Here at Neocate, we often talk with concerned parents who tell us they’ve read other stories from parents whose children had a terrible rash that was only helped by Neocate after lots of trial and error. Frequently, these parents tell us they don’t feel their doctor is familiar with food allergies. Just yesterday a father told me that his pediatrician kept telling him that “every baby gets rashes, it’s normal; he’ll grow out of it.”
Some pediatricians and many parents are surprised to learn that about seven percent of children have food allergies. Many parents who eventually learn that their child has a food allergy, which can only be treated by changing the diet, wish their journey to a solution had been shorter and simpler. Here are some tips for what you can do if you feel your doctor isn’t recognizing your little one’s rash as a possible sign of a food allergy.
Take Careful Notes
A rash is often the first sign of a food allergy that a parent notices. While it’s true that almost all babies experience diaper rash at some point, this is not the same as a rash caused by food allergy. Diaper rash, like many rashes, is caused by something on the outside: wet or rubbing diapers, scented lotion, rough fabrics, or even fabric softener. It’s important to rule out these other causes that might contribute to eczema, atopic dermatitis, or itching.
If you’ve eliminated potential causes, it’s more likely that the rash is caused by something on the inside: a food allergen. If you document all steps you’ve taken to eliminate other culprits, the doctor is more likely to consider a food allergy as the cause of your baby’s rash. If you notice that your baby has a rash and you think it might be related to a food allergy, check to see if your baby exhibits any other signs of a food allergy. It’s unusual for a baby with food allergy to only have a rash. Make a list of your baby’s symptoms which could also be caused by a food allergy to provide to the doctor.
Many parents tell us that they went through multiple different infant formulas before finally finding relief with Neocate. Some infants don’t even tolerate breast milk because of dairy foods in the mom’s diet. Make notes of the different symptoms that did not go away with each formula you’ve tried. Many doctors assume a soy formula or hydrolyzed formula will help if the baby has a milk allergy. However, many babies with a milk allergy also have a soy allergy and can be extremely sensitive to even small amounts of milk protein.
Make an Appointment with Your Baby’s Doctor
When you discuss your baby’s rash with the pediatrician, explain that you think you have ruled out other causes, and explain the list of changes you tried that did not help. Inform the doctor that food allergy is common among infants, and explain the other symptoms your child is experiencing which could be related to food allergy. Skin creams are commonly prescribed for rashes. While these creams may help to reduce inflammation and itching caused by a food allergy, they will not help other allergy symptoms such as diarrhea, gastroesophageal reflux disease (GERD), or wheezing. Only a change in the diet will truly solve the problem.
When you see your pediatrician, you may also want to request a referral to an allergist (narrow your search by selecting the “Food Allergy” specialty). The allergy testing that these professionals perform provides the best information to help your child find a diagnosis and relief from a food allergy.
Finally, share with the doctor your knowledge of Neocate, the amino acid-based formula that makes such a difference for babies with food allergies. It’s important to follow the steps to help give your baby’s rash the best chance to heal. We know that it is so hard to see your little one feeling so uncomfortable but remember it may take some time, even after you start using Neocate.
What steps did you take to know that your baby’s rash was caused by food allergy?
A friend told me she went to an office Halloween party as a peanut allergy. I wondered: What would you wear that says, “I am an allergy?” I still don’t know the answer to that question! Thinking about that made me wonder: Since babies don’t come with labels and can’t tell us what they experience, how do they tell us “I have an allergy?”
More and more, children are diagnosed with food allergies, with cow’s milk allergy being the most common. In fact, more than 100,000 babies each year suffer from milk allergy. There are multiple clues pediatricians look for that help diagnose a cow’s milk allergy that you can look for too. Below is a list of eight questions to help parents of infants identify a potential milk allergy, designed by Dr. John Moissidis, a Board certified pediatric allergist at The Asthma Allergy Clinic in Shreveport, La.
Milk Allergy Symptoms
1. Diarrhea Diarrhea is common in babies, but if it is persistent (an average of two to four times a day for more than five to seven days) and/or if there is blood or mucous in the stool, it could signal a more serious milk allergy.
2. Vomiting Babies often spit up bits of food, but vomiting beyond the typical mealtime regurgitation should be examined by a doctor. Reflux symptoms, such as spit-up and difficulty swallowing, can also be milk allergy symptoms.
3. Skin Rash There are many causes for infant skin rashes like eczema. Milk allergy is one possible cause, especially if the rash occurs along with some of these other symptoms.
4. Extreme Fussiness Every baby cries, but crying continuously and inconsolably for long periods of time is abnormal. When there is no apparent reason, this is usually called colic. Sometimes this extreme fussiness is actually caused by the gastrointestinal pain resulting from an allergy to the proteins found in milk.
5. Low or No Weight Gain Most infants double their weight by six months and triple it by 12 months. But when babies are not getting the nutrition they need because of excessive diarrhea and vomiting, they are unable to grow like they should.
6. Gassiness All babies have gas, but when it occurs along with several of these other symptoms, it can also signal an allergy to milk proteins.
7. Respiratory Problems Colds are common for infants, but wheezing, struggling to breathe and developing excess mucus in the nose and throat is not. For some kids, these respiratory problems can be the baby’s reaction to the protein found in milk.
8. Failure to Thrive Babies with milk allergy often suffer from a lack of proper nutrition characterized by dehydration, loss of appetite and lack of energy. This overall failure to thrive is often the result of the effect the other symptoms have on the infant’s body.
My baby has one or more of these symptoms – what now?
Babies with an allergy to cow’s milk protein cannot process the complex proteins found in milk-based baby formula, and many babies also react to soy-based infant formulas. Because of this, infant milk allergy is treated by either eliminating the milk proteins from the nursing mother’s diet or by replacing the regular formula with an amino acid-based formula.
An amino acid-based formula is safe for babies with milk and soy allergies because it is made using amino acids, the building blocks of protein. Amino acids are small enough that they won’t cause an allergic reaction in the way that complete protein chains or partly broken down proteins found in other formulas will.
The next step should be to schedule an appointment with your child’s pediatrician in order to receive a more thorough evaluation and diagnosis. Bring this information with you and ask your doctor if your baby might benefit from an amino acid-based formula.
What symptoms did your baby have that led you to suspect a milk allergy?
Successful breastfeeding can get complicated if your baby is diagnosed with an allergy to cow milk, or when other food allergies are suspected. So, what can you do when breastfeeding your milk-allergic infant comes into question?
Chances are you have given quite a lot of thought and preparation regarding your plans to feed your new infant. Breast milk is the best source of nutrition for your baby. It is the first choice when you ask the World Health Organization (WHO), the American Academy of Pediatrics (AAP), Centers for Disease Control (CDC), and healthcare professionals worldwide. However, when your baby is diagnosed or is suspected of having a milk allergy, your baby’s diet must be free of cow milk protein.
Is it possible to manage your baby’s food allergies while sticking to your plan to breastfeed? Absolutely. Let’s look at a few scenarios and possible solutions.
My infant is reacting to the foods I’m eating.
Answer: Ask your healthcare professional for their advice.
It’s possible for small amounts of protein from foods in mom’s diet to make their way into her breast milk, which can cause allergic reactions if the infant develops an allergy to those foods.
The first option your healthcare professional should suggest in this situation is for mom to follow an elimination diet and continue to breastfeed. An elimination diet means you remove suspected allergens - both whole foods and most ingredients derived from that food - from your diet. This means protein from the potential allergen don't make it into your breast milk, thus removing the allergens from your baby’s diet.
It may take up to two weeks to see if the foods you've removed from your diet have made the difference for your little one. If your baby continues to have problems tolerating your breast milk or perhaps has only a minimal improvement in their symptoms, then additional foods may need to be eliminated from your diet. This may be referred to as a “total elimination diet (TED)”. Read more about one mom Rachel, and her experience with TED.
It is key that you maintain a healthy diet to maintain your own health so that you can be well and also provide the nutrition needed for your infant through breast milk. Eliminating some foods, especially large groups of food such as dairy, may jeopardize your health, so it is important to seek medical supervision from your doctor and/or a registered dietitian when planning an elimination diet to make sure all potential gaps in your nutrition are filled.
Supplements of certain nutrients may be recommended, depending on the number of eliminated foods. Key nutrients often obtained from dairy in the diet, at a minimum calcium and vitamin D, may be recommended by your healthcare team as supplements, for example, if you’re avoiding all dairy. They may also look for alternative foods to provide these and other essential nutrients.
Some moms have even found Neocate products to be a great hypoallergenic option to supplement their own diet and meet their own nutrition needs to continue breastfeeding their babies. This might be particularly helpful when mom is asked to eliminate multiple food items from her diet, or follow a “total elimination diet”. If this is something your curious about, you could discuss Neocate Splash with your healthcare team, although any Neocate product can be used as a supplement.
I want to continue breastfeeding but am not producing enough breast milk.
Answer: Ask your healthcare professional for their advice.
Some mothers struggle to produce enough breast milk to meet the needs of their growing baby. First, you should ask for a referral to a lactation specialist - experts in breast feeding strategies. Many healthcare professionals will recommend supplementing with infant formula so the baby still gets the benefits of breast milk while also getting enough calories and nutrients to ensure proper growth of the infant while the underlying cause of the low breast milk yield is addressed.
A hypoallergenic formula like Neocate is recommended to supplement your breast milk if your little one has reacted to your breast milk. That’s because guidelines advise that babies with food allergies, or who are already struggling to tolerate breast milk due to food allergies, should be given a hypoallergenic formula like Neocate when a supplement for mom’s breast milk is needed. (The reason? The fragments of protein from mom's diet that are found in breast milk are roughly the same size as those found in formulas made from broken-down dairy protein, which means they are likely to provoke an allergic reaction.)
Supplementing breast milk with Neocate can help you continue to provide your baby the wonderful nutrition from breast milk, while also making sure your baby gets the full amount of calories and nutrients they need to continue to grow and develop from a hypoallergenic formula. Your healthcare team, such as your pediatrician or registered dietitian, will advise you on what is needed for you and your baby specifically. The amount of formula needed should be directed by your healthcare professional and will be unique to your infant’s individual nutrition needs.
However, this can also present some challenges. Babies often have a hard time switching between breastfeeding and bottle feeding. I hear from many mothers in this situation that the baby will often prefer one feeding over the other, and usually the baby prefers breast milk. For example, moms have told me that their baby drinks well when they are breastfeeding but they struggle with bottle feedings. Even mothers that are exclusively bottle feeding will often say that the baby prefers the bottles of breast milk over the bottles of infant formula.
Some Tips for Moms Supplementing their Breast milk:
Many healthcare professionals suggest manually expressing your breast milk and bottle feeding only to help in this situation.
It is often recommended to add prepared Neocate consistently to the bottles with expressed breast milk. This can help with bottle acceptance because the bottles are consistently the same taste and the baby is consistently being bottle fed.
The amount of prepared Neocate needed should be directed by your healthcare team based the nutrition needs of your baby and your breast milk production.
Let’s say, for example, that your healthcare professional determines that your baby needs an additional 10 fluid ounces of Neocate daily and your baby is drinking 5 bottles daily. In this example, your healthcare professional might recommend an additional 2 fluid ounces of prepared Neocate added to each bottle of expressed breast milk. You would prepare the Neocate at the recipe recommended by your healthcare professional, then add 2 fluid ounces to each bottle of breast milk. This ensures the baby is getting a similar blend of breast milk and Neocate at each bottle.
Again, your healthcare professional will direct you regarding what is best for both you and your little one, so ask your pediatrician or registered dietitian for what is best for you.
I am adding prepared Neocate to breast milk, but my baby is not gaining weight.
Answer: Ask your healthcare professional for their advice.
For some infants, the calories in breast milk or formula may not be enough to support weight gain at a normal rate. When your baby can’t consume any more breast milk or formula in a day, the healthcare team may suggest other options to help your baby gain weight and keep on track with their expected weight gain, or growth curve. (You can track your baby’s intake using the Neocate Footsteps App, so you can show the healthcare team exactly what she’s taking.)
Often an increase in calories is needed. One option your healthcare professional may recommend is concentrating the Neocate before adding it to your breast milk. This can help to increase the calories and nutrients from Neocate that your baby is consuming, on top of the breast milk. The same tips discussed above can be helpful in this situation when expressing your breast milk, especially adding the Neocate to your breast milk consistently between bottles.
Again, your pediatrician or registered dietitian will advise you what is best for you and your baby, and how exactly they want you to prepare Neocate before adding it to your expressed breast milk. It's important to only change the concentration if directed by the healthcare team, and to always follow their instructions: formula that is too concentrated can lead to dehydration and other health issues. In other words, consult the healthcare team first – please do not attempt this on your own!
What other questions do you have about breastfeeding your baby with food allergies? Please share any questions or any suggestions you might have for other mothers facing this situation in the comments below.
Food Allergy Living is a resource for parents of children with food allergies, brought to you by Nutricia, the makers of Neocate. For more in-depth information about our purpose & authors, see our About Food Allergy Living page.