Baked Milk Food Challenge: Refusing to Eat

I have a really hard time hiding my emotions. Yesterday morning, in particular, was challenging for me. After finishing off two small pieces of cake made with powdered milk, my 3-year old suddenly refused to eat another bite during his food challenge. We had to stop the test. After only two doses, even though he didn’t have a reaction, the results were inconclusive because he wouldn’t eat all five doses. While I tried to remain upbeat and cheerful, my frustration was clearly visible.

Food challenge doses

This was his fourth food challenge, so we all knew the routine pretty well. Of all the scenarios I considered, my son refusing to eat wasn’t one of them. All of us kept talking about how wonderful the food challenge would be, since my son would get to eat cake during the test. Compared to his 3-year check-up a few weeks earlier—which required a painful finger-prick for a blood sample and a vaccination injected in his thigh—the baked milk food challenge would be so much easier.


Signs of Trouble

Once at the hospital though, the signs of trouble appeared early on. First, I was disappointed to learn the cake contained chestnut flour, instead of an all-purpose flour made from wheat. My son doesn’t have a wheat allergy or gluten intolerance, but this was apparently the standard cake the hospital used for a baked milk challenge. While I didn’t mind the taste of the cake, my finicky son wasn’t loving it.

While his first small piece of cake went down relatively easily, the second almost made him vomit. As he started lurching, the doctor quickly grabbed a bowl for him. Thankfully it stayed down, but I started wondering how he could possible manage the final and largest dose, if such a small piece caused this type of response.

For the third dose, the nurse suggested crumbling the cake and mixing it with applesauce. We did this during his food challenge with baked egg, and he gladly ate it up. Today was different though. When the spoon was presented, he refused to open his mouth. He really didn’t want to eat it, but at the same time, he had a little sparkle in his eyes, like we were playing a game—and he was winning. Did I mention our son is 3 years old?

We waited an hour after the second dose with all of us attempting to feed him the cake and applesauce mixture. Airplane spoons were flying into his mouth. I tried dancing and singing with him, while sneaking in a spoonful. His older brother even tried to help out. Nothing worked, and so the doctor said we should stop. You can’t force someone to eat, and our attempts just seemed to strengthen his determination.


How often does this happen?

According to my son’s pediatric allergist, this certainly wasn’t the first time a child refused to eat during a food challenge. It happens—especially with kids around our son’s age. I poked around for some data on the prevalence of situations like ours, but haven’t come across any yet. I’m curious about this, so if you have any info—either stories from your own experiences or quantitative data from a peer-reviewed journal article, for example, please let me know.


Next Steps

In 6 months, my son will repeat the food challenge for baked milk—except this time I may be bringing a homemade cake. The pediatric allergist will be sending a recipe, so I’ll practice it a few times with all-purpose flour, along with a little cocoa powder or some Enjoy Life chocolate chips. I’ll do whatever it takes to make sure we don’t have the same result!

In the meantime, while we’re waiting to redo the test, we’ll be scheduling another food challenge for raw/undercooked egg as soon as possible. We’ve already been serving our son lots of foods containing baked eggs, so I’m really hoping for a negative test result in the coming months.

Have you ever repeated a food challenge because your child refused to eat? If you have any advice to share with us and others about food challenges with children, please leave a comment below or send me an email. Thanks in advance for your help!


8 Comments on “Baked Milk Food Challenge: Refusing to Eat”

  1. Sandy Shaw says:

    Sent from my iPad Heddi and Nate…. I can imagine that this will be a story told over and over as he grows up. Kind of like one of Grandpa’s stories! It must have been frustrating though! Hope it works next time. Sandra

    >

    • Heddi says:

      Hi Sandra, Yes, I agree. It’s one of those stories that will make us laugh as we look back on it, but for now… I’m still disappointed. Feeling better today though. Hope you are too! :-) -Heddi xoxo

  2. Marla says:

    Hi Heddi- I am curious about these food challenges. I remember the last milk challenge when he developed redness around his mouth, and the doctor kept giving him doses, despite his apparent reaction. Has your son ever reacted to dairy outside of the challenges? I ask, because my son is nearly 5 and has yet to have a food challenge. Granted, he has had major reactions to dairy so a food challenge was obviously out of the question. But I was confused the last test when your son reacted and the doctor kept giving him more. What are the standards en Suisse? From what my doctor has told me, he stops at the first sign of a reaction. Are they more proactive out there?

    • Heddi says:

      Hi Marla! Very good questions. He was 2 for his first cold milk food challenge. We first learned of his allergy at 9 months, and then avoided milk since that time with no severe reaction, except mystery hives maybe a handful of times. Since his blood test here in Switzerland had a very low IgE level, and the skin prick test didn’t result in a huge wheal size, our allergist thought it would be a good time to do a food challenge, since she thought there was a good chance he could have outgrown it. When he got hives right away, I thought the challenge would be stopped too. However, he had no other symptoms at that time, and we wanted to be sure it wasn’t just a contact allergy (?). Yes, I think the standards may be somewhat different b/c after this initial test, we started giving him small doses of milk at home (details here: http://dairyfreeswitzerland.wordpress.com/2013/07/02/treatment-stopped/), which is not something that’s currently done in the US, at least not when we started. Not sure this answers your questions, but just send me an email if you want to discuss this further. I can give you more specifics, if you need them. Did you have a good trip this summer? I just drove through the town you visited, and it looked beautiful! Hope all is well. Always good hearing from you. So very helpful. -Heddi

  3. hsw says:

    My son is only going to be three another week or so but I can just envision him doing something similar with refusing to continue eating. It is so tantalizing to think he was doing well on the challenge up to that point but then of course you start to wonder whether he was resisting the cake because he was starting to not feel well, etc. That age is so tricky. I had a friend that went to National Jewish in Denver with her kiddos recently and they had to start doing placebos for some of the challenges because just awareness of the presence of the allergen posed issues. Food challenges may be the gold standard but getting there is a challenge. Six months will certainly make a world of difference in his maturity – sending good thoughts your way!

    • Heddi says:

      Hi Homa, Thanks for your thoughtful comments and your continued support. Yes – several people have suggested he refused the cake b/c he was starting to have a reaction to the milk. I just assume it was the chestnut flour and the taste, but we just don’t know – which is the frustrating part. For the 3 challenges prior, he had no issue eating his allergens, but as the doctor reminded us, he’s getting older and more aware. Six months seems like a long time, but it will be here again soon, and hopefully we can do the egg challenge yet this fall. Hope you are having a good summer, and happy early birthday to your son! All the best, and many thanks. -Heddi

  4. Marla says:

    You know, the more I think about it, the more sense it makes to me that you might not want to rush it. As his language skills get better, he will be able to tell you how he feels. When my son was almost 4 he had a reaction and could tell me that his mouth tasted weird and felt tingly. He could tell me that his stomach hurt and that he felt itchy. Having him describe his bodily sensations makes a huge difference than refusing to eat or getting fussy (my son’s m.o.).

    • Heddi says:

      Marla, more information is always better, isn’t it! That’s great your son can articulate how he’s feeling. It’s amazing how much these kids can change in a year’s (or less) time. I know waiting is the best option right now, but it’s hard too because 2 out of my son’s 3 challenges so far allowed us to change his diet (adding in baked egg and almonds). These have been major improvements, and I’m so excited by the possibility of baked milk being OK too. I’ll be patient though. And, next time I’ll bring along matchbox cars as little surprises/rewards for him after each successful dose! :-) Thanks again for your thoughtful advice and support. Very much appreciated. -H


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