If the dietary therapy is not working and symptoms have not improved, check potential problem areas:

• Does your child truly want to be on the diet? There needs to be full buy-in from your child. If they are not actively participating and engaged, they may be SCD-compliant at home but not elsewhere. If your child isn’t ready to be on the SCD, don’t force the subject, as this will often backfire. Instead find another appropriate therapy, with the goal that they may come back to it in the future.
• Check if the diet is balanced, and talk with your dietitian. Although the SCD components bring down inflammation, too much of any one food item may cause a problem. A common issue is that a child will like one or two items so much that they will depend on this item exclusively. I had one young lady who loved LaraBars. She ate them at breakfast, lunch, and dinner. All of her inflammatory markers, which had been markedly elevated prior to the SCD, normalized, yet her symptoms remained. After consultation, she significantly decreased her LaraBar intake and her symptoms disappeared. Other common exclusively consumed foods include honey and sweets, fruits and juices, nut flours, and yogurt. Despite it’s being a bit of a cliché, variety is the spice of life. This is especially true for diet and nutrition.
• Is your child ingesting hidden additives in foods and supplements? Although the majority of the food eaten on the SCD consists of whole foods and not pre-package, processed foods, hidden additives can still be lurking. Possible offenders may include “natural” store-bought chicken that is sometimes presoaked in a sugar-salt solution, “plain” steamed veggies at a restaurant can have a starch coating, tomato juice often has added sugar, prepacked veggies like baby carrots are often prewashed in chlorine or other disinfecting solutions. Another area where additives can sneak into the diet is through supplements and vitamins.
• Are you adding advanced foods too quickly? Some children may take longer to improve, and their SCD advancement needs to be tailored to each patient.
  Symptoms seen in IBD (such as abdominal pain, diarrhea, and fatigue) can be caused by other illnesses as well. For example, abdominal pain is frequently a symptom of constipation, diarrhea a sign of fructose intolerance, and fatigue omnipresent in mononucleosis—all common issues during childhood and adolescence. Talk to your physician, who can help with a full evaluation of your child.
• Finally, if the SCD is being strictly followed and no other problems are identified that could be affecting the efficacy of the diet, it may be that dietary measures simply will not work for your child. This may be a difficult disappointment, but the end result of any therapy, be it medication or diet, is to make your son or daughter healthy, happy, and able to do all of the things that they want. If a therapy doesn’t work, no matter how much we are invested in it, we need to find another option.