For Margaret – as strict as possible and reasonable. The difficultly is it can be age dependent and really what is in the parents control. For younger children, it is much easier to control diet as long as the the family dynamics are stable, i.e. both parents on board with approach, support from other family members. Also, it is a single child or are there other siblings. When other non-affected siblings are around the dietary restrictions are more challenging. When a child gets older, i.e. middle school school and high school than total control is lost as there is often too many other outside influences. Therefore, the best advice is “reasonable attempt” with the understanding that improvement in diet and staying away from too much sugar will help, but the antifungals will help too.
For Elizabeth – I think antifungals are important. I agree, that improving health is not likely if people themselves, or parents for their kids, don’t improve diet. With special needs kids, they most often need both diet and antifungal treatment. I don’t believe you are being too lenient at all. The difficulty for all of us as practitioners is we have no control over what people feed their kids. This is why I want parents actively engaged in the process of education so that they understand what needs to be done. For some people dietary intervention is easier than others and the fact is that there are some kids that are extremely resistant to dietary changes.
Dr. Woeller