Does your child have a food allergy or food sensitivity?

June 9, 2014 Uma Pisharody, MD, FAAP


“Every time my child eats, his belly hurts. I think he must have a food allergy. Can you help us?”

Countless times have I heard this from parents of children worried about foods being the cause of their child’s gastrointestinal (GI) complaints. Some families wonder whether their child should start a “gluten-free” or other type of dietary change. More often than not, families have already tried a few diets before meeting with me.

Parents considering these types of elimination diets need to be aware of a few key points:

  • The difference between “food allergy” and “food sensitivity”:

    • When someone is “allergic” to a food, it means that their body is developing a reproducible, immune-mediated, inflammatory response, usually to the protein molecules in the food. (In other words, carbohydrate and fats don’t typically cause allergies per se.) For a nice explanation on this, please read this guideline from the National Institutes of Health.

  • Sometimes, when we take away a certain type of food from a child’s diet, we unintentionally remove something else, and it’s the “accidental” consequences that actually lead to the diet’s benefits. Here are two examples:

    • Dairy elimination can help someone who is both allergic to milk (protein) or intolerant to lactose (carbohydrate). In the case of dairy allergy, it could potentially be a life-threatening, life-long condition. Lactose intolerance on the other hand, may be transient and mild, allowing a child to gradually start taking dairy over time.

    • The elimination of certain grains will certainly help a person who has celiac disease feel better, but could similarly help a person feel better because grains not only contain gluten (protein), but also small carbohydrate molecules (“FODMAPs”) to which many children are very sensitive. In the case of celiac disease, gluten must be avoided for life, whereas in the case of FODMAP sensitivity, grains may be tolerated to some degree.

    • In both of the above examples, once the diet seems to be helping, it’s hard to know if, how, and when to stop, as the underlying explanation is not known.

  • Having pain or other symptoms after eating food doesn’t always mean there is a disease.
    • Sometimes, it’s not the food per se, but how the body reacts to eating, that’s the true cause of symptoms. For instance, when we all get ready to eat, our intestinal tract, in response to certain chemicals released by our brain, starts to behave differently. Intestinal muscles start to contract and digestive juices start to flow. For some children, these expected responses start to induce physical pain because they process the sensations differently. These children have what is known as functional abdominal disorders.
  • Very restrictive diets can lead to malnutrition.
    • With each food group eliminated from a child’s dietary repertoire, whether it is dairy, gluten, FODMAPs, or something else, there are certain micronutrients that may need to be replaced. For instance, with the elimination of dairy products, it’s imperative to make sure that a child is getting enough vitamin D and calcium that may have otherwise come from milk and other forms of dairy. When considering an elimination diet for your child, make sure you speak to your child’s doctor and do this under careful supervision.

If these points lead you to wonder about whether your child might have a food-related GI problem, the pediatric GI specialists at Swedish can help. Call 206-215-6005 to make an appointment with our providers who are always here to help and support you.


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