Pediatric Eosinophilic Esophagitis (EoE)

If your child has ongoing feeding problems, vomiting, heartburn, or trouble swallowing, it may take time to understand the cause. Some children also become very selective about foods or need frequent drinks during meals. 

At Westchester Medical Center Health Network (WMCHealth), pediatric gastroenterologists evaluate and treat children with eosinophilic esophagitis (EoE) at Maria Fareri Children’s Hospital. Your child can also receive nutrition support and allergy evaluation when needed. 

Our team works with your family to understand your child’s symptoms, confirm the diagnosis, and develop a treatment plan that fits their needs. 

Symptoms of Pediatric EoE 

EoE does not always look the same in every child. Symptoms can also change as children get older. 

Your child may experience: 

• Nausea 
• Vomiting 
• Belly pain 
• Heartburn 
• Chest pain 
• Choking or gagging 
• Trouble swallowing 
• Frequent reflux symptoms 
• Food getting stuck when eating 
• Feeding difficulties or food refusal 
• Drinking frequently to help finish a meal 
• Becoming increasingly selective about foods 
• Preferring liquids or softer foods over solid foods 

Younger children may be more likely to have feeding problems, vomiting, or poor growth. Older children and teens may have swallowing problems or food getting stuck. 

Some children are initially thought to be picky eaters or to have behavioral feeding concerns. Pediatric gastroenterology evaluation can help determine whether a digestive condition may be contributing. 

Diagnosing Pediatric EoE 

Your child’s evaluation begins with a pediatric gastroenterologist. Depending on their symptoms, testing may include blood tests, X-rays, and an upper endoscopy. 

During an endoscopy, your child’s gastroenterologist looks inside the esophagus and takes small tissue samples called biopsies. The samples are examined for inflammation and eosinophils to help confirm an EoE diagnosis. 

WMCHealth also offers advanced testing when needed. EndoFLIP and esophageal manometry can provide additional information about how your child’s esophagus stretches and moves. 

Pediatric EoE Treatment 

Treatment depends on your child’s symptoms, biopsy results, age, disease severity, and your family’s preferences. Your pediatric gastroenterologist will explain the options and help you determine an appropriate approach. 

Treatment may include: 

• Proton pump inhibitors (PPIs): These medications can help reduce inflammation in some children with EoE. 
• Swallowed steroid medications: These medicines help treat inflammation in the esophagus. 
• Biologic therapy: Some children may benefit from targeted medication given by injection. 
• Diet therapy: Removing certain foods can help identify and manage foods associated with your child’s EoE. 
• Esophageal dilation: If EoE has caused significant narrowing, a procedure may sometimes be needed to widen the esophagus. 

Treatment is not one-size-fits-all. Children with more advanced inflammation or narrowing may need medication sooner. For other children, your family may choose to explore dietary treatment. 

Your family does not have to make every decision during the first conversation. Our pediatric gastroenterology team takes time to answer questions and discuss which approach best fits your child’s needs. 

Nutrition Support for EoE 

If dietary changes are part of your child’s treatment, knowing what to remove is only one part of the process. Your child’s diet still needs to support healthy growth and nutrition. 

The WMCHealth team provides educational materials to help families understand foods and ingredients that may need to be avoided. Your child can also meet with a dietitian for additional guidance. 

For example, if dairy is removed, the dietitian can help you find other sources of calcium and protein. The team can also provide documentation to help your child’s school understand changing dietary needs. 

Monitoring Your Child’s EoE 

Your child’s symptoms alone may not show whether inflammation in the esophagus has improved. Repeat endoscopy and biopsies help the gastroenterology team see how the esophagus is responding to treatment. 

If your child is trying an elimination diet, another endoscopy may be performed after a treatment period. Foods can then be added back carefully as the team works to identify possible triggers. 

Children receiving medication also need ongoing follow-up. Your child’s care team will determine how often visits and repeat testing are needed based on treatment and response. As your child gets older, the team can also help plan the transition to adult EoE care.