What should you do when your breastfeeding baby gets fussy?
Your Fussy Baby
Like a formula fed baby, you should make sure your fussy breastfeeding baby isn’t hungry and doesn’t have a fever, colic, reflux, teething, an upper respiratory tract infection, and all of the other things that can make them fussy.
After eliminating those, and seeing your pediatrician to make sure that your baby has been gaining weight well, it might be time to eliminate things from your diet, as your baby might have allergic colitis (protein-induced colitis).
This is especially true if your breastfeeding baby is fussy, extra gassy, and has foul smelling, green, mucousy stools. You might also notice streaks of blood in your baby’s stool or that your baby has bad eczema already.
While babies can’t be allergic to your breast milk, they can certainly be allergic or intolerant to any number of things that you eat or drink and which enter your milk.
Foods To Eliminate First
Even before you start to think about foods to eliminate from your diet, please keep in mind that this isn’t a reason to stop breastfeeding and switch to formula. Since most formula is based on cow’s milk, your baby will likely continue to have problems on most routine formulas. Some babies even continue to have problems drinking an expensive hydrolyzed protein formula (Alimentum or Nutramigen) and have to move to an even more expensive elemental formula (Elecare, Neocate, or PurAmino).
Once you do begin to think about eliminating foods from your diet, you should probably start with milk and diary foods. Those are the most likely to cause issues with your baby, either an allergy or intolerance. And they are probably the easiest to avoid. If supplementing with some formula, be sure that it is milk and soy free. A hydrolyzed protein formula (Alimentum or Nutramigen) would usually be a good first choice.
The Breastfeeding Elimination Diet
If that doesn’t work, you can continue to eliminate other foods or foods groups from your diet, one at a time until you find what is triggering your babies symptoms, including:
- citrus fruits
- fish and shellfish
The Academy of Breastfeeding Medicine recommends that after eliminating a food or food group, breastfeeding moms “wait a minimum of 2 weeks and up to 4 weeks,” although they should see improvement much sooner, within 2 to 3 days.
A Faster Breastfeeding Elimination Diet
Eliminating one food group at a time and waiting to see if it works can take time. A faster, but much more extreme approach is to eliminate most high-allergen foods all at once.
So what do you eat on this restrictive diet?
On this type of low-allergen diet, a breastfeeding mom might end up only eating foods like lamb, pears, squash, and rice. Other foods in this type of total elimination diet might also include chicken and turkey, potatoes, apples, and bananas.
Once your baby’s symptoms resolve, you can then slowly start introducing foods back into your diet, one food or food group at a time each week. Of course, stop a food if your child’s symptoms come back after it is reintroduced into your diet.
After avoiding a problem food for about six months and once your infant is 9 to 12 months old, you can likely reintroduce it into your diet and watch for symptoms
Another option, before trying the total elimination diet, might be to avoid milk, soy, fish, shellfish, and wheat. Then go total if that doesn’t work.
More About Breastfeeding Elimination Diets
Remember that once your baby is better and you are back on a fairly regular diet, simply avoiding the one or two foods that your baby can’t tolerate, it is still possible that your baby will be fussy sometimes. While it could mean that you ate something you weren’t supposed to, it also mean that you baby is teething, has a cold, is off her schedule, has developed reflux, or any number of other things. It’s not always going to be about food issues.
Also keep in mind that:
- you should take vitamins (in addition to your daily prenatal vitamin, you will likely need extra calcium) to make up for anything you are missing in your elimination diet, especially calcium, vitamin D, iron, and folate, etc. and make sure you are getting enough protein and calories
- missing the hidden ingredients in foods are likely a big reason why babies continue to have symptoms while you are following an elimination diet (for example, milk can sometimes be found as an ingredient in luncheon meats, many baked goods, and many other nondairy products) – check food labels and understand how to identify hidden ingredients in foods
- lactose free cow’s milk, low fat cow’s milk, and other animal milks, including goat milk, are not good substitutes if you are trying to avoid cow’s milk in an elimination diet. Even soy milk and other soy products can often cause similar reactions. You also should try and make your own, homemade baby formula.
- some vitamins and supplements can be a source of hidden milk, soy, and wheat
- after avoiding a food for about six months and once your infant is 9 to 12 months old, you can likely reintroduce it into your diet and watch for symptoms
- a registered dietician can help manage make sure you are getting all of the nutrients you need on this restrictive diet
- in addition to your pediatrician, a pediatric gastroenterologist can also help manage your baby with allergic colitis, especially when you need to follow a total elimination diet
Fortunately, allergic colitis is not common, so few breastfeeding mothers should have to try, or stick with, any of these types of restrictive diets.
And since some studies are showing that babies who just have some rectal bleeding don’t even have allergic colitis and that their symptoms go away without any interventions, make sure your baby’s symptoms actually warrant these types of treatments.
What To Know About Breastfeeding Elimination Diets
A breastfeeding elimination diet can be helpful if your baby is overly fussy and might have a milk protein allergy or intolerance to other foods that you are eating.
More Information on Breastfeeding Elimination Diets
- Why Does My Baby Cry So Much?
- Responding To Your Baby’s Cries
- Tips for Avoiding Food Allergens
- Tummy Troubles, Colic, and Mama’s Diet
- A Mom’s Journey with TED (Total Elimination Diet)
- GI Kids – Breastfeeding
- GI Kids – Cow’s Milk Protein Intolerance
- Breastfeeding a Baby With Food Allergies
- Nutritional Needs While Breastfeeding
- AAP – How a Healthy Diet Helps You Breastfeed
- Study – Prevalence and Outcome of Allergic Colitis in Healthy Infants With Rectal Bleeding: A Prospective Cohort Study
Last Updated on September 25, 2017 by Vincent Iannelli, MD