Food Challenges For Kids With Allergies. What Really Happens? (Hospital Food Challenge Explained)

What Really Happens During a Paediatric Food Challenge (And How to Know If Your Child Is Ready)

When your allergist first mentions doing a food challenge, your stomach probably drops.

Wait – you want to do WHAT?

Feed my child the very food I’ve been keeping away from them for years? On purpose? In a hospital?

It sounds completely counterintuitive. Reckless, even.

But here’s what I wish someone had told me earlier: food challenges are one of the most powerful tools we have in allergy management.

They can open up foods your child might actually tolerate, end years of unnecessary restriction, and give you concrete answers instead of living in the exhausting “what if” zone.

Let me walk you through everything you need to know.

What Is a Food Challenge (And Why Would We Do This?)

You can watch the video below, listen to the podcast or keep reading!

🎥 Watch or Listen First

If you prefer to watch or listen, you can start here:

👉 Watch the YouTube video

You can also keep reading below for a clear written breakdown

Watch or Listen First

If you prefer to listen, you can start here:

Listen to the podcast here below:

You can also keep reading below for a clear written breakdown

A food challenge ,also called an oral food challenge or OFC, is a medically supervised test where your child eats increasing amounts of a suspected allergen to see if they react.

It’s considered the gold standard for diagnosing food allergies because skin prick tests and blood tests can’t tell you the whole story. They show sensitization, but not necessarily a true allergy.

Here’s what food challenges can tell you:

✓ Whether your child has actually outgrown an allergy
✓ If they can tolerate baked or cooked forms of a food (even if they can’t eat it raw)
✓ Whether a positive test result means a true allergy or just sensitization
✓ If a food you’ve been avoiding “just in case” is actually safe

The goal isn’t to be reckless, it’s to get certainty so you’re not restricting foods unnecessarily.

What Actually Happens During a Food Challenge?

Let’s demystify this process because it’s much more controlled than you might think.

Timeline:

Total time: 5-6 hours (yes, it’s a long day – bring activities!)
Dosing: Your child receives 4-6 increasing doses of the food, spaced 20 minutes apart
Observation: After the final dose, you wait 2 hours while the medical team watches for any reactions
If there’s a reaction: You may stay longer until it completely resolves

What you’ll need to bring:

Entertainment for your child (books, tablets, quiet toys – they can’t leave the ward)
A change of clothes in case of vomiting
Snacks for you and your child (non-challenge foods)
The specific challenge food (varies by allergen – your hospital will give you a list)

The environment: The food challenge ward is busy. There might be 10-15 other children there, all eating different foods. Your child may witness another child having a reaction, which can be unsettling. Talk to your nurse if this concerns you.

Important logistics:

Only ONE parent can attend (space is limited)
A parent or legal guardian MUST be there – grandparents can’t substitute unless they have legal guardianship
No siblings allowed

How to Prepare Your Child (Without Creating Anxiety)

This is the delicate balance every parent struggles with: you want your child prepared, but not terrified.

What works:

Keep it matter-of-fact. Use age-appropriate language like: “We’re going to visit the hospital to see if your body is ready for this food now. The doctors and nurses will be watching you very carefully to make sure you’re safe.”

Focus on the positive. “If your body is ready, you might get to eat [food] whenever you want!” Don’t dwell on worst-case scenarios.

Let them have some control. Can they pick what to mix the challenge food with? Choose their favorite stuffy to bring? Decide what movie to watch during the waiting period?

Validate their feelings. “It’s okay to feel nervous. This is new and different. But the doctors are really good at keeping kids safe.”

Don’t over-prepare too far in advance. Mention it a week before, remind them a day or two before, but don’t let it dominate every conversation for weeks.

What the Medical Team Is Watching For

During the challenge, the medical team is monitoring your child for any signs of an allergic reaction:

Skin: Hives, redness, swelling, itching
Respiratory: Coughing, wheezing, throat tightness, difficulty breathing
Gastrointestinal: Vomiting, severe stomach pain, diarrhea
Cardiovascular: Dizziness, pale coloring, drops in blood pressure
Behavioral changes: Sudden lethargy, irritability (especially in young children who can’t verbalize symptoms)

They’re also watching for delayed reactions – which is why that 2-hour observation period after the last dose is so important.

If a reaction occurs, they have emergency medications on hand including antihistamines, steroids, and epinephrine. This is literally the safest place for your child to try a potentially allergenic food.

When Does a Food Challenge Make Sense?

Not every child with allergies needs a food challenge. Your allergist might recommend one if:

✓ Blood test or skin test numbers have decreased significantly
✓ Your child had a reaction as a baby/toddler but may have outgrown it
✓ You’ve been avoiding a food based on family history but never confirmed the allergy
✓ Your child might tolerate baked forms (like baked egg or milk) even though they’re allergic to the plain version
✓ Test results are unclear or borderline

When to wait:

If your child had recent or severe anaphylaxis
If test numbers are still very high
If your child’s asthma is poorly controlled
If your child is sick or recently had a vaccine
If you or your child just don’t feel ready (your gut matters!)

What Happens If Your Child Reacts?

Let’s address the elephant in the room: what if the challenge doesn’t go well?

First, a reaction during a food challenge is NOT a failure. It’s information.

If your child reacts, the medical team will:

Stop the challenge immediately
Treat the reaction (antihistamines for mild reactions, epinephrine for severe ones)
Monitor your child until all symptoms resolve
Send you home with a clear action plan
Update your emergency care plan and prescriptions as needed

You’ll leave knowing definitively that your child still has the allergy, which foods to continue avoiding, and when to reassess in the future.

Some families find this clarity incredibly valuable – no more wondering or second-guessing.

Questions to Ask Your Allergist Before Scheduling

Before you commit to a food challenge, have a conversation with your allergist:

📋 Why are we doing this challenge now? What’s changed?
📋 What are the chances my child will pass based on their test results?
📋 What happens if they react? What’s the protocol?
📋 If they pass, can they eat this food freely or are there restrictions?
📋 If they fail, when would we consider trying again?
📋 Can we do this at home or does it need to be in the hospital?
📋 What should I tell my child about what’s going to happen?
📋 Should we stop any medications beforehand?

The Bottom Line

Food challenges can feel terrifying. I won’t sugarcoat that.

But they can also be incredibly empowering.

They give you answers instead of anxiety. Clarity instead of constant guessing. And sometimes – not always, but sometimes – they give your child back a food they thought they’d never eat again.

You don’t have to say yes to a food challenge if it doesn’t feel right for your family. But understanding what they are, why they’re recommended, and what they involve puts you back in control of the decision.

And that’s exactly where you deserve to be.