Nourishing Your Child with FPIES: A Parent’s Guide to Nutrition Management


What is FPIES?

Food Protein-Induced Enterocolitis Syndrome (FPIES) is a non-IgE mediated food allergy that primarily affects infants and young children. Unlike typical food allergies that result in immediate allergic reactions, FPIES is characterized by delayed gastrointestinal symptoms, typically 1-4 hours after ingesting the trigger food. The most common presenting symptom is vomiting. FPIES is often challenging to diagnose as it’s symptoms can be mistaken for other conditions, leading to delayed recognition and management. Identifying trigger foods through careful observation and medical evaluation is crucial for effectively managing FPIES. The primary therapy is to eliminate the food-protein triggers from the diet. Because of this, it may lead to nutritional deficiencies and hinder development if not managed appropriately. This blog post aims to provide parents with valuable insights, practical tips, and nutritious meal ideas to help them nourish their infant or child while managing FPIES stress-free!

Understanding FPIES

Symptoms and Diagnosis

Recognizing the symptoms of FPIES is crucial for early detection and proper management. The most common symptom is severe vomiting, which may occur repeatedly and persistently after consuming trigger foods. Other symptoms can include diarrhea, dehydration, severe lethargy, and changes in blood pressure.

Since FPIES symptoms are delayed and not immediately apparent, it can be challenging to diagnose the condition. Healthcare professionals rely on a combination of careful observation, a detailed medical history, and diagnostic tests to reach an accurate diagnosis. This may involve conducting elimination diets, where suspected trigger foods are removed from the child’s diet and reintroduced under medical supervision to induce a reaction. This is called a supervised oral food challenge test and is the gold standard for diagnosis. Blood tests may also be performed during a reaction, and the results may mirror the child’s response to an infection.

Triggers and Allergens

FPIES can be triggered by a variety of foods, but the most common culprits include cow’s milk, soy, grains (such as rice and oats), eggs, poultry, and certain fruits and vegetables (including peas, sweet potatoes, avocado, and bananas). It’s important to note that trigger foods can vary from child to child, and some children may have multiple trigger foods.

Identifying the specific trigger foods for a child with FPIES is crucial to effectively manage the condition. This is typically done through a process of careful food introduction and monitoring, with close collaboration between parents and healthcare team. Keeping a detailed food and symptom diary can be helpful in tracking symptoms and identifying potential triggers.

Impact of FPIES on Overall Health

FPIES can have a significant impact on your child’s health and overall well-being. The repeated episodes of vomiting and diarrhea can lead to dehydration, electrolyte imbalances, and poor weight gain. The avoidance of trigger foods may limit the variety of foods your child can consume, potentially affecting their nutrient intake and increasing the risk of nutrient deficiencies.

The impact of FPIES goes beyond physical symptoms, as it can also affect your child’s emotional well-being and social interactions. Dietary restrictions and the need for careful meal planning can be challenging for both you and your family potentially causing stress, anxiety, and feelings of exclusion.

By identifying trigger foods, implementing appropriate dietary modifications, and ensuring proper nutrient intake, you can help your child thrive despite the challenges posed by FPIES.

Nutrition Guidelines for FPIES in Infants

Building a Balanced Diet

When managing FPIES in infants, building a balanced diet is crucial to support their growth and development. Since infants have specific nutritional requirements, parents must carefully select safe and nutrient-rich foods. Here are some key strategies for building a balanced diet for your infant with FPIES:

  • Breastfeeding: For infants with FPIES, breastfeeding is a lower risk option. Mothers do not need to eliminate trigger foods from their own diet as long as their baby is not symptomatic.
  • Hypoallergenic Formulas: If breastfeeding is not possible or if your baby’s FPIES is triggered by breast milk, hypoallergenic formulas are a safe alternative. These formulas are specifically designed to be easier to digest and are less likely to cause allergic reactions.
  • Introduction of Solid Foods: When introducing solid foods to your baby with FPIES, it is important to start with single-ingredient, hypoallergenic baby foods. See some examples in the next section. Begin with a small quantity and monitor your baby for any adverse reactions.
  • Gradual Food Introduction: Introduce new foods one at a time, allowing a gap of at least 3-5 days between each new food. This helps identify trigger foods and minimizes the risk of multiple reactions.
  • Monitor Growth and Development: Regularly track your baby’s growth and development to ensure they are meeting their milestones and growing adequately. If there are concerns, consult your pediatrician or registered dietitian for guidance.

Safe Foods and Substitutes

When selecting safe foods and substitutes for infants with FPIES, it is essential to choose options that meet their specific nutritional needs. Here are some safe food choices and potential substitutes for infants:

  • Safe Fruits and Vegetables: Consider introducing safe fruits and vegetables such as pureed broccoli, cauliflower, pumpkin, blueberries, plum, peach, strawberries, or watermelon. Tolerance to fruits and veggies can vary from each individual, so it is extremely important to utilize a food and symptom diary.
  • Introduction of Grains: Use caution with grains. Lower-risk grains include quinoa, millet, or amaranth. Some healthcare providers may suggest a home or in-office wheat challenge beyond 1 year of age.
  • Protein-Rich Foods: For protein sources, consider pureed meats like lamb, beef, or pork if they are well-tolerated.
  • Milk and Milk Alternatives: Breast milk and hypoallergenic formulas are safe options for infants with FPIES. Safe alternatives for cooking include fortified coconut, flax, or hemp milks.

Recipe: Turnip and Apple Puree


  • 1 medium-sized turnip, peeled and cubed
  • 2 apples, peeled, cored, and chopped
  • Water for cooking
  • Formula or breast milk for blending


  1. Peel the turnip and chop it into small cubes.
  2. Peel the apples and remove the cores. Chop the apples into small pieces.
  3. In a medium-sized pot, bring water to a boil over medium heat.
  4. Once the water is boiling, add the turnip and apple pieces to the pot.
  5. Reduce the heat to low and let the turnip and apples simmer for about 15-20 minutes or until they are tender and easily pierced with a fork.
  6. Drain. Transfer the cooked turnip and apples to a blender or food processor. Add 1-2 teaspoons of formula or breast milk to help with blending.
  7. Puree the mixture until you achieve a smooth, creamy consistency. Add more liquid if needed to reach your desired texture.

Nutrition Supplements

Due to dietary limitations, infants with FPIES may be at risk for specific nutrient deficiencies such as protein, iron, zinc, B vitamins, Vitamin D and calcium.

  • Infant Multivitamins: An infant multivitamin may be recommended to ensure your baby receives essential vitamins and minerals necessary for growth. It is important to look for a supplement that contains iron, as your baby may not be able to consume iron-fortified grains and cereals yet.
  • Vitamin D Drops: Infants who are exclusively breastfed may need vitamin D supplements to support bone development. The American Academy of Pediatrics recommends 400 International Units per day.
  • Specialized Infant Formulas: For infants with multiple trigger foods or severe reactions, specialized amino acid-based formulas may be prescribed to ensure complete nutrition.

It is recommended to consult with a pediatrician or a registered dietitian experienced in managing FPIES to determine the most appropriate nutrition plan for your baby. Close monitoring of the infant’s progress and regular follow-ups with healthcare team will help ensure they are receiving the necessary nutrients for healthy development.

Meal Planning and Preparing Safe Meals

Tips for Meal Planning

  • Keep a detailed food and symptom diary: Track all foods, symptoms, and any potential trigger foods. This can assist in identifying patterns and making informed decisions about which foods to include or avoid. Make sure to have this handy for nutrition appointments.
  • Variety is Key: Aim for a diverse range of safe foods to ensure your child receives a wide spectrum of nutrients. Experiment with different fruits, vegetables, grains, and proteins to keep meals interesting and nutritious.
  • Focus on Whole Foods: Minimally processed foods are less likely to contain hidden allergens or trigger foods.

Snack Ideas for Children with FPIES

  1. Fresh Fruit: Serve slices of safe fruits like apples, peach, or melon. For added variety, create fruit kabobs with safe fruits threaded onto wooden skewers.
  2. Vegetable Sticks: Offer a colorful assortment of vegetable sticks like carrot, cucumber, and bell pepper paired with a safe dip, such as coconut milk yogurt dressing.
  3. Safe Yogurt: If dairy is not tolerated, opt for dairy-free yogurt options or coconut yogurt as a creamy and nourishing snack.
  4. Smoothie Popsicles: Blend a refreshing smoothie with safe fruits and coconut milk, then freeze them in popsicle molds for a yummy treat.
  5. Quinoa Crackers: Choose gluten-free crackers made from safe grains like quinoa and pair them with a safe dressing, dip, or cheese if tolerated.
  6. Pumpkin Muffins: Bake muffins with allergen-free ingredients, such as pumpkin, for a delicious and portable snack.

Meal Ideas for Children with FPIES

  1. Quinoa Porridge: Cook quinoa in coconut milk or desired milk and add a touch of cinnamon and maple syrup for a hearty and nutritious breakfast.
  2. Smoothie Bowl: Blend a smoothie with safe fruits and vegetables and top it with allergen-free granola, chia seeds, and fresh fruit.
  3. Beef and Millet Soup: Prepare a nourishing beef and millet soup using beef or other safe protein, millet, and a vegetable broth base.
  4. Zucchini Noodles: Spiralize zucchini into noodles and toss with a safe pesto sauce or a simple tomato sauce.
  5. Lamb Lettuce Wraps: Use lettuce leaves as wraps and fill them with cooked lamb in safe seasonings and diced vegetables.
strawberry smoothie bowl

Challenges of FPIES

Eating Out and Traveling

When it comes to eating out or traveling with your infant or child with FPIES, there are a few challenges to consider. However, with some preparation and communication, it is possible to navigate these situations successfully.

  • Research: Before going to a restaurant or traveling to a new destination, research the available food options and their allergen policies. Look for allergen-friendly restaurants or those that accommodate special dietary needs. You can always reach out to the establishment beforehand to discuss your dietary needs and see if they will accommodate.
  • Pack safe snacks: It’s always a good idea to bring along safe snacks that you know your child can tolerate. This will help you avoid any last-minute hunger emergencies and provide a backup in case safe food options are not available. See the section “Snack Ideas for Children with FPIES” for some tasty ideas!
  • Consider bringing your own food: In some cases, especially when dealing with severe FPIES reactions, bringing your child’s food from home might be the safest option. This way, you have full control over the ingredients and preparation methods.
  • Cross-contamination: Cross-contamination can be a significant concern for individuals with FPIES. Even if a restaurant claims to have allergen-free options, it’s essential to remain vigilant. Ask questions about how the food is prepared and cooked to ensure there is no risk of cross-contamination.

Addressing Nutritional Gaps

FPIES can sometimes lead to nutritional gaps due to the limited variety of foods your child can tolerate. It’s essential to address these gaps and ensure your child receives adequate nutrition for their growth and development.

  • Consult with a healthcare professional: Work closely with your child’s healthcare team, including a pediatrician and registered dietitian, to develop a comprehensive nutrition plan. They can assess your child’s dietary needs, identify potential nutritional gaps, and provide guidance on appropriate food choices and supplementation if necessary.
  • Focus on nutrient-dense foods: When working with limited food options, prioritize nutrient-dense foods that provide essential vitamins, minerals, and macronutrients. Incorporate a variety of fruits, vegetables, lean proteins, and whole grains that your child can tolerate. This helps ensure they receive a wide range of nutrients despite the restrictions.
  • Explore safe alternatives: Look for safe alternatives to commonly allergenic foods. For example, if your child is unable to tolerate dairy, consider introducing calcium-rich plant-based sources like fortified non-dairy milk, leafy greens, or calcium-fortified tofu. Experiment with different ingredients to provide a well-rounded diet.
  • Consider supplementation: In some cases, supplementation may be necessary to address specific nutritional gaps. Discuss with your pediatrician or registered dietitian whether your child requires any specific supplements such as vitamins, minerals, or specialized formulas. They can guide you on appropriate supplementation based on your child’s individual needs.
  • Monitor growth and development: Regularly monitor your child’s growth and development to ensure they are thriving despite dietary restrictions. Work with your healthcare team to track their progress, address any concerns, and make adjustments to the nutrition plan if needed.

Conclusion and Key Takeaways

For most children, FPIES is not a life-long condition. In fact, many children outgrow the condition by age 3. In one recent FPIES study:

  • 100% of children with barley as their FPIES trigger food outgrew the condition by age 3.
  • 60% of children with a dairy FPIES trigger outgrew the condition by age 3.
  • 40% of children with rice as their FPIES trigger food outgrew the condition by age 3.

Some children continue to experience FPIES symptoms into adolescence and beyond. With proper medical attention and a personalized dietary plan to ensure proper nutrition, children with FPIES can grow and thrive.

Throughout this guide, we have explored the essential aspects of FPIES, from understanding the symptoms and triggers to crafting a balanced diet and meal planning. Embracing the journey of nourishing your child with FPIES means celebrating every milestone, no matter how small, and cherishing the victories that come with each safe and enjoyable meal. It’s about fostering a positive environment that promotes healthy eating habits, supports emotional well-being, and encourages your child’s exploration of safe foods and new flavors.

Remember that every child with FPIES is different, and what works for one may not work for another. Be patient with yourself and your child as you navigate through dietary trials and triumphs. Seek support from others who understand the challenges you face, whether it be from support groups or online communities of parents with children with FPIES. Above all, remember that you are doing the absolute BEST to support your infant’s and child’s health and happiness. Embrace this journey with an open heart, and may it be filled with moments of growth, discovery, and cherished memories as you nourish and care for your child with FPIES. By doing this, you can ensure your child will have the healthiest, happiest tummy!


KELLY., M., LAURA. MULLIN, GERARD. TAPPENDEN,. (2022). Section 2: Nutrition and Gastrointestinal-Related Disorders. In Health Professional’s Guide to Gastrointestinal Nutrition (pp. 138–139). AMERICAN DIETETIC ASSN.

Groetch, M., Durban, R., Meyer, R., Venter, C., & Nowak-Wegrzyn, A. (2021, February). Dietary management of food protein-induced enterocolitis syndrome during the coronavirus disease 2019 pandemic. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

Food protein-induced enterocolitis syndrome (FPIES). GiKids. (2021, July 7).

The Children’s Hospital of Philadelphia. (2014, February 23). Food protein-induced enterocolitis syndrome (FPIES). Children’s Hospital of Philadelphia.

Introducing food to the infant with Fpies – Children’s hospital Los Angeles. (n.d.).  

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