FPIES in babies and children

Updated 30 October 2026

Author: Kathy Beck APD, Paediatric Allergy Dietitian

Watching your child have an FPIES reaction can be frightening. Afterwards, introducing another food may feel daunting.

With a clear management plan and practical feeding support, children with FPIES can enjoy a varied diet that supports their growth and development. The aim is to avoid their triggers while helping them explore foods they can safely eat.

What is FPIES

Food Protein-Induced Enterocolitis Syndrome, or FPIES, is a delayed food allergy affecting the gastrointestinal system. It usually starts in infancy, often when formula or solid foods are introduced.

FPIES is called a non-IgE-mediated allergy because it does not involve the IgE antibodies responsible for most immediate food allergies.

The typical acute reaction involves repeated, sometimes profuse vomiting, usually one to four hours after eating a trigger food. Children may also become pale, unusually tired, floppy or cold. Diarrhoea can follow several hours later.

Unlike an immediate allergic reaction, FPIES does not typically cause hives, swelling or wheezing. However, it can still be serious: severe reactions may cause dehydration, low blood pressure and shock.

A less common form, called chronic FPIES, can occur with regular consumption of a trigger food. It may cause ongoing vomiting, diarrhoea and poor weight gain.

What should I do if my child has a reaction

Ask your child’s doctor for an individualised ASCIA Action Plan for FPIES and share it with other caregivers.

If a reaction occurs, follow that plan. Seek urgent medical attention for repeated vomiting or difficulty keeping fluids down. Call 000 if your child becomes pale and floppy, difficult to wake, collapses or appears seriously unwell.

Treatment focuses on maintaining hydration. Some children are prescribed ondansetron to help control vomiting; severe reactions may require intravenous fluids in hospital.

Adrenaline injectors and antihistamines do not treat FPIES. However, if your child also has an IgE-mediated food allergy and develops suspected anaphylaxis, follow their anaphylaxis action plan, including prescribed adrenaline.

How is FPIES diagnosed

A paediatrician or allergy specialist assesses the foods eaten, the timing and pattern of symptoms, and other possible explanations.

There is no routine blood or skin-prick test that confirms FPIES. Negative allergy tests therefore do not rule it out. Testing may still be appropriate if a separate IgE-mediated allergy is suspected.

Sometimes a medically supervised oral food challenge is needed to clarify the diagnosis. Do not deliberately give a suspected trigger at home to test whether it causes another reaction.

Which foods can trigger FPIES

Any food can cause FPIES. Current ASCIA guidance lists rice, oats, cow’s milk and egg among the most common triggers in babies and children. Other triggers include chicken, fish, and some fruits and vegetables.

Most children have one trigger, although some react to several foods.

Management involves avoiding identified triggers. Some children also need advice before introducing particular associated foods. For example:

With rice FPIES, seek advice before introducing oats.
With cow’s milk FPIES, seek advice before introducing soy products.
With chicken or fish FPIES, discuss other poultry or seafood with the treating team.

Foods already eaten without symptoms should usually remain in the diet. For example, a child with rice FPIES who already tolerates oats should not automatically stop eating oats.

An individual feeding plan helps avoid unnecessary restrictions.

How can a paediatric allergy dietitian help

Avoiding a trigger is only one part of care. Your child also needs enough nutrition, opportunities to develop feeding skills, and support to feel comfortable with food.

A paediatric allergy dietitian can help you:

Understand which ingredients and foods to avoid.
Choose suitable replacements for excluded foods.
Plan the introduction of new foods with your child’s allergy team.
Offer a range of age-appropriate textures.
Monitor dietary intake and growth.
Manage feeding anxiety, food refusal or a narrowing range of accepted foods.

Support is particularly valuable when several foods are excluded or your child also has other food allergies.

Choosing alternatives when cow’s milk is a trigger

Dairy-free products vary considerably in their nutritional content. A calcium-fortified yoghurt alternative, for example, may still contain much less protein than dairy yoghurt.

Your dietitian can assess the whole diet and help replace energy, protein, calcium and other nutrients, while offering varied textures using tolerated foods.

For babies under 12 months, ordinary plant-based drinks should not replace breastmilk or infant formula as the main milk feed. If formula is needed, your treating team can recommend an appropriate specialised formula.

Can my child still try other common allergens

Having FPIES does not mean all common allergy-causing foods should be avoided.

Your dietitian and allergy specialist can help you introduce foods that are not identified triggers or specifically restricted in your child’s plan. This includes considering timely introduction of other common allergens, such as peanut and well-cooked egg, where appropriate.

Early introduction advice does not apply to a food your child has already reacted to. That food requires a separate specialist plan.

Can I keep breastfeeding

Yes. Breastfeeding can usually continue, and most breastfeeding mothers do not need to remove their child’s FPIES triggers from their own diet.

Reactions through breastmilk are uncommon. If your baby has ongoing symptoms or poor growth while breastfeeding, seek assessment before changing your diet. Any necessary exclusions should include nutritional support for you as well as your baby.

Will my child outgrow FPIES

Most children outgrow FPIES during childhood, but the timing varies with the child and the trigger food. Some outgrow it in the preschool years; others take longer.

Your allergy specialist will advise when to reassess. Reintroduction usually involves a medically supervised oral food challenge where treatment is available if a reaction occurs.

Do not restart a trigger food or use a home milk or egg ladder unless your specialist has specifically advised this.

Support for your family

At ChildD, we work alongside your child’s medical team to make feeding advice practical and manageable. We can help you build dietary variety, choose suitable alternatives and support your child’s growth while avoiding their FPIES triggers.

Contact ChildD for individualised paediatric allergy nutrition support.

Further information

ASCIA FPIES information and dietary guide

ASCIA Action Plan for FPIES

Allergy & Anaphylaxis Australia FPIES information

About the author

Kathy Beck is an Accredited Practising Dietitian and founding dietitian at ChildD, supporting families across Brisbane and the Sunshine Coast. She has more than 30 years of dietetic experience and specialises in paediatric food allergy. Kathy combines clinical care with professional education, helping families and health professionals navigate food allergies with practical, evidence-based advice.