Fiber for Kids with Eosinophilic Esophagitis (EoE)

If your little one has recently been diagnosed with Eosinophilic Esophagitis (EoE), you might be feeling overwhelmed by the food restrictions and symptom management. EoE is a condition where certain foods trigger an allergic reaction in the esophagus, causing inflammation and making eating uncomfortable or even painful for some kids.

About 7 out of every 100,000 kids are diagnosed with EoE each year (1). Treatment often involves elimination diets to figure out which food is causing the reaction. But with any elimination diet, cutting out whole food groups can also lead to unintentional problems like constipation, especially when high-fiber foods like wheat and soy are removed.

So let's review how your little one can get enough fiber while navigating an EoE diagnosis and treatment.

Why Fiber Intake Can Be Low in Kids with EoE

There are several reasons why kids with EoE can struggle to get enough fiber:

• Wheat & Soy Elimination: These are two of the most common foods removed early on, but they also contain some of the most substantial sources of fiber for kids - bread, pasta, and processed snacks.

• Avoidance of Fruits & Vegetables Due to Texture: EoE can make the esophagus feel tight or sore. Because of this, kids tend to avoid hard textured foods (like fruits and vegetables) that could be painful to swallow. 

• Limited Variety: When your little one is avoiding multiple food groups at once, it naturally reduces how many different foods they’re eating, which limits fiber too.

• Picky Eating: Many kids with EoE often become picky eaters over time due to repeated elimination diets and the discomfort they’ve felt after eating certain foods (1). This can lead to a more limited diet and make it harder to include enough high-fiber foods.

Signs Your Kiddo Might Need More Fiber

It’s not always easy to spot constipation in kids with EoE because some symptoms can overlap. 

Here are some signs that they might need more fiber in their diet:

• Small, hard poops or straining

• Going several days without pooping

• Frequent hunger (especially right after meals)

• Bloating

• Alternating constipation and diarrhea

Fiber Needs for Kids

According to the Cleveland Health Clinic, the recommended fiber intake per day for kids is: 

• 1-3 year olds: 19 grams

• 4-8 year olds: 25 grams

• 9-13 year olds: 26-31 grams

High-Fiber Foods That Are EoE-Friendly

It's important to note that everyone with EoE has different trigger foods. This list is based on the common six-food elimination diet (removing dairy, gluten, eggs, soy, seafood, and nuts), but always talk to your care team to know which foods are safe for your kiddo.

Fruits:

• Raspberries

• Blackberries

• Avocados

• Pears (with skin)

• Apples (with skin)

• Figs 

• Prunes

• Guava

• Passion fruit

• Bananas

Many of these fruits might be better tolerated if softened, cooked, or even blended into a smoothie.

Some kids with EoE also need to eliminate high acid fruits like tomatoes, oranges, lemon, and kiwi, so speak with your doctor about the introduction of these fruits. 

Vegetables

• Artichokes

• Green peas

• Broccoli

• Brussels sprouts

• Turnip greens

• Collard greens

• Sweet potatoes (with skin)

• Carrots

• Kale

• Spinach

Along with fruits, these vegetables will likely be better tolerated if softened and well cooked or blended into a sauce or smoothie. 

Grains & Starches (all gluten-free)

• Quinoa

• Brown rice

• Oats (certified gluten-free)

• Potato

• Sweet Potato

• Buckwheat

• Wild rice

• Cornmeal

Legumes & Seeds

Your doctor may advise removing some legumes, so always check first.

• Lentils

• Black beans

• Chickpeas

• Kidney beans

• Navy beans

• Pinto beans

• Chia seeds

• Flaxseeds

• Pumpkin seeds

• Sunflower seeds

Tips for to Maximize Fiber Intake

1. Introduce it Slowly

Introducing too much fiber too quickly can cause bloating, gas, and an upset tummy. Start with one high-fiber food a day, then work up to including them at most meals. 

2. Use a Fiber Supplement

With all the ongoing diet changes, it can be tough to keep track of which high-fiber foods your kiddo can safely eat. A fiber supplement can make things easier and help you stay consistent. 

Begin Health’s Growing Up Prebiotic is a great choice for kids with EoE, especially if they're picky or sensitive to textures. It’s a flavorless, texture-free powder that mixes easily into food or drinks with 3 grams of prebiotic fiber to support gut health and smoother digestion.

3. Highlight Fruits and Vegetables

Fruits and vegetables are often some of the least restricted foods and can be a great source of fiber for kids. If your little one has turned them down before, try offering them in different textures like blended into a smoothie, cooked into a soft puree, or frozen into a sorbet or popsicle.

4. Don't Overrestrict

Although EoE requires phases of strict food elimination, these diets should be short term followed by reintroduction and assessment of symptoms. Avoid overrestricting by being in close contact with your care team and having a plan for food reintroduction. 

Summary

Many kids with EoE end up not getting enough fiber, which can lead to constipation and other digestive issues. By knowing which high fiber foods are safe, softening textures, and possibly using a supplement, you can help your little one meet their fiber needs without triggering symptoms.