When babies are sensitive to food
Once medical issues have been eliminated with your doctor, the following symptoms can sometimes be food related:
UNSETTLED / COLIC / FUSSINESS / TUMMY PAIN
RASHES or ECZEMA
MUCOUS STOOLS +/- GREEN
BLOOD IN STOOLS / COLITIS
For exclusively breast fed babies, this means the foods in the mother's diet while for formulae fed babies this applies to the formulae provided. Once baby starts some solids, sometimes the issues may improve eg less mucous in stools or sometimes can worsen.
The great difficult is these symptoms above can be the same regardless of what is causing the issue. Food allergy and intolerance can look the same, if the allergy is mild. And often allergy may not show up on testing. If there is family history of allergies including food allergy, then consultation with a Medical Allergist or Immunologist should be considered to exclude the possibility of IgE reactions, the type of allergy that can cause serious reactions such as anaphylaxis (severe allergic reaction that affects breathing and can be fatal).
It is possible but extremely unlikely that a breast fed baby would have an anaphylaxis as a reaction to food passed through the breast milk. Any allergy reactions tend to be reduced and delayed when delivered via the breast milk.
The protein in cow's milk (dairy), egg, peanut and tree nuts, soy, wheat, fish and shell fish and lupin account for 90% of the allergies in people in Australia. Other foods that can cause allergies but they are less common. All foods contain protein, so potentially any food can cause an allergy. There are many different proteins in foods so potentially could be any number of the protein in the whole food causing the allergy issues.
Allergy testing can test for IgE mediated allergies which are the more serious type of allergy that have the potential to cause anaphylaxis (although rare). These tests are blood tests and skin prick tests. These tests do not pick up on the cell mediated allergies which are not associated with anaphylaxis, and may often have delayed reactions.
Skin prick tests are commonly done with children and adults but are less sensitive in children less than 2 years of age. Some doctors will perform them in babies , although less likely if symptoms are not severe.
Some allergies do not show up on testing and these are called cell mediated allergies. Only a carefully constructed elimination diet will be able to identify these foods. These type of allergies can be treated in a similar fashion to whole food intolerance.
While 2 - 4% of Australian adults reportedly have food allergies, up to 10% of infants (less than 12 months) and 4 - 8 % of children less than 5 years of age have food allergies in Australia.
The most common IgE mediated food allergy foods (comes up on testing) in babies under 12 months are
The most common non IgE mediated food allergies (do not come up on testing) in babies under 12 months are
Milk, soy and egg allergies commonly resolve over time. Most young children grow out of their milk allergy by 3-5 years of age, with 85% grown out of their milk allergy by 5 years of age. Roughly 50% tend to grow out of their egg allergy by the age of 6. Peanut and tree nut allergies tend to persist or be life long.
FOOD CHEMICALS & BABIES
Some food sensitive babies may have reactions to natural chemicals in foods: salicylates, amines and glutamates as well as food additives such as preservatives and MSG. Often there may be a family history of such sensitivities and maybe reactions noted when a baby is given liquid pain relief which is very high in flavours as well as added food preservatives.
These chemicals are spread out among lots of different foods, and are dose related. This means that reactions may only occur after a certain amount of the chemical is eaten so foods may seem to be ok one day but not another day. Allergies can often be easier to pick as small amounts of the offending food bring on a reaction.
FODMAPS & BABIES
'Windy foods' such as cabbage, Brussel sprouts, cauliflower and legumes are often thought to cause issues for some sensitive breast-fed babies, but the mechanism of how this happens remains unclear. Note that some 'windy' foods like cauliflower are high in FODMAPs while cabbage is generally low in FODMAPs.
Until recently, FODMAPs consumed by the mother were not considered to affect the breast-feeding baby as FODMAPs were not thought to pass into the maternal milk supply. There has been a very recent study, however, that shows a reduction of colic symptoms in young babies under 9 weeks of age when the mother followed a short term low FODMAP diet (Locovou et al, 2018).
Food Related Issues for Sensitive Babies
REFLUX: 1/3 to ½ serious reflux cases associated with cow’s milk protein, although other foods can also be implicated.
COLIC: A low FODMAP diet may help for babies diagnosed with colic, although can also be due to food proteins as well as food chemicals. Colic has been shown to usually improve as a baby matures, without any action been taken.
ECZEMA: food is only one of many triggers so for many cases food may not be a trigger at all. However, food can for some babies exacerbate their eczema, such as cow's milk protein/soy and egg.
COLITIS (blood in the stools): cell mediated allergy (wont show up in blood or skin testing).
Cow's milk protein an issue in 50-65% of colitis cases, while soy is often implicated as well.
Other protein foods can also trigger colitis as well such as wheat and can also be caused by natural food chemicals.
CONSTIPATION: most common trigger food is cow's milk protein, although food chemicals can also be a problem.
ELIMINATING FOODS and Beast Feeding
Guidance when eliminating foods can be useful, and in the case go IgE allergy, an Allergist recommendations is essential.
The main issues centre around
Ensuring replacement foods and/or supplementation that provide the needed calories and nutrients lost when whole food groups such as dairy or wheat are eliminated
Reducing the real risk of over restriction
The importance of challenging eliminated allergens/foods for a couple of reasons:
Some foods may be needlessly eliminated so no point avoiding if not helping
Foods are eliminated that could have been tolerated can actually result in a food allergy developing
Baby's tolerance may improve over time for example challenge dairy/soy very 3-4 months to check for improved tolerance
The recommendation to introduce allergy foods to bub in the first 12 months to reduce risk of food allergy developing.
Delaying introduction of allergens to a baby after the age of 1 can actually cause an allergy to develop. So wherever possible, trial allergy foods once solid foods are being taken before bub turns 1. The nip allergies in the bub website gives great hints on how allergy foods can be introduced in the diet.
Challenging with these foods via breast milk is a good way to get an indication of any likely issues. If your baby seems to be fine with foods challenged through your breast milk then you can then trial directly with your baby. If there seems to be a reaction then seek medical advice before trialling directly with your baby in case an allergy has developed.
When eliminating foods, looking to replace any nutritional gaps will help avoid nutritional deficiencies, and challenging foods will help to not over restrict, and to check for improved tolerance over time.
Join my new Facebook support group for FAILSAFE babies and children Australia (dedicated solely to food allergens and/or babies and children sensitive to salicylates, amines, glutamates and food additives)
Book online (book an extended session as more time is required usually) or make contact via email or call/text on 0412 586 836 to organise a skype or telephone consultation.
Anderson, J. Food-sensitive babies, dietary investigation for breastfed babies. 2017, Specialist Dietitian and Lactation Services. Link: http://dieteticsandlactation.com.au
Iacovou M1, Craig SS2,3, Yelland GW1, Barrett JS1, Gibson PR1, Muir JG1. Randomised clinical trial: reducing the intake of dietary FODMAPs of breastfeeding mothers is associated with a greater improvement of the symptoms of infantile colic than for a typical diet.Aliment Pharmacol Ther. 2018 Oct 10. doi: 10.1111/apt.15007. [Epub ahead of print]
Nip Allergies in the Bub website (National Allergy Strategy). Accessed: 27 Oct 2018