Over the past 10-15 years, feeding babies human milk (instead of cow’s milk formula), has been on everyone’s mind. The U.S. Surgeon General, the American Academy of Pediatrics, the Centers for Disease Control - just about every medical and public health group has come out in support of breastfeeding. Numerous strategies have been developed to support mothers, insurance plans now cover consultations and breast pumps, and research continues. Yet there is still so much that we do not know.
One question continues to puzzle us: Why do some babies seem to be sensitive to their mother’s milk, or rather, to something their mother eats?
It doesn’t make sense. If human milk is the perfect food for babies, and a source of precious growth factors and protection against infections, why do some babies seem to fuss, and cry, and even spit up when they breastfeed?
Breastfeeding is designed to expose newborns to tiny amounts of food proteins via their mother’s milk. This allows the immune system in their gut the opportunity to learn to “tolerate” these proteins without over-reacting. A baby’s gut expects to see these proteins again sometime in the future, and ignore them.
Unfortunately, some babies DO over-react to specific foods their mother is eating. Thankfully, very few babies have a classic “allergic reaction” to proteins in breastmilk, caused by histamine release, which leads to hives, difficulty breathing, or low blood pressure. The vast majority of breastfed babies reacting to a food are having a temporary “sensitivity” or “intolerance”. Many babies begin having their symptoms between three to six weeks of age, and most babies outgrow their sensitivity sometime in the first one to two years.
What are the most common symptoms of a food sensitivity in a breastfed baby?
• Eczema (dry, flaking skin- usually starting on the face but may spread)
• Fussiness (NOT easily consoled by picking baby up or offering the breast)
• Spitting up
• Very liquid stools, stools with mucus, or infrequent stools (< one per day in a baby who has NOT started solid foods)
• Respiratory congestion (usually just a stuffy nose, no mucus)
• Blood visible in the stool
(None of the above symptoms always mean there is a food sensitivity! Food sensitivities are complicated and not well understood, even by the experts.)
In MY experience, the most common food sensitivities in breastfed babies are:
• Cow’s milk (Including ALL products made from cowsmilk!)
• Beef (Another part of the cow!)
But, honestly, it potentially CAN be just about anything.
OK—so what can you DO if you suspect your little one may be reacting to a food? Well, my advice would be, it depends! I wish there was a simple test that could be done to identify what is bothering your baby, but there is not. Skin testing and blood testing for food sensitivity are not very accurate at any age. If the symptoms are not “too bad”, you could wait and see. If they are significant enough you feel the need to do something, I would try avoiding dairy products completely. The good news is that you should be able to tell you are on the right track within 72 hours. It may take up to 2 weeks for the symptoms to get as good as they are going to get on your new diet, but you can usually see SOME improvement within 72 hours. Then you can try small amounts of cow’s milk products and watch for a return of the symptom(s). Some babies will tolerate a little ranch dressing, and others will not.
Some mothers find that their baby improves a bit with dairy avoidance, but continues to have some very fussy days. At that point you could try keeping a diary of what you are eating and how baby is acting, to see if you can identify something that looks suspicious. (Like on the days when you have corn chips for a snack and that night is bad.)
Other mothers may decide to go down my “list” of the most common culprits, choose one they eat frequently, and try eliminating that for a few days. I do NOT recommend avoiding many foods all at once. There are “Total Elimination” diets on the internet that suggest moms eat 5 foods, and 5 foods only. Yes, most of the time a baby will improve TEMPORARILY. But then babies often get fussy again in a week or two. They have started reacting to one of the foods mom is eating SO MUCH of. Not only is this approach very difficult and not good for mom, it often back-fires.
SO…once the offending food (or foods) are identified, and you have figured out if you can get away with eating a little or none...how long should you wait until you try eating more of the food(s)? The truth is, it usually happens on its own. You are out to eat somewhere and you accidentally “challenge” your baby earlier than you intended. However, if possible, it does make some sense to try and gradually eat increasing amounts of the offending food(s) to try and encourage “tolerance” to take place. If you find your baby was not ready, then you might wait another month or so and try again. If you figure out that you need to avoid more than 2-3 foods, consider seeing a registered dietitian to review what you ARE eating and make sure you are not missing any essential nutrients.
Here are links to some resources pertaining to this issue:
The Milk Mob
Articles for food sensitivities and intolerances
Kids with food allergies
The bottom line is that your milk is very good for your baby. It contains ingredients that will benefit your baby for the rest of your baby’s life. But not all babies have a smooth time breastfeeding. You may find breastfeeding more work than you thought it would be. There are steps you can take to help your baby be less fussy if they are a “sensitive” kid. But you may not be able to fix it 100%. As a mom, you will face many choices, some easier than others. You are the only person who knows what is best for your baby.