birthday cake. Get to know the many options available for gluten free baking: Mixes, cook books, and recipes are everywhere. Gluten free birthday cakes are indistinguishable from a wheat flour cake when done right. Eggs can be replaced with non-protein egg substitutes.
– If your child has used antibiotics often, replenish healthful gut bacteria with probiotics. Use potencies of at least 15 billion colony forming units (CFUs) per dose, with blends that include Lactobacillus and Bifido strains. Check Special Needs Kids Go Pharm Free for more detail on using probiotics in infants and children. Some children in my practice have responded best to potencies as high as 60-100 billion CFUs/day of mixed strain friendly bacteria probiotics. Most store bought brands deliver 1-5 billion CFUs per dose. If you’ve tried probiotics from your local health food store and not seen results, you may need to go to a stronger product. Consult a provider experienced in using these.
– Extreme and severe EE cases may be placed on an elemental formula diet, which lets the GI tract rest, heal, and recover, while getting the nourishment it needs. Do this with close medical supervision and have a plan to transition back to food within a few months. Monitor gut microflora and keep it healthy, as elemental formula may shift the colonies of microbes in the gut to less favorable species. Insist on referral to a knowledgeable pediatric dietitian to help you. Liposomal glutathione is a supplement that has been helpful in person with inflammatory bowel conditions; add this to your regimen too if you want to accelerate gut tissue healing. Glutathione is an antioxidant that is ample in a normal, healthy bowel, but depleted in persons with inflammatory conditions of the GI tract.
– Good news has continued to emerge on potent natural anti-inflammatories like curcumin and turmeric. Eating these in foods is fine, if you like lots of these spices and of course, if your child can tolerate eating foods. But when used medicinally, higher amounts are needed than are normally in a serving of Nepalese curry. If your child can swallow capsules, curcumin and turmeric may help cut inflammation while helping to balance bowel microflora too. Enhansa is a product showing success in my practice for some children (I don’t sell it; you can order it from Lee Silsby Pharmacy).
Here are some of my favorite resources for kids with EE, and multiple food protein intolerance/allergy:
Gluten free girl (see the “cake” button)
Mary Capone, celiac chef (Italian specialties a specialty)
Gluten and Peanut Free Summer Camps
Neocate Junior elemental formula for kids over 1 year old (link from here to infant options too). This can be purchased over the counter or prescribed. It’s widely available on sites like amazon, e-bay, or NexTag; coupons are often available to reduce the cost of Neocate. Some states may cover this formula on insurance with an EE diagnosis.
Options to replace eggs in recipes
State by state insurance mandates for specialized formulas (inherited disorders)
States with mandated insurance coverage for specialized formulas for EE
Essential Amino Acid Mix – a powder that can be added to soft foods or thick drinks as a safe protein source. This requires authorization from a registered dietitian or physician, and may be covered on insurance in some states
Hello EE moms.
Feel like I should interject a moment and hope that you will take a second look at Judy’s words and work. She is someone that has gone above and beyond in investigating the nutritional underpinnings of many conditions that mainstream docs just shrug their shoulders and tell their patients and their parents to just deal with. With lots of successes!
My own son has serious GI issues, mostly gone due to the kinds of interventions that Judy talks about. And she is like Colombo in sniffing out problems in kids. Truly committed to helping kids get better, not just leaving them to suffer.
The birthday cake comment was not at all to disparage ways to give your child a good day (she is part of a huge autism community that is constantly figuring out tricks like this to make our kids lives as nice as possible) but only that it is unfortunate that these kids have to settle for this when there may be solutions to their medical needs that might allow them to eat.
Docs give up on kids like ours. Judy looks beyond what they do to help children truly heal as much as they can. I hope you will take a second look at her because she is someone I really respect and have affection for, for her commitment to our children.
Dear Ms. Converse,
… the idea of a birthday cake is to symbolize and celebrate another year in one’s life. While all children with EOS are on restricted/elemental only diets, a “fake” cake is the only appropriate option. For these children, being able to celebrate another birthday is the greatest feeling in the world. Then your article is now taking value away from this huge accomplishment. As for the celebration, it is all up for the interpretation of the birthday boy/girl. If the child wants a cake made from dum dims or a cake made from playdoh, then that’s ok.
… the fake birthday Cake isn’t there just to be there, it symbolizes so much. Without it, it estranges the children even more from society, and this can really tamper with their self-esteem.
I read this and I can see how it would make a kid feel but if the child is having fun doing it who is it really hurting. I don’t have a child with this particular special need. But I do have a special needs child who was basically born with a 1/2 a heart and he has a pacer also. He has a lot of limitations and I do things to make him feel like the other kids. It doesn’t seem to bother him that he’s not like everyone else. Sure it may be different, but at least he isn’t excluded. My personal opinion on this is that limiting a child from doing things others get to do is much more harmful then letting them do it a different way. It like sorry you’re not allowed to do this so go do something else while the rest of us have fun. But I do let the others do it the same way as my son has to so he wont feel as bad.
My heart goes out to each and every family living with EE and food allergies. Watching food hurt my child is truly one of the most heartbreaking challenges of my lifetime. At 2 years old my son was referred to as “one of the most allergic children in the world” by National Jewish Hospital. We had a safe list of ten foods for two years. We never had a feeding tube and I can only imagine the challenges these children and parents face each mealtime. For one of my son’s birthdays we put a candle in his mashed potatoes. I had no idea how to make a cake out of bananas, apples, peaches, carrots, broccoli, spinach, chicken, potatoes, green beans and rice.
For two years we struggled to find a health care team and nutritionist could help us get to the root of our son’s health issues and help our son get healing nutrition. We visited multiple allergists and medical professionals before we found the right care team for our son. Judy helped us get to the root our many of our son’s food issues, provided us safe new recipe options and helped get us on a better path to healing.
Most of us with EE and food allergic kids are navigating new territory. It is really hard and it is absolutely exhausting. What I have learned after six years of food allergies: Find the right care team for your child. Find medical professionals who will help you get to the root of your child’s problems and get them on a path of healing. Listen to your gut, you know your child better than anyone. Birthday cakes? I say make your cake out of whatever works with your child and what you feel is best at that time: mashed potatoes, lollipops, play-doh. A birthday cake should make you and your kid smile and enjoy the celebration of the day, whatever it is made of.
My sincere love and support to each of you Moms managing the challenges of EE and Food Allergies. It is a rough road and we are all amazing Food Allergy & EE Warrior Mamas.
Angie Nordstrum, Director
Boulder Allergy Kids
I have been following this exchange and have a few thoughts to offer. When I initially read your post, I felt sadness for children and parents who must live with this, and also glad that some medical alternatives that you are aware of are available to help them. Although my son does not have EE, he had a lot of problems with food when he was young. The scary part is that no doctor could diagnose his underlying digestive problem. It took YEARS of him being sick physically, and mentally. All that was offered was drug therapy, with no explanation as to underlying cause.
What I am hearing in your post, Judy, is there are alternatives that most doctors are not using. As a parent, I would do anything to save my son from a lifetime of pain. We have an opportunity here to come together, share information for the good of our children. These are the tests that have saved us (similar to what Judy offers in her post):
(1) gluten sensitivity testing through Enterolab
(2) comprehensive food sensitivity testing through ALCAT
(3) GI stool testing for bacteria, yeast, parasites, digestive enzymes
(4) cortisol saliva testing
(5) thyroid and ferritin testing
(6) vitamin and mineral testing (D, zinc, B-6, B-12)
This is the type of help someone like Judy can provide. If you haven’t had the opportunity to consult with someone like her (some nutritionists, naturopath, holistic MD), I urge you for the health of your child and the future of the next generation to be aware of all the tools that are available to you. And those who criticize food sensitivity testing are simply those who have not had the opportunity to use it in practice. It works – I’ve witnessed it.
I would like to extend an invitation to all families with eosinophilic disorders to join the support forums on Kids With Food Allergies. For many years, KFA has helped families make “cakes” out of whatever is SAFE for the child. Whether that may be 6 ingredients or 3, 10 ingredients or 0, the creative and caring parents there will help you find a meaningful and inclusive way to celebrate birthdays–whether it involves food or not.
Trish, there is a way to make “muffins” with just rice, potato and banana. We can also help you with banana-only ice cream and rice-only rice crispy treats. KFA also has numerous “sugar-only” recipes to help with birthday celebrations (and Neocate ice cream!).
Please consider referring our clients to APFED (http://www.apfed.org) for EGID information and research; CURED Foundation (http://www.curedfoundation.org/) for fundraising for a cure; and KFA (http://www.kidswithfoodallergies.org) for parental support and food/cooking assistance (where parents can get tailored suggestions for meal ideas, birthday celebrations and no-food party ideas for those that are g-tube fed on elemental formula only).
I am astounded that people with children who are dealing with these very difficult issues are upset with this incredibly informative and helpful article. And just for the record, I have a son who deals with multiple food allergies and intolerances though he does not have EE.
What I felt you were saying was that, though a limited diet presents some very serious challenges, there are other alternatives to fake cakes for those families whose children have EE and that many people who are advising and trying to help them are not as well-informed about this issue and the nutritional aspects as they should be.
I feel that some families may consider what you are saying about this condition as if it were a personal challenge to them. They have been doing X because they were told that this is the right way to handle their child’s condition. Now, you are saying that X may not be right but Y should be tried and that means that THEY are personally wrong. Nothing could be further from the truth. Because this is a fairly recent condition, I think that much of the treatment is guesswork and we as parents need to not only listen to those who are ‘experts’ but also observe our children, try new things and be open to change.
Speaking of which, I have a question. Years ago, I read a book which I believe was called “I Don’t Want to be Ty”. It was about a young boy who was vaccine-injured and had many, many physical and behavioural issues as a result.
His mother tried everything but what finally worked was supplementing Ty with donated breast milk (the mother had weaned due to medical advice but she had a group of women she was friendly with who were breastfeeding and they pumped and donated their extra milk to Ty). Ty was a changed boy after that.
Since EE seems to have a lot in common with what Ty had, I wonder if anyone has ever done any research on treating children with EE with donated human milk from milk banks and the like? I wonder what the result would be?
Thanks so much for your hard work and please don’t be discouraged. Sometimes when there is the greatest amount of resistance, it means that you are closest to the truth.
My son suffers from EoE and has a detailed dx, non of which includes autism. He was dx @ 3wks of age, most likely caught so early due to his other health problems. After him vomitting formula after formula (already only tube fed due to oter ealth problems.) he was on TPN for a month and then slowly elecare was introduced and he did well on it. He has no true food allergies, but many foods cause severe EoE reactions! After many trials we found some fresh local grown foods are safe for him. He still cannot have: dairy,soy, eggs, wheat, tomatoes, pork, all citrus fruit, sage, carbination, crayons, wheat playdo, many soaps, wipes, diapers, and almost all pre-packagged food. I have made him a potato cake, using iccing decortating tools, I have made marshmellow crisp cake, he thinks it’s fine, but other kids his age (4) don’t understand and he feels bad at his own party! This year we has a family party with his safe foods, and we went to the circus with his friends as a party. They all had cotten candy and it was fun. In the future I think this will be our normal party for him. We are blessed that he can have so many foods! He actually has a mild form of EoE. I know many people who can eat by mouth at all, or have sugar and water as food groups. If a playdo cake is what works for that kiddo, then I say go for it! How do you think it feels when he goes to a party and everyone else is eating cake and I give him a dum dum sucker or they have movie day at school and the smell of popcorn overwhelms the air, and he sits with homemade potato chips. There is no way for him not to be different when food is involved! In the US almost everything involves food. And by the way, I make everything he eats from scratch, I buy directly from the farmers… I have yet to find a “cake” he can eat without him sufering for it later. I leave you with a quote from a good friend: “judging, don’t do it!” until you are the one raising special needs children… Make a cake for my son that tastes like “cake” and only contains safe foods. For more info about this disease check out: http://www.apfed.org or http://www.cured.org for more info on my son and his brother (who both have feeding tubes and are on special diets) check out the group:pray for AJ and Bill on facebook.
We deal with a major children’s hospital and nutritionist that treats/manages children with eosinophilic disorders from all over the country. It is not as easy as letting the gut heal for a while on elemental formula and throwing some probiotics in for good measure. After the child is on an elemental formula for a period of time (if that time comes because elimination diets have failed), the child must then trial individuals foods for a period of time to check for reactions, before undergoing an endoscope to see whether or not these white blood cells have returned. Although some children suffer horribly by ingesting certain foods, others may appear to be tolerating the foods, when in fact, silent damage is happening inside the esophagus. This damage could eventually alter the esophagus, causing food impactions.
As far as the fake cake, unless you have lived the nightmare of not being able to feed your child, you should not judge. While my son is around people eating constantly, I may choose not to rub it in on HIS birthday by having a real cake. I also will not choose to have him in pain later that day or the next, or confuse him by feeding him just this once, in order to make everyone feel better. Who cares what their “cake” is made from, or even if they have one at all.
I have read this article and have to agree that nutrition information is crucial and somewhat lacking. I wish that there was someone who could teach me to cook for my child. I am not a creative cook, and this was very challenging for me. But what do you do when your child has no safe foods, or their safe foods are pork rice, & applesauce?? I am not creative enough to make a cake out of those 3 ingredients. Maybe you are. I have made a variety of non- food cakes including playdo. Especially when my daughter had no safe foods, or just a few. What do you suggest for those children?
My son is almost 3. He does not have EE but instead has been diagnosed with eosinophilic colitis. Both illnesses must be diagnosed by a GI after the results of an endoscopy and in our case colonscopy. He was diagnosed when he was just 9 weeks old after he stopped gaining weight and my husband and I chose to self-refer to a pediatric GI. In his short life he has already been to see 3 different pediatricians, a pediatric GI, an allergist, a registered dietician, and has undergone feeding therapy for oral texture issues. The first pediatrician we saw had never heard of eosinophilic gastro-intestinal disorders and repeatedly told us that our son was ‘normal’, told us ‘all babies spit up’, and ‘babies gain weight differently’ when we raised concerns to her about projectile vomiting and failure to gain weight. By the time we chose to stop listening to her ‘professional advice’ and took him to the GI, he was at 5% on the national percentile chart, diagnosed by the GI with failure to thrive and had to spend over a week in the hospital until he was able to maintain and begin gaining weight. The second pediatrician, while she treats EE in adults did not know how to treat EC in a child and had to research how to do so on the APFED website referenced above by a previous commentator. The third pediatrician formerly worked in a children’s hospital and is the first non specialized doctor that has been able to explain eosinophilic disorders to me rather than the other way around.
Not everyone with a child who has an eosinophilic disorder has the luxury of being able to take their child to any of the types of medical professionals that our son has seen. People who live in rural areas may go years without a diagnosis, let alone the ability to see someone to ‘help them teach their children to eat’.
Not to mention, it is extremely difficult to figure out which foods are causing the child’s reaction. In our case, the only food that showed up on allergy testing as a food allergen for my son was peas. My son is NOT allergic to peas. He is however allergic to soy, eggs, red dye, liquid milk, and a few other foods which we have still not been able to pinpoint. He also has a number of foods that he started out not being able to eat (carrots, peas, pears, banana, beef, peaches to name a few) that he can now eat.
When someone has a child with this type of illness he has to make compromises in order to feed his child. While it would be nice to be able to prepare a ‘normal’ birthday cake for these children, it’s not always a possibility. So people compromise to give their children a “normal” experience. My own son did not have a cake for his first birthday, we found something else to use that worked for our situation instead. My child is does not have celiac disease and is not gluten intolerant. Not all children with EGID are on a gluten free diet nor do they need to be.
I Can see everyone’s point. It is so devastating for all of us parents dealing with so much, EE is a very complected and for the most part an unanswered unknown illness always having to hope for a treatment that will insure our kids safety and cure and a possibility to have food in there life that will sustain them and not make them sick.I always feel like we live with an unknown walk in the dark..the lucky ones get a glimpse of light that comes in for a sort time for its only a mater of time when we get hit with that darkness such as a failed food ,pain, reactions,etc… never to know whether a trailed food will attack and bring back Eos saver emotional suffering once again devastating.I do understand some of the parents here that are feeling angry with you ,the pain of watching our kids with unbelievable and tragic struggles. as you say there is so much information out there but not if you didn’t get it to begin with from the Dr’s .finding resource is so limited for some of us. unless you know your way around the internet.I must say to you Judy Converse I appreciate your candor about the lack of help within the professional arena some Dr are taking there time and not doing anything to recognize such illness wast of time including the dietitians to only drag you for years with no substantial help, and after you are finely facing the illness with a diagnose the help is so slow 95% of the time if you don’t have a team such as in a EE clinic its so hard to get everyone on the same page.It takes for ever.For me it has been self motivation, learning everyday researching and doing the leg work for the PEDIATRICIAN for years now.We have been dragging with my sons for 13 years he has been sick since he was 2 years old if it was not for my fighting every Dr insisting something was terribly wrong he would not be here today.we had many close calls. thank God we finely found the Dr that recognized the EE .my son has already 3 known organs affected by the bodies Immune system.This Article should go to all the Dr to read so they get your massage not to the parents of EE to be attic for trying to do the best they know how and give there kids some pleasure why don’t you see what else can be done since your published books with Penguin/Perigee – and yet there is no change in 10 years WOW LETS GET TOGETHER AND HAVE A POSITIVE DIALOG AND HELP ONE ANOTHER AND KEEP IT MORE HUMAN LIKE THANK YOU
As Colleen said if her son wants a cotton candy birthday cake because he knows he won’t have a reaction to it than why not. My son can eat most foods eventhough he has EE. Eggs seem to be his main trigger. He won’t eat more than a bit or two of cake even egg free cake because it has caused him pain in the past. Guess what I have more important things to do than fight my child to eat cake. He eats the healthy food and if he doesn’t want “safe” cake than why am I going to make safe cake if he wants something else. It is his birthday shouldn’t he have a say in what food is served at HIS party.
Yes this is different than parents thinking they don’t have a choice. Some kids can and some can’t. Some kids have to go elemental a month or two before their birthday. These parents don’t have a choice. They are just doing their best to let their child have a normal birthday party.
My son has a normal diet (minus eggs and nuts). Next month when he turns 4 he gets to help pick the food that we will have at his party. If he wants something other than cake (egg free of course) than that is what we are having. No he doesn’t dictate what we have everyday but birthdays are supposed to be special and about the birthday boy (or girl).
Many kids with EoE can’t eat ANY foods AT ALL and are strictly elemental formula-fed and often only tube-fed at all.
The ritual of making a wish and blowing out candles on a beautiful birthday cake can mean A LOT to such a kid.
How sad that kids with EE have such a hard time. My son had digestive problems that only cleared up with food sensitivity testing. It took a lot of hard work with elimination of gluten, dairy, soy, egg, yeast and sugar, but eventually, we were able to normalize his diet. The funny part was multiple doctors missed this piece of the puzzle. We treated him with fish oil and probiotics, and had stool testing done to find out about yeast and bacteria overgrowth. Those issues were dealt with. So glad we did – the transformation has been incredible! Judy, I’m thanking God for professionals like you who are literally saving lives. Jennifer – my heart goes out to you. I hope you are able to find some answers.
Amazing and sad that readers are thinking I take EE lightly. My apologies if that is the message received. Not intended! Worse, to hear that any child would suffer for 9 years before being diagnosed just makes my blood boil. What has gone wrong here is that our pediatricians and GI MDs do not study nutrition (see my earlier post on that topic). So, food intolerance, inflammation, failing growth, and other symptoms progress past the point of no return. I have witnessed this in practice repeatedly for more than ten years. That’s exactly why I have published books with Penguin/Perigee – this needs to change.
For calcium supplementation or means of getting other minerals in EE, consider bone broths like this, if meat broths are acceptable in your case (the broth contains no meat, but some children are too sensitive to use them). For pure calcium supplements, consider a manufacturer like Kirkman Labs hypoallergenic calcium.
Thank you Jennifer, the fake cake was new to me. While I am glad it has worked to bring some younger children through birthdays, I am unhappy to hear that this option is widely used. In my opinion, these are children who are underserved for the nutrition piece, whose dietitians and doctors need to do more for them.
I work with many EE children and have been able to find options individualized for them – and have never had one need a fake cake. Some of them need a trial of elemental diet only, done with MD and RD supervision of course – but in my opinion, going more than a year with such restriction is not necessary, if your providers are doing a good job and helping your child’s gut /GI heal.
I was a consultant to Nutricia, maker of Neocate and its other elemental products, from 2007-2009. So, I know the products well, and use them often in practice. My own son used them for several years (he no longer needs them). I do know their limitations, taste, applications and all. I still find ways to work them into a child’s program, and your dietitian should too. My son certainly has given candid opinions on how these taste! So he was a great help in creating acceptable ways of using these things.
My goal in practice is to normalize diets for children as much as possible, and help their GI disease heal/recover. This ought to be your providers’ goal too. There are tools that afford EE children improved food tolerance over time. If your parent group or local providers are not aware of these, look into using probiotics, antivirals, antifungals, liposomal glutathione, elemental amino acids, and adequate total calories more effectively. All this is outlined in Special Needs Kids Eat Right and Special Needs Kids Go Pharm Free.