The World Alliance for Breastfeeding Action and breastfeeding advocates in more than 170 countries worldwide will be celebrating World Breastfeeding WeekAugust 1-7! We all know how important breastfeeding is, so we wanted to share some information about this week as well as breastfeeding a little one with food allergies.
It’s always suggested that the first choice should be to breastfeed your baby because studies have shown that breastfeeding1, 2:
Protects the baby against infections, such as ear infections and the flu; and
However, while breastfeeding is important, it can become more complicated if your baby has food allergies. In that case, healthcare professionals typically recommend that the mother start an elimination diet, where she will remove the offending allergen or allergens from her diet, ultimately removing them from her baby’s diet. This can become problematic if the mom is not getting the nutrients she needs, resulting in the baby not getting the right nutrition from the breast milk alone. Therefore, a lactating mom on an elimination diet should be closely monitored by a doctor or Registered Dietitian to ensure she is getting all the vitamins and minerals she requires while avoiding the specific allergen(s). To read more about elimination diets and how to best educate yourself on reading labels to avoid certain allergens like milk, soy, peanuts, eggs, tree nuts, fish, shellfish and wheatwe recommend checking out the Consortium of Food Allergy Research website.
Here at Nutricia, we always support breastfeeding, but understand that some moms are just not able to breastfeed as they wish. If the baby has a known food allergy and if the mom is not able to breastfeed, then a formula like, Neocate Infant DHA ARA, can be an appropriate alternative.
As always, talk to your doctor about the best way to help your baby get the right nutrition they need as well as any questions you have about breastfeeding your baby.
Are you a mom who has breastfed a food allergic infant and had to follow an elimination diet? Was it hard for you? Do you have any recommendations or insights for other moms in this same situation? We would love it if you shared!
The title of the article is “Associations of Infant Feeding Practices and Picky Eating Behaviors of Preschool Children.” We can simplify it to “how feeding infants might add to picky eating later on.” The authors looked into the way that feeding patterns in infancy, when eating patterns start to develop, affect picky eating behavior later in life. We know that every child will exhibit picky eating at some point; what we don’t know is how picky they will be and how long it will last. We don’t know any parent who wouldn’t do whatever they could to lower the risk of picky eating!
The authors of the study looked at data from 129 mothers of preschool children. The focus was on how early the moms started solid foods. They compared this with how willing the children were later in life to try new foods and how much variety their diets had.
The authors found that children in the study who were exclusively breastfed for the first 6 months of life were less likely to be picky about how their food was prepared, less likely to reject food, and less likely to be afraid of new foods. By waiting until 6 months to introduce solid foods, their children were less likely to be picky eaters later in childhood.
What the Results Mean
While it’s tempting to take the results of this study at face value, waiting until 6 months to introduce solids will not guarantee no picky eating. For starters, the authors admit that picky eating is hard to define, and each parent sees picky eating differently. This study also relied on parents’ memories about feeding their infants, and the small study group may not represent the whole population.
What we should take away from this study is that infant feeding practices, particularly the age when solids are started, can have an impact on picky eating behavior later in childhood. This study presents evidence that waiting until 6 months may be a good start, and that further studies could be useful. Introducing solids at 6 months is in line with the recommendations of the Academy of Nutrition and Dietetics (AND) and the American Academy of Pediatrics (AAP). For infants with documented allergy or risk of allergy, an expert panel has also suggested that it’s best to wait until 6 months to introduce solids. This is part of the reasoning behind why we suggest waiting until 6 months to introduce Neocate Nutra, the only hypoallergenic, amino acid-based semi-solid designed specifically for infants and children with allergies.
Would you change the age that you introduce solids based on the results of this study?
We often hear from moms of infants with cow milk allergy who would like to continue breastfeeding their infant. It’s very rare that an infant will be truly allergic to the breast milk: usually the infant reacts to one or more foods in the mother’s diet that affect breast milk contents. For this reason, many clinicians might suggest that a mom try to follow an elimination diet to continue breastfeeding. Other times, they will recommend Neocate Infant DHA/ARA as an appropriate replacement for breast milk. We always suggest that you check with your little one’s healthcare team and follow their advice, but below are some links to information you may find helpful.
Elimination Diet Basics
The general idea behind an elimination diet is that certain foods are strictly eliminated. This includes removing “whole” foods, like cow milk, and specific ingredients. For example, a mom whose infant has cow milk allergy may need to screen ingredient lists for anything derived from dairy. This video, featuring members of our team, explains the basics behind an elimination diet, such as eliminating dairy and soy ingredients. Your healthcare team can provide more detailed instructions on what foods you should eliminate and what ingredients to look out for.
Beyond the Basics
For some nursing infants, an elimination diet that removes common allergens like dairy and soy from mom’s diet may only provide minimal symptom improvement. If that’s the case for you, please seek advice from your healthcare team. For some families, the team may suggest a diet that restricts more foods, which they may refer to as a “total elimination diet.” You can read about one mom’s experience with the total elimination diet here. This previous blog post suggests some other websites that may be helpful to you.
But if a more strict approach like the total elimination diet still doesn’t completely help, is there still an option to breastfeed? If you are truly committed to breastfeeding, we have heard of moms who drink an elemental formula themselves so that they haven’t got ANY food in their diet that the infant could react to. You can read about my two-day experience of nothing but Neocate here. And two days is nothing: there are many teens and even adults who depend on Neocate every day to help meet their nutrition needs safely.
Elimination Diet Caution
For many moms who try an elimination diet, there is often a need to eliminate more than just dairy and soy. This can lead to a diet that is restricted in one or more nutrients, which could pose a risk to both mom and her baby. Please read this previous blog post to make sure you’re aware of some potential risks. While the article discusses a scenario in which a child is on an elimination diet, some of the key principles hold for a nursing mom (and her baby) as well. One option may be for mom to consume Neocate Junior as a safe, supplemental source of nutrition: I’d recommend the Vanilla with prebiotic fiber!
What experience can you share with other moms who are considering an elimination diet?
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.