Adventures in an Elimination Diet with a Picky-Eating Toddler

Joaco and Papi at StarbucksEver since Joaquin was born at an overly ripe two and a half weeks late, looking like a scaly reptile, he’s had issues with his skin. At a few weeks old he had cradle cap, which I successfully treated with some extra virgin olive and coconut oil. He had dry patches and mild forms of baby eczema on and off for the next year and a half.

I’d always chalked it up to him having sensitive skin, but recently things have gotten worse. He came down with a bumpy red rash all over his back that eventually spread to his limbs. He also had several very dry, red patches that looked like they itched, though he didn’t really put up a fuss aside from bath time.

A visit to the dermatologist left us with a diagnosis of “viral rash” and a prescription for steroid creams and gentle bath wash. The steroids helped overnight, but the rash seemed to depend on these harsh creams, and I grew increasingly uneasy using them day after day. The derm again prescribed a “more gentle” steroid, which we were supposed to use for maintenance. But why was this happening?

In the back of my mind, I intuitively knew that his issue was food related. But given that I have one of the pickiest eaters on the planet, I subconsciously hushed this growing suspicion, hoping he’d grow out of it. But when my in-laws (his caregivers) let me know he had never had a well-formed poop, always pasty, and knock-you-over stinky, I knew it was time to get serious.

I explored my options. Take him to an allergist where he was sure to be traumatized by needle sticks, blood draws and scratch tests? Or, do an elimination diet. As a dietitian, I know that this is the gold standard for investigating food intolerance. And the alternative just seemed plain crappy.

So even though I had a child who ate nothing other than dairy (and lots of it), bread, peanut butter, fruit, and chicken tenders – yes, pretty much a nutritionists’ worst nightmare – I dove in head first to an elimination diet.

For a willing adult, an elimination diet isn’t so bad. You know that you’re only giving up these foods for a short time and are therefore more willing to accept a meal of steamed vegetables and grilled chicken. But trust me, with a toddler, this will be no easy fete.

The key is to try to keep things as consistent in taste, appearance, and texture as before. Toddlers like routine. Here’s what to do if you’re faced with a similar situation:

Foods to eliminate:

  • Gluten (wheat, barley, rye)
  • Dairy
  • Soy
  • Tree nuts
  • Peanuts
  • Fish
  • Shellfish
  • Eggs

Substitutes to try:

Milk: Try quinoa, hemp or rice milk. Quinoa is great since it has at least some protein. Hemp has some inherently nutritious properties like omega-3 fatty acids and a little protein. Rice milk is essentially sugar water fortified with vitamins.

Yogurt: If your kid will eat it, go for the chia pods. Mine didn’t, so I caved and let him have almond milk yogurt. (This was one exception to my elimination plan. Hey, you do what you have to.)

Cheese: I find all cheese alternatives to be pretty nasty, and so did my son, but you might find luck with this one from Go Veggie Foods.

Butter: This one from Earth Balance is actually decent tasting and the nutritional profile isn’t terrible. And I like that it’s soy free.

Bread: There are several gluten-free breads available. I like Rudi’s Soft White Sandwich Bread for grilled cheese and “PB&J” (made with a nut butter alternative) or Rice Millet Bread by Food for Life for toast. You’ll pay an arm and a leg, but you really only need one piece per serving since it’s so dense.

Peanut Butter or Nut Butter: Try Sunflower Seed Butter. Admittedly, I thought this tasted like ground up bird seed (cause it is!), so I added a tablespoon of honey to the entire jar and stirred it up. MUCH better.

Let me be clear – this is far from a “healthy” diet. It’s meant to be temporary so you can discover what’s bugging your kiddo’s digestive system. So commit to doing it for 2 weeks or longer if you can. Then, reintroduce ONE food at a time. I would suggest starting with gluten, then fish or shellfish, then tree nuts or nut butter (one type at a time), then peanuts, soy, butter or cheese, yogurt, and lastly milk.

For us, cow’s milk was the culprit. We definitely cheated in our efforts to eliminate everything for the solid 2 weeks – (Did Dad just give you a piece of his dairy-laden chocolate chip cookie? Oops!) But it was pretty clear Joaquin could only tolerate a certain amount of dairy, and milk was enough to put him over the edge. Once we cut it out, his skin improved significantly over a matter of days.

He got used to his quinoa milk, which we later mixed with almond. Then, call it lucky, but a bout of the stomach flu meant Joaquin didn’t want to drink any type of “milk” for a full week, so we took advantage of the situation and decided to eliminate the ritual altogether. Afterall, who says a kid needs to be drinking a white substance? He does just fine on water and whole foods for his fluid, protein, calcium and vitamin D.

(I do occasionally supplement. More on that in a future post…)