Tag: fussy baby

The Breastfeeding Elimination Diet for Fussy Babies with Allergic Colitis

What should you do when your breastfeeding baby gets fussy?

Your Fussy Baby

Babies cry. Talk to your pediatrician if the crying seems to be excessive, especially if you have a hard time consoling your baby.
Babies cry. Talk to your pediatrician if the crying seems to be excessive, especially if you have a hard time consoling your baby. (CC BY 2.0)

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:

  • soy
  • citrus fruits
  • eggs
  • nuts
  • peanuts
  • wheat
  • corn
  • strawberries
  • chocolate
  • 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

Treating Hard to Control Reflux

Acid reflux is common, especially for newborns and infants.

Many parents are surprised to know that reflux can affect older kids too though. Fortunately, reflux is temporary for most of these kids and can be easily treated.

It can be even easier to treat younger kids, most of whom don’t need any treatment if they are just messy and don’t have true acid reflux disease.

Happy Spitters and Reflux Symptoms

Children who spit up have acid reflux or more specifically gastroesophageal reflux (GER).

Many babies spit up or have reflux.
Many babies spit up or have reflux, but most are just “happy spitters” and don’t need treatment. Photo by Ryan Dickey (CC BY 2.0)

They may not have acid reflux disease though (GERD), with other associated signs and symptoms, such as:

  • refusing to eat
  • recurrent vomiting
  • weight loss or poor weight gain (failure to thrive)
  • irritability or trouble sleeping
  • respiratory symptoms, such as a chronic cough, hoarse voice or cry, or hard to control asthma, etc.
  • Sandifer syndrome – reflux plus head tilting and back arching

Without any of these symptoms, your baby who spits up, even if it is very frequent and it seems like they spit up a large amount each time, is likely what is classically called a “happy spitter.” If they are just messy, they don’t need any treatment and you can wait until they outgrow their reflux.

Remember – “Spit Happens.”

Older children with acid reflux might complain of heartburn, chest pain, or say that they have a sour taste in their mouth (sour burps).

Lifestyle Changes for Reflux

Once you recognize that your child has GERD and needs to be treated, you might start with these lifestyle changes:

  • avoiding milk and dairy products for two to four weeks if you are breastfeeding an infant with GERD
  • changing baby formula to an extensively hydrolyzed protein (Nutramigen, Gerber Extensive HA, Alimentum) or amino acid–based infant formula if your formula fed baby has GERD
  • thickening your baby’s formula (typically about one tablespoon of rice cereal per every one to two ounces of formula) vs switching to a baby formula for reflux (Enfamil AR or Similac Sensitive R.S.)
  • making sure you aren’t overfeeding your baby, including that you don’t re-feed your baby right after they spit up
  • avoiding seated and supine (on his back) positions after feedings, although you shouldn’t put your baby down prone (on his stomach) if he is going to fall asleep (risk factor for SIDS)
  • helping older children with acid reflux lose weight if they are overweight and making sure they don’t smoke or drink alcohol
  • encouraging older children to avoid acid reflux triggers, especially caffeine, chocolate, foods with acid, and spicy foods

When can you expect your infant’s reflux to go away? In most babies, reflux symptoms peak at about 4 months and go away by the time they are 12 to 18 months old. In older children, reflux symptoms generally go away after a few months of appropriate treatment.

Acid Reflux Medicines

If lifestyle changes aren’t working, your child with reflux likely needs medicine to treat his reflux.

These acid reflux medications include:

  • antacids – may be okay in older children with very rare symptoms, but not for routine use
  • histamine-2 receptor antagonists (H2RAs) – such as Zantac (ranitidine) – works quickly, but may stop working over time (tachyphylaxis)
  • proton pump inhibitors (PPIs) – such as Prevacid (over-the-counter for adults) and Nexium (Nexium packets are FDA approved for infants) – considered more potent and superior to H2RAs but may take up to four days to start working
  • prokinetic agents – rarely used because of side-effects

In general, if your child’s symptoms improve or go away within two weeks of taking an acid reflux medication, then you should likely continue it for at least two to three months.

Treating Hard to Control Reflux

What do you do when lifestyle changes and reflux medicines don’t work or symptoms return after you stop your child’s reflux medicine?

First, make sure you are giving the right medicine, the right dosage of medicine, and are giving it at the right time, keeping in mind that PPIs should be giving 30 minutes before a meal.

Next, consider if there are any other lifestyle changes that you can try. For example, you might encourage your older child with persistent reflux to eat smaller meals more frequently, avoid a bedtime snack, and you may even elevate the head of his bed by about 30 degrees.

Lastly, you might make sure that your child really does have reflux.

Just because your baby is fussy and wakes up a lot at night, it doesn’t automatically mean that he has reflux. It could instead be colic, or be related to a food intolerance or allergy, with breastfeeding mothers needing to go on a more restrictive diet or infants drinking a hydrolyzed formula might need to switch to an elemental formula (Elecare, Neocate, or PurAmino).

Older kids with difficulty swallowing (dysphagia), which is often blamed on acid reflux, might have post-nasal drip caused by allergies or a sinus infection, etc.

And even if truly spitting up, instead of GERD, a child might have any number of other conditions instead of GERD, from an intestinal obstruction to a metabolic disorder.

It is usually at this point, when classic acid reflux treatments aren’t working, that a referral to a pediatric gastroenterologist would be a good idea.

What To Know About Acid Reflux

Acid reflux in kids is usually temporary and can often be controlled with lifestyle changes and medications, but unfortunately, acid reflux symptoms are not always caused by reflux, leading to some treatment failures.

For More Information on Acid Reflux