Tag: milk allergy

The Breastfeeding Elimination Diet for Fussy Babies with Allergic Colitis

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.

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

What’s Wrong with Homemade Baby Formula?

Stick to breastmilk or an iron fortified baby formula until your baby is at least twelve months old. There are no benefits to feeding your baby a homemade baby formula and there are certainly some risks. Those risks go up even more if you use raw goat milk or leave out key nutrients.

Once upon a time, before we had commercial baby formula, didn’t everyone make their own homemade baby formula if they couldn’t breastfeed or were separated from their baby?

Not necessarily.

Some parents hired a wet nurse and others simply fed their baby wheat containing porridge or milk from camels, cows, goats, or even pigs. Of course, wet nursing was the safest option by far.

History of Homemade Baby Formula

There were recipes for ‘baby formula’ though, which often “consisted of a liquid ingredient (milk, beer, wine, vegetable or meat stock, water), a cereal (rice, wheat or corn flour, bread) and additives (sugar, honey, herbs or spices, eggs, meat).” These recipes were missing foods with vitamin C and were later missing vitamin D, iron, and protein, as they were mixed with more water and less meat and eggs.

Before commercial baby formula was widely available, public health nurses had to sometimes teach new moms how to make their own formula.
Before commercial baby formula was widely available, public health nurses had to sometimes teach new moms how to make their own baby formula.

Fortunately, there were several major breakthroughs in the mid-nineteenth century that offered hope to babies who couldn’t breastfeed, including the invention of the rubber nipple and other feeding devices, improved methods of hygiene and later pasteurization, and the first commercial baby formula.

Many of the first baby formulas basically looked like homemade recipes, such as the Leibig formula – a powder made up of wheat flour, malt, and potassium bicarbonate that was added to diluted cow’s milk. Later, there were recipes to make baby formula from condensed and then evaporated milk (mixed with corn syrup).

And eventually, in the 1950s, we got the commercial baby formulas that we still use today.

What’s in Baby Formula

Like breastmilk, baby formula has three main components that provide the calories:

  • a sugar
  • fats
  • proteins

Different combinations of these proteins (cow’s milk vs soy), sugar (lactose vs corn syrup), and fats (vegetable oils), etc., help produce cow’s milk based, soy based, and elemental baby formulas.

And then, to make it more like breastmilk, lots of other stuff can be added to baby formula, including DHA, probiotics, and nucleotides, etc.

Enspire, the newest formula from Mead Johnson, also adds lactoferrin, Milk Fat Globule Membrane (MFGM), and prebiotics, to try and make it their “closest formula ever to breast milk.”

What’s Not in Baby Formula

Are you still confused about what’s in your baby’s formula?

While it might make you feel better to feed your baby goat milk, it won't make your baby feel any better, and could make them sick...
While it might make you feel better to feed your baby goat milk, it won’t make your baby feel any better, and could make them sick… (CC BY-ND 2.0)

It’s possible that you are just confused about what you think is in your baby’s formula?

Kristin Cavallari has written that she made her own homemade baby formula because “I would rather feed my baby these real, organic ingredients than a heavily processed store-bought formula that contains ‘glucose syrup solids,’ which is another name for corn syrup solids, maltodextrin, carrageenan, and palm oil.”

So what are glucose syrup solids and why are they in your baby’s formula?

While cow’s milk based baby formulas use lactose (glucose plus galactose) as their source of sugar, non-milk based formulas usually use use sucrose (cane sugar) and corn syrup solids (glucose).

Should you worry about cane sugar in some organic formulas?

What about the corn syrup in formula? Isn’t that bad for them?

No. These are just different types of sugar. Even maltodextrin is simply glucose polymers made from corn starch that is used as a thickening agent in baby formula and other foods.

And no, corn syrup solids don’t have anything to do with high fructose corn syrup.

Goat Milk Formula

In addition to warning about making homemade formula, pediatricians have long warned about feeding baby’s goat milk and goat milk based baby formula.

Goat milk is very high in sodium and protein, giving almost three times the amounts present in breast milk. And cross-reactivity that occurs between proteins means that babies who are sensitive or allergic to cow’s milk will likely have problems with goat milk too.

“It is recommended that formula-fed infants who are allergic to milk use an extensively hydrolyzed, casein-based formula. This type of formula contains protein that has been extensively broken down so it is different than milk protein and not as likely to cause an allergic reaction.”

FARE on Formula for Infants with a Milk Allergy

Of course, that doesn’t keep folks from pushing “false and potentially dangerous information” about what some think are benefits of goat milk for infants.

What’s Wrong with Homemade Baby Formula?

In her latest book, Kristin Cavallari, known for dangerous stance against vaccines, even offers a recipe for a goat’s milk baby formula that is made with:

  • filtered water
  • goat milk powder
  • pure organic maple syrup – provides calories from sugar
  • extra virgin olive oil – provides calories and monounsaturated fats
  • unflavored cod-liver oil – for extra vitamin D and vitamin A
  • unsulfured blackstrap molasses – for extra iron and calcium
  • coconut oil – for omega-6-fatty acids
  • probiotics

In this homemade formula, much of the sugar, protein, and fat and half of the calories comes from goat milk.

The majority of the sugar comes from the maple syrup though, which is just sucrose. Just like the sucrose from cane sugar that folks complain about in some organic formulas.

Extra fat comes from the olive oil.

What about the other ingredients?

They provide extra vitamins and minerals, including vitamin D, vitamin A, and iron.

What’s missing?

This homemade formula seems to be missing folate. Goat milk is deficient in folate and can lead to megaloblastic anemia and it is one of the main reasons babies should avoid unfortified goat milk.

And it is missing enough vitamin D to avoid vitamin D deficiency.

Cavallari’s recipe seems to add just 100IU of vitamin D to the whole 32 ounce batch (from the cod liver oil). That’s just 10IU per 100ml, about 6 times less than baby formula. Keep in mind that it is recommended that infants get at least 400IU of vitamin D each day.

Remember that formula is fortified with vitamin D and breastfeeding babies are supposed to take a vitamin D supplement. Depending on your water filter, this homemade baby formula recipe might also be missing fluoride, which infants start to need beginning at around six months.

Can You Find a Safe Homemade Baby Formula Recipe?

You probably can, especially if you use a full fat milk powder that has been pasteurized and fortified with vitamin D and folic acid and the right combination of other ingredients to get enough calories, protein, fat, sugar, and all of the essential vitamins and minerals that your baby needs to gain weight and development normally.

“FDA regulates commercially available infant formulas, which are marketed in liquid and powder forms, but does not regulate recipes for homemade formulas. Great care must be given to the decision to make infant formulas at home, and safety should be of prime concern. The potential problems associated with errors in selecting and combining the ingredients for the formula are very serious and range from severe nutritional imbalances to unsafe products that can harm infants. Because of these potentially very serious health concerns, FDA does not recommend that consumers make infant formulas at home.”

FDA Questions & Answers for Consumers Concerning Infant Formula

You will almost certainly have to give your baby a multi-vitamin each day too.

Also, you will have to make sure you are mixing all of the ingredients of your recipe correctly and safely, so that you don’t contaminate any of the batches.

But it still won’t be any better for your baby than store bought formula.

So just like skipping your RhoGAM shot, skipping your baby’s vitamin K shot and delaying or skipping vaccines, you will have some very big risks and absolutely no health benefits.

What to Know About Homemade Baby Formula

Stick to breastmilk or an iron fortified baby formula until your baby is at least twelve months old. There are no benefits to feeding your baby a homemade baby formula and there are certainly some risks. Those risks go up even more if you use raw goat milk or leave out key nutrients.

More About Homemade Baby Formula

The Best Milk for Kids – Does It Still Come from a Cow?

While each type of milk has its fans, in general, unless your child has food allergies or intolerances, the best milk is going to be the one you can afford, with the nutrients your child needs, and which he is going to drink, whether it comes from a cow, soybean, almond, or hazelnut.

You wouldn’t think that the idea that kids should drink milk would be controversial.

Of course, it is…

The new joke seems to be that you can turn anything into milk.
The new joke seems to be that you can turn anything into “milk,” even peas.

The controversy is more over the type of milk now and not so much over the amounts though.

Few people disagree with the American Academy of Pediatrics 2014 clinical report on Optimizing Bone Health in Children and Adolescents, in which they recommended that “Children 4 through 8 years of age require 2 to 3 servings of  dairy products or equivalent per day. Adolescents require 4 servings per day.”

Which Kind of Milk You Got?

While you used to have to go to Whole Foods to get soy milk, nearly every grocery store now has every type of “milk” you can think of, and some you haven’t.

So in addition to raw milk and pasteurized cow’s milk, it is possible to buy:

  • almond milk
  • cashew milk
  • coconut milk
  • flax milk (flax seeds)
  • goat milk
  • hazelnut milk
  • hemp milk
  • lactose free milk (cow’s milk without lactose)
  • oat milk
  • potato milk (as powdered milk)
  • quinoa milk
  • rice milk
  • ripple milk (peas)
  • 7 grain milk (Oats, Brown Rice, Wheat, Barley, Triticale, Spelt and Millet)
  • soy milk
  • sprouted rice milk

Complicating matters even more, once you decide on the type of milk to give your kids, you will have a lot of other options to choose from – organic, hormone free, sweetened vs unsweeted, enriched vs original, and a long list of flavors, etc.

The question is no longer simply Got Milk?

Best Milk for Kids

So which milk is best for your kids?

While each type of milk has its fans, in general, unless your child has food allergies or intolerances, the best milk is going to be the one you can afford, with the nutrients your child needs, and most importantly, which he is going to drink.

What about the idea or argument that cow’s milk is made for baby cows?

Following that logic, if you weren’t going to give your kids cow’s milk, then you probably wouldn’t give them most plant based milks, as they are commonly made from seeds. Almonds, peas, and soybeans, etc., aren’t “made” to make milk. They are produced to make more plants. But just like we pasteurize and fortify cow’s milk so that we can consume it, we have learned to use these other foods.

Best Milk for Kids with Food Allergies

While the wide availability of so many different types of milk is confusing for many parents, it has been great for pediatricians and parents of kids with food allergies and intolerances. Having more of a variety has also been helpful for vegan families.

In general, you should breastfeed or give your infant an iron fortified formula until they are at least 12 months old, avoiding milk or other allergy foods as indicated if you are breastfeeding and your child develops an allergy to that food, or switching to a hypoallergenic or elemental formula if your child develops a formula allergy.

And then, after your toddler is old enough to wean from breastmilk or formula, you:

  • should avoid cow’s milk, lactose-free cow’s milk, and goat milk if your child has a milk protein allergy
  • should avoid almond, cashew, coconut, and hazelnut milk if your child has a nut allergy (yes, even though almonds and coconuts are really stone fruits and not true nuts, they have been rarely known to cross react and trigger allergic reactions)
  • should avoid soy milk if your child has a soy allergy
  • should make sure your child’s milk is fortified with calcium and vitamin D

Most importantly, talk to your pediatrician and/or a pediatric allergist before switching to a plant based milk if your child has food allergies and before trying to switch back to cow’s milk after you think they have outgrown their allergy.

Other Things to Know About Kids Drinking Milk

Kids don’t necessarily need to drink any kind of milk.

They do need the nutrients that you commonly get from milk, including fat, protein, calcium, and vitamin D, etc.

You should also know that:

  • the American Academy of Pediatrics recommends that most toddlers drink whole milk until they are two years old, when they should switch to reduced fat milk.
  • switching to reduced fat milk can be appropriate for some toddlers who are already overweight or if their pediatrician is concerned about their becoming overweight or about their cholesterol, etc.
  • most cow’s milk that you buy in your grocery store doesn’t have any added growth hormone (labeled rBST-free), even if it isn’t organic
  • the AAP, in a report on Organic Foods: Health and Environmental Advantages and Disadvantages, states that “there is no evidence of clinically relevant differences in organic and conventional milk”
  • if a company makes more than one type of non-dairy milk, such as rice, almond, and soy, then cross-contamination could be a problem for your child with food allergies
  • most kids with a lactose intolerance can tolerate some lactose in their diet, so may be able to drink some cow’s milk and eat cheese, yogurt, and ice cream, even if they can’t tolerate a lot of regular cow’s milk
  • while plant based milks are lactose free and some are unsweetened, others might have added sugar, including cane sugar or cane syrup
  • reduced-calorie and no added sugar flavored cow’s milk often use artificial sweeteners
  • unlike cow’s milk, most plant based milks are very low in protein, so look to give other protein rich foods to make up for it, like eggs, peanut butter, beans, tofu, and of course meats
  • although they aren’t labeled as 1% or 2%, plant based milks typically have less fat than whole milk, so look to give other foods with healthy fats to make up for it, like avocados, hummus (provides protein and fat!), peanut butter, some fish (salmon), and use olive oil, coconut oil, and real butter when possible
  • phytoestrogens in soy milk are a concern for some people
  • most milk, even oat milk, is gluten-free, with the exception of 7 grain milk, which obviously contains wheat
  • UHT milk undergoes ultra-high temperature processing or ultra-pasteurization to allow it have a longer shelf life, even if not refrigerated, at least until the carton is opened
  • although some experts warn about cross reactivity, like between peanuts and green peas, the Food Allergy Research & Education website states that “If you are allergic to peanuts, you do not have a greater chance of being allergic to another legume (including soy) than you would to any other food.”
  • raw cow’s milk, in addition to being a risk for bacterial contamination and outbreaks of Escherichia coli, Campylobacter, and Salmonella, is very low in vitamin D and has no proven health benefits over pasteurized milk
  • some brands of almond milk contain only about 2% of almonds, which leads some critics to say that you should just eat a few almonds to get even more nutritional benefits

But don’t forget about cost. Plant based milk can be at least two to four times more expensive than cow’s milk.

So again, remember that while each type of milk has its fans, in general, unless your child has food allergies or intolerances, the best milk is going to be the one you can afford, with the nutrients your child needs, and which he is going to drink, whether it comes from a cow, soybean, almond, or hazelnut, etc.

For More Information On The Best Milk For Kids:

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