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!
We get lots of questions from Moms (and Dads) about elimination diets. Today we would like to help address some of those questions.
What is an elimination diet?
Elimination diet is strict removal of certain foods from the diet. Often based on allergy tests or removal of one or more of the top food allergens seen in children: milk, soy, egg, nut (tree nut and peanut), wheat, and fish or shellfish. Elemental formula such as Neocate may be used to supplement the restricted diet to meet all nutritional needs.
What am I going to feed/eat on an elimination diet?
If your child is fed an amino acid-based formula, you won’t need to worry about eliminating anything from your diet. However, if you choose to breastfeed, you will need to follow an elimination diet and remove all milk and soy protein from your diet.
For your reference, here is a list of the basic foods that may contain dairy or soy protein that you should avoid when on the elimination diet:
All dairy and soy products
Whey or Casein on the label
Non-broth (cream) soup
Kids With Food Allergies also has another in-depth list you can take a look at. Click here to see the full list.
These are just some things to look out for when implementing an elimination diet. Of course, if you feel the need to supplement your baby’s diet or if the elimination diet is compromised, an amino acid-based formula is always a great option. And, as always, please speak with a registered dietitian or your pediatrician before starting the elimination diet.
Also, for more elimination diet information and resources check out some of our previous blog entries:
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?
Many people who find their way to Neocate as part of an elimination diet. Sometimes this is for moms nursing their infants, whereas other times an elimination diet is used for older children with allergies. If you are exploring an elimination diet for yourself or your child, here are some resources and a few suggestions.
1 – Know the Basics
The general idea behind an elimination diet is that certain foods are strictly eliminated. This video, featuring members of our team, explains the basics behind an elimination diet, such as eliminating dairy and soy ingredients. You can also read some of our related posts: Elimination Diets and Breastfeeding, and Resources for Your Elimination Diet.
2 - Ask for Advice
We always suggest that you check with the healthcare team and follow their advice for an elimination diet. Your healthcare team can provide much more detailed and tailored instructions on what foods you should eliminate and how to avoid them. It can help to take a list of questions to the healthcare team – here are some suggestions to help prepare for the appointment.
3 – Remember the Risks
Make sure the healthcare team explains what should improve with the elimination diet and how quickly. Also look to understand any risks. For instance, in cases of multiple food allergies there is often a need to eliminate more than just dairy and soy. This can lead to a diet that is low in one or more nutrients, which could pose a risk of deficiency. Please read this previous blog post about a child on an elimination diet to make sure you’re aware of some potential risks.
What experience can you share with others who are exploring an elimination diet?
Infancy is a time marked by rapid growth, requiring important nutrition in the form of breast milk and/or infant formula. You may need to make changes from breast feeding to Neocate, or from another formula to Neocate, due to cow milk or food allergies and related symptoms, or you may need to add Neocate to an elimination diet.
Any transition to a new formula, like Neocate, can present challenges. Many parents come to us with questions about the taste of Neocate. Infants, especially older infants, can have trouble changing to a formula with a different taste and consistency to what they're used to. We can't provide medical advice, so the first and most important thing to do is to talk to your healthcare team! We've got a great resource, below, but here are a few points:
Some feeding specialists and pediatricians often recommend sticking with the straight Neocate - it depends on the clinician - it often is just a matter of time for many infants to adjust to Neocate's taste. Like the unfamiliar taste of a new vegetable, it can take up to 15-20 times before they get used to the new taste of Neocate.
We can’t provide recommendations for changing the flavor of Neocate Infant DHA/ARA – formula manufacturers are prohibited from flavoring or artificially sweetening infant formulas. It’s best to discuss with your child’s healthcare team to see if they have recommendations.
Some clinicians make recommendations for changing the taste of the formula, but we cannot recommend this. Again please discuss with your healthcare team.
When it's necessary to supplement breast milk with Neocate Infant DHA/ARA, many parents see success when they express breast milk, mix it with prepared Neocate according to the healthcare professional's instructions, and feed the infant using a bottle. That way the “taste” and feeding method are consistent between feedings. A baby may be more likely to refuse the bottle if she goes back and forth from breast to bottle feeding, especially if the bottle feeds are only Neocate Infant DHA/ARA.
Because parents come up with lots of questions for these transition scenarios, we have worked with a Feeding Specialist in developing helpful tips to use in these transition situations. You can find two printable, 2-page documents with helpful tips titled ‘A Guide to Transitioning to Neocate’ and ‘Feeding Tips for a Successful Transition’ on this page of helpful resources.
The key strategy for many transitions is a process called 'fading.' Fading involves adding the new formula (Neocate) to the old one in increasing amounts over time. It's important to talk to your LO's healthcare team to see if they recommend fading, and if it might work for you. (Sometimes, especially if food allergy symptoms are challenging, they may not want you to keep the old formula in your baby's diet.) Here are some of the highlights:
First, remember that schedules and routines are important when embarking on a transition. Keeping consistent with these will have an impact on your success. Be patient and relax.
The overall goal is to have your child accept the new combination as they work their way into the overall change. This might require lessening the first amount of Neocate that’s introduced, however; try to avoid returning to 100% of the previous product.
Transition times will vary between children. Some may readily accept the new combination while others may require more time. The goal is to move forward with success even if the pace is very gradual.
Transitions can impact the digestive system and can be marked by changes in body outputs- stools, gas and spit-up. These might be something new, or changes to existing habits. See our FAQs page and read the ‘What you may see’ entry for more details.
If changes feel a little too unsettling, talk to your healthcare provider or ask them to refer you to a Feeding Specialist.
Below are links to further posts from our Food Allergy Living blog that address transitions.
As always, if you have questions about using Neocate products, please give our Nutrition Services team a call at 1-800-365-7354, Mo-Fr, 8:30am-5:00pm, EST. We can't give medical advice, but we can answer your questions about using the products!
What tips have you found helpful in your transition?
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.
Our guest blog today comes from Alexia Beauregard. Alexia is a food allergy specialist dietitian who also specializes in eating and feeding disturbances and is based in Greenville, South Carolina. She loves working with food allergy families to help make food fun again. Alexia believes that eating should be one of the basic joys in life and wants everyone to be able to enjoy whatever foods they can. She works with families in an outpatient setting and also teaches college courses. Her professional organization memberships include the American Academy of Allergy, Asthma and Immunology (AAAAI), American College of Allergy, Asthma and Immunology (ACAAI), the Council for Pediatric Nutrition Professionals (CPNP), and the International Network for Diet and Nutrition in Allergy (INDANA). She speaks regularly at conferences for medical professionals and for families. You can find her on her Facebook page www.facebook.com/thrivewithfoodallergy or in her private practice--Seagrass Nutrition & Therapy (www.seagrassnutrition.com). Her three children and husband keep her pretty busy at home. The Beauregards love sailing, biking, hiking, and just being outside in general. As a family, they are very active in sea turtle conservation and believe in conservation through education on the importance of preserving marine life habitat. You can often find them enjoying the beaches of South Carolina.
1. You can start getting ready to implement the full elimination diet gradually
You do not have to run to the grocery immediately following the appointment in which you are told to avoid milk, wheat, and soy (for example) to try to find alternative products. You have time to process that information and figure out how to make it work. It is important to determine what foods your child relies on the most for calories, protein, vitamins and minerals and what substitutes are available. As with any diet change, slow and steady wins the race. Pick one or two foods at a time that you are going to change and experiment with alternative allowable foods. Try new cooking techniques. Also, take this time to inform school, daycare and anyone that may be involved in feeding your child about these dietary changes. The important thing to remember is that you or your child needs to be on your full elimination diet for at least 8 weeks before getting another endoscopy to determine if diet therapy is helping. The faster you begin to implement the full elimination diet, the faster you can start the countdown to your next endoscopy, and the faster you may be able to expand your diet again.
2. It will take more time
Be prepared to spend more time finding and preparing foods. The good news is that once you find your set “go to” foods at your usual grocery store or a grocery store new to you, the amount of time required will decrease. Commit the time to finding as many alternative allowable foods as you can at the beginning of your elimination diet period. It will take more time to plan for travel or even going out to dinner on a Friday night. Remember, that this time is an investment in your or your child’s safety and can help prevent accidental exposure. It is heartbreaking to hear stories of a family that is 6 weeks into their 8 week elimination diet only to learn that they included a food that had milk in it because they did not take the time to fully read a food label. When this happens, the elimination diet clock has to start over. Time spent finding and preparing allowable food is time well spent.
3. You can select the start date
You and your doctor agree that your child should start an elimination diet to determine if that will help reduce their EoE symptoms. It’s September and all you can think about is Halloween, Thanksgiving, and Christmas and how to manage this diet around the holidays. I tell the families I work with to pick an 8-week time frame when they know they will have the highest likelihood for success. Some families may choose to use medication until they start their diet while others want to jump in and think of a milk free and wheat free Thanksgiving as a good challenge. However you feel about the diet, pick a time to implement the diet when you know you can be successful.
4. It does not have to cost more
Yes, alternative products such as wheat free bread are more expensive. That is an undeniable fact. But, the diet does not have to include bread made from specialty flours. Think outside the sandwich when it comes to lunch. Single ingredient whole foods (think whole chicken) actually costs less per pound then chicken already cut up and sold in marinade. Grocery stores will charge more for items in which they do most of the prep work. Single ingredient foods are going to be a safer choice by decreasing the risk of accidental exposure to foods/ingredients that need to be avoided. Utilize websites like amazon.com or vitacost.com for some alternative products. Some families have found that purchasing other staple household items online is cheaper and provides more money in their budget for food items that may be more expensive. Get creative with how you shop and meal plan. Remember point #2…it will take more time at first.
5. You are not alone
Any medical diagnosis can feel very isolating for the person with the illness or for the entire family. The good news is that in our highly connected and wired world it has never been easier to find people to connect with that are living with a similar situation. Organizations such as APFED have a tremendous amount of valuable information on their website to not only manage an elimination diet but can also help find a local support group. Other websites like Inspire can help connect you with other EoE families in an online community. Families that have done an elimination diet in some form or fashion are a great source of information about products, restaurants, hotels, and finding food free activities. This is a hard diet but it can be done. Find support to help make this challenging time a little bit easier for your family. EoE is not something that a family has to endure alone.
6. You or your child may not feel any differently
The truth is that you or your child may not feel any differently on this diet. Some EoE patients have very pronounced symptoms and feel much better when they avoid their trigger foods. Some people have much more subtle symptoms and may not feel any differently on this diet. Even in the absence of symptoms, it is important to follow the elimination diet. Remember, the goal of this diet is to prevent damaging inflammation in your esophagus and find the foods that cause the body to react in this way. The goal is to avoid those EoE symptoms that may occur both inside and outside the esophagus, and avoiding trigger foods is one way to do that.
Alexia Beauregard is a Registered Dietitian. The inspiration for this blog is based on her extensive experience working with the families of patients diagnosed with EoE. Please be sure to talk to members of your child’s healthcare team to determine if this information is appropriate for your child.
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.