Die-Off Classification
A detailed reference for discussing treatment-related changes with your care team.
Draft framework for clinical review
New or worsening symptoms can have different causes. This guide does not establish a diagnosis.
Bacterial
Changes may occur in response to different types of bacterial infections.
Context and symptoms require clinical review.
Viral
Changes may occur in response to viral infections, such as the herpes family.
Context and symptoms require clinical review.
Fungi / Yeast
Changes may occur in response to fungal organisms, such as yeast and molds.
Context and symptoms require clinical review.
Parasitic
Changes may occur with parasitic infections, including protozoa and worms.
Context and symptoms require clinical review.
Understanding the Classification
Explore the categories used in the original framework and a separate guide to describing symptom severity.
Reaction Severity Scale
Describe changes from your child's usual baseline.
Level
Changes to describe
Clinical discussion
0
Baseline
Usual functioning
Typical behavior, mood, sleep, appetite and activity for your child.
Used as a reference point for comparison when changes occur.
1
Mild
Small temporary changes
Mild or temporary changes that are noticeable but do not interfere significantly.
Monitor and discuss with your clinician, especially if changes persist.
2
Moderate
Noticeable changes in routines
More consistent changes that may affect daily routines or behaviors.
Discuss with your clinician to determine if further evaluation is needed.
3
Significant
Changes affecting daily functioning
Clear impact on functioning at home, school or in social settings.
Consult your clinician for guidance and possible next steps.
4
Severe
Major disruption of daily life
Substantial changes that interfere with normal activities and well-being.
Prompt clinical discussion is recommended to assess and plan next steps.
5
Extreme
Urgent clinical assessment
Intense or rapidly worsening changes.
Seek timely clinical evaluation to determine appropriate support.
What to Record
Timing and duration
When changes started, how long they last.
Recent treatment changes
New medications, supplements, or adjustments.
Sleep and appetite
Changes in sleep patterns and eating habits.
Daily functioning
Impact on behavior, learning, social interactions and routines.