Babies can be unsettled for many reasons and it can sometimes take time and effort to work out the cause. However it can be a real concern if your baby is uncomfortable, in pain, distressed or if he is being sick, experiencing diarrhoea or has other symptoms. The Unhappy Breastfed Baby can help you determine whether your baby’s behaviour is due to something other than an allergy.
But when you have ruled out most of the obvious causes and your baby is still, unhappy, colicky or experiencing dry and itchy skin, you may start to wonder whether your breastfed baby could be reacting to something in his diet, environment, or, if he is exclusively breastfed, something in your own diet. Certain medical conditions can have symptoms similar to those of an allergic reaction. It may be wise to rule these out before deciding whether a baby’s symptoms are due to an allergy.
Breastfeeding generally helps to protect against allergy but it may still occur. If one or both parents have an allergy or food intolerance, it makes it more likely that their baby will too. Early exposure to infant formula based on cows’ milk or soya increases the risk of allergy or intolerance both in childhood and in later life.
A baby’s immune system is immature at birth.
Colostrum, or early milk, is rich in antibodies, particularly sIgA, which provides a protective coating inside a baby’s intestines. Mature mother’s milk continues to provide protection, helping to prevent potential allergens from reaching a baby’s blood stream.
A food allergy occurs when a baby’s immune system creates specific antibodies to a particular food. If the baby is then given that food, his immune system releases chemicals including histamine that trigger inflammation and allergic symptoms. Symptoms can occur within minutes or up to several hours after eating the food responsible. It’s wise to see your GP if your baby is showing signs of allergy, but some symptoms are more worrying than others. Seek medical help quickly if your baby has an anaphylactic reaction: breathing difficulties, swelling, or a rash appearing immediately after physical contact or eating a particular food.
A food intolerance doesn’t involve an allergic reaction but can cause similar symptoms. You may not need to stop giving your baby a food to which he is intolerant—reducing the amount may be enough.
Eczema, other dermatitis and dry skin rashes can also be reactions to products such as bubble bath, baby wipes, skin cream, fabric conditioner or washing detergent. Many mothers find avoiding unnecessary products or a change of detergent improves things. Reading packaging can help avoid problems with common allergens such as lanolin and perfumes. Use fragrance-free products whenever possible. Be aware that herbals can also be allergenic—being natural doesn’t necessarily make a product less irritating. Hay fever symptoms and other ear, nose and throat symptoms can be caused by spring and summer pollens and other airborne allergens such as dust.
Tummy symptoms include:
• Seeming hungry for the breast but pulling away after a minute or two, arching the back and screaming.
• Vomiting, projectile vomiting.
• Diarrhoea—large numbers of large, loose, watery poos.
• Cramping, constipation and wind.
• Blood in poos. May be accompanied by anaemia—NB there are other causes for these symptoms too.
• Poor appetite, poor weight gain.
• Refusal to feed.
• Constant, excessive dribbling. Ear, nose and throat symptoms include:
• Lots of ear wax.
• Runny nose, sneezing, coughing.
• Nasal congestion, lots of secretions.
• Noisy breathing.
• Lung problems such as asthma or bronchitis.
• Swollen tonsils.
Eye and skin symptoms include:
• Swollen eyelids, dark circles under eyes.
• Eczema, dermatitis, hives, other rashes and itching.
• Redness around mouth, on cheeks or in the nappy area.
• Inflamed skin can become red on lighter kin, and darker brown, purple or grey on darker skin. This can also be more difficult to see on darker skin.
• Cradle cap.
• Spotty ‘milk rash’.
• Excessive sweating.
If your baby is having only your milk
• Are you taking any laxatives, medicines, vitamins, iron tablets or other supplements?
• Do you drink lots of caffeinated drinks? Coffee, cola, tea and some pain relievers, cold remedies, weight control aids and diuretics contain caffeine. Chocolate contains a substance called theobromine that can have a similar effect to caffeine if you eat a lot.
• Have you recently eaten a new food or any particular food in large amounts?
• Are there any foods that you don’t like but have decided to eat during pregnancy or breastfeeding because you think they will be good for you and your baby?
• Are there foods that you crave? What foods do you snack on when you have a bad day?
• Do close family members have problems with any particular foods? Depending on how sensitive your baby is, removing or cutting down on the offending items in your diet may well solve the problem.
If your baby is not fully breastfed
The majority of babies don’t need anything other than mother’s milk before about six months—no infant formula, drinks, solids or vitamins. Babies over six months who have started solids can be sensitive to certain common foods until they are a little older.
• Could your baby be reacting to the drinks or solid foods he is having?
• Is he on any medication or vitamin supplements?
• Could he be receiving other drinks such as infant formula or juice, or solid food, from anyone else without your knowledge?
Infant formula or follow-on formula is usually cows’ milk-based and a common, avoidable cause of allergy or intolerance. Babies don’t need follow-on formula at all. Removing the offending food from your baby’s diet for now should solve the problem; he may be able to tolerate it in a few months time. If you think your baby may be reacting to a prescribed medication that he has to take, speak to your doctor—he may be able to prescribe an alternative.
Common problem foods
• Cows’ milk, other dairy products and certain protein foods: soya, egg, pork, fish and shellfish.
• Wheat, corn, nuts and peanuts.
• Oranges and other citrus fruits; seedy fruits such as tomatoes, berries and kiwi fruit.
• Cabbage, onions and spices. Fenugreek is closely related to peanuts.
• Certain additives, artificial colourings, flavourings and preservatives.
Cutting out suspect foods
If your baby is exclusively breastfed you may need to eliminate the suspect food from your own diet for a while. Only cut out one or two foods at a time and allow 2–3 weeks to see if your baby improves. Be aware that symptoms sometimes get worse before they get better. If there is no improvement after this time then that food is unlikely to be the culprit and you can reintroduce it into your diet.
Work down the list (above) cutting out one food at a time. Start with cows’ milk, the most common cause of problems. Check package labels for milk products, which may be listed as: butter, yoghurt, cheese, whey, casein or caseinate, or lactose. These can turn up in the most unexpected foods and in some medicines and vitamin tablets.
Some milk-allergic children do well on goat or sheep milk, but these are comparatively rare—more usually a cows’-milk allergy predicts an equally severe allergy to other animal milks, although they can provide a temporary respite. Some children who are allergic to milk also react to beef.
Find out as much as you can before you start an elimination diet and ask your doctor for a referral to a dietician, especially if you need to cut out a major food group. Unless your baby has experienced a severe reaction, you may find you can reintroduce the offending food later in small amounts without causing symptoms. Seek medical help if your baby has shown definite anaphylactic signs, such as an immediate rash, swelling or noisy breathing.
Breastmilk contains tiny traces of whatever foods a mother has herself been eating. This is the ideal way to prepare a baby gently for the eventual introduction of solids. The best weaning foods for your baby are usually healthy foods selected from your diet. The best time to start weaning is whenever he starts reaching out for the food on your plate.
Did you know?
• More than 20 substances in cows’ milk have been identified as human allergens.
• If a baby reacts when his mother drinks milk or has dairy products, this is a sensitivity to cows’ milk protein, not lactose intolerance.
• Most infant formulas contain cows’ milk, often referred to as ’whey based’ or ‘casein based’.
• Soya, the basis of some infant formulas, is also a common allergen.
• Infant formula may also contain fish oils and vegetable oils (eg palm, rapeseed, coconut, sunflower).
• Medicines and supplements can contain other ingredients that are potentially allergenic.
• If you or a member of your immediate family has an allergy or intolerance, your baby is more likely to have one too.
It can be quite an effort to be an allergy detective with a fussy baby on your hands, so seek information and support. The good news is that small changes to your diet could make a big difference to a baby with a food allergy or intolerance. An LLL Leader can help you determine the most likely cause of your baby’s symptoms. Local LLL groups are great for practical and moral support and you may find others there who have had similar experiences.
Written by Sue Cardus and mothers of LLLGB
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.
My Baby Won’t Breastfeed
Safe Sleep & The Breastfed Baby
The Unhappy Breastfed Baby
Toddlers and Food
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Copyright LLLGB 2016