Sticking with an elemental diet

Elemental Diets: Can I really take all of the food away?
The following information is available in PDF format - Elemental Diets.pdf

The thought of transitioning to a formula-only diet can be overwhelming. No food? At all? Ever?
For parents of children beginning on elemental diet, parental attitude will be an important factor in your child’s ability to cope successfully with an elemental diet. The same is true for adults who face an elemental diet after a lifetime of ‘regular food’.
In our society, food has taken on meaning far beyond nutrition and sustenance. Eating is a social event – in the classroom, with friends, at holidays. We use food as a means of achieving happiness, coping with sadness and in response to other emotions. Readjusting attitude towards food is a very important first step. Food is nutrition. Nothing more, nothing less.
Your child still eats on an elemental diet, only differently. Formula is food. If a feeding tube is required, the fork and spoon are replaced by a tube and port. For many adults and children, they are receiving a nutritionally sound diet for the first time in years. Feeling healthy and more energetic has rewards food cannot give.
Conveying a positive attitude to the affected family member requires belief and effort from the entire family that food is nourishment and nothing more. Avoid food-focused family activities and instead focus on other activities. Depending on your family's interests, hiking, swimming, crafts, music and board games are all good alternatives to food-related outings.
If the child or adult on the elemental diet sees that those around him/her view ‘not eating’ as ‘no big deal’, they too will reflect that attitude. The whole family will become healthier as a result.
Convincing other family members and friends that ‘formula-only’ is the best way to achieve health may prove more difficult. However, over time they will come to appreciate not only the gains made because of the elemental diet but also that there is more to life than food.

For school and holidays suggestions that are not food-focused, see our “Guide to celebrating without food”.

Which foods are safe on an elemental diet?

The specifics of which foods are allowed on an elemental diet is best discussed with your health care team. Different medical centers and different situations require different diets.
In general, all proteins, in whole or partial form, are avoided. All natural foods contain some protein. Even very small amounts may be too much. “Safe foods” may include pure sugar, artificial flavors, salt, certain oils and ice. You can freeze formula into frozen treats, but the elemental formulas lose their nutritional value when heated or frozen.
As always, check with your doctor regarding specific recommendations for your individual situation.

How do I get my child to drink formula?

Some children will drink the elemental formulas, others will not. Many require a feeding tube if long-term elemental feeds are anticipated.

The single most important thing parents can do to help a child adjust to ‘no food’ is to be consistent.  A clean break from food eliminates confusion young children will have when they can’t understand why they can have one food but not another.  Giving in and allowing ‘just a bite’ of food will not make things easier in the long run.  Inconsistent parents who give in and sometimes permit children to eat foods that are not allowed will only be rewarded with relentless begging. If parents are consistent, the child can move on to acceptance of their situation.  Not eating really does become their norm in time and it does get easier.  Some tips to get you started:

• Be consistent, NO food means NO food. Period.
• Be sensitive to the family member that can’t eat and refrain from eating their favorite foods in their presence.
• Some foods have particularly strong odors and might upset the patient on the elemental diet—refrain from cooking these foods.
• Since smell can affect taste, covered cups, such as a sports-bottle, sippy cups or cups with straws help to disguise the taste.
• Try drinking the formula ice-cold, or mixed with ice and blended to make a ‘smoothie’.
• Use sticker charts for children, with small rewards for each half-day that the intake requirements are met.  In time, spread the rewards out to every day, every few days or every week.  Eventually larger ‘prizes’ can be given each month.
• Make the most of the water the patient is permitted to have.  Sno-cone makers make ice much more interesting, and even a very young baby can safely eat a sno-cone without risk of choking.
• Freeze water in candy molds to make ice shapes.
• Ice lollipops can be made by freezing water in candy lollipop molds.
• Treat the child to bottled water when out, allow them to purchase the water from a machine.
• Indulge them and try for as much normalcy as possible; cups of ice can be ordered when the rest of the family goes through the drive-thru.
• Avoid setting dates and counting the days until the child can try a food, as treatment plans change depending upon how the child responds to the formula. It is easier to be pleasantly surprised than sorely disappointed.

Some adjustment in the family routine may need to occur during the initial transition, but eventually it is helpful to allow the child to see others eating some food. It may be nearly impossible to avoid food entirely in social interactions and learning to cope in that situation is essential for psychological health and emotional growth.

Author: Cindi Sutter , Updated 3-31-06 by wendy@apfed.org