Baby ProblemsElimination Diets

Breastfeeding a Baby with an Allergy or Food Intolerance

by Justine Deputy

With my background working as a nurse at The Birth Center and working with Balanced Breastfeeding, I was lucky to know the importance of planning to breastfeed. Through working with mamas and babies for over four years prior to having my own baby, I was able to pull my knowledge and experiences to help prepare for the postpartum period. My husband and I reviewed my notes and PowerPoints from the classes I had taught as well as information from Katie to make sure we were both up-to-date on what we needed to know. I am grateful I did not run into any major issues postpartum besides a brief period of sore nipples that quickly healed as I paid close attention to Warren’s latch.

Breastfeeding seemed to be going very well. A few weeks later, I switched Warren into his cloth diapers. Soon after, he started to get a very bad rash. I switched from cloth to disposable and tried using a couple different diaper creams, but the rash never fully went away. It would get better, but then get worse again. For weeks, I thought there was a problem with my wash routine. The cloth diapers were causing the rash. I hated my HE top loading washer and everything I found online said it could be difficult to find a good wash routine in that type of washer.

Then I started to notice the mucousy stools. At first, it was just some of them. Dairy intolerance crossed my mind, but I knew that for most people it probably isn’t something you ate. So I followed this great advice from Katie in one of her blogs:

When something odd happens…

 

The first time, take note and say, “Huh. That’s weird. It is probably a fluke.”

The second time, pay attention and look for trends: “I am going to watch closely to see if this happens again.”

The third time, seek help: “I had better call my pediatrician on this one.”

Okay, so maybe I waited more than three times, but I was eliminating other possibilities. I also try to avoid being stressed about anything that isn’t concrete, and he wasn’t showing any super concerning signs in the beginning (like blood in the stool). Eventually, though, all Warren’s poops were mucousy. Gross, I know, but I could put the poop between my thumb and forefinger and stretch it out without it breaking apart. That was when I was convinced that something was going on and that this wasn’t normal. Warren’s spit up was also very frothy, and fussiness coincided with the frothy spit up or mucousy stools. I also noticed the diaper rash occurred with the mucuosy stools whether he was in a disposable or a cloth. It wasn’t my wash routine!

I had mentioned the mucousy stools to the pediatrician once and she wasn’t concerned as it wasn’t frequent, but now that it was all the time and Warren seemed irritated, I scheduled an appointment. The pediatrician told me that Warren was allergic to milk, including my milk, and I would need to discontinue breastfeeding. I quickly responded, “Can’t I just take dairy out of my diet?” I was told that it wasn’t my diet, it was my milk. I was obviously bawling my eyes out. I am a crier on a good day, so you can imagine this was another level. The pediatrician gave me nutramigen formula (a special formula without allergens) and told me to feed formula and schedule an appointment with the GI department at AI.

Now, my number one piece of advice to anyone in any area of healthcare is this: IF IT DOESN’T SEEM RIGHT, GET A SECOND OPINION! After meeting and talking with Katie and reviewing the Academy of Breastfeeding Medicine’s (ABM) protocol on allergic proctocolitis I confirmed I did not need to discontinue breastfeeding; I could start with diet elimination. I confirmed this with the GI doctor as well.

Per the recommendation, I started by eliminating dairy, the most common allergen. After about three weeks I saw improvement, but Warren was still having issues. At that point dairy should have been fully out of my system, so I eliminated soy. The Academy of Breastfeeding Medicine (2011) recommends eliminating one allergen at a time for simplicity and the ability to identify the allergen causing the reaction. After a few more weeks of no dairy and soy, Warren’s symptoms were completely gone!

After six months of elimination and once baby is at least nine months of age, reintroduction can be attempted (Academy of Breastfeeding Medicine, 2011). If baby no longer has a reaction, the foods can now be included in the mother and baby’s diet. Most babies can tolerate the previous allergen after six months of elimination if the baby is at least nine months old (Academy of Breastfeeding Medicine, 2011).

Now, at 17 months, Warren and I are still dairy and soy free. We have attempted reintroduction, but they still have an effect on him. I had a dairy intolerance as a baby and my mom had to put me on a special formula, and as I got older dairy still never really agreed with me. So I am thinking the dairy free diet is good for me, too.

So here are my tips and tricks and the places I have found to eat over the past year or so. Honestly, I have gotten to the point where I don’t really miss anything thanks to finding substitutes with different recipes.

Eating In:

  • Butter: Ghee is clarified butter. It is free of both lactose and casein protein, and therefore an option even if you are avoiding all other dairy. Earth Balance has a dairy and soy free butter. It easily subs for butter whenever necessary. 
  • Cream: Coconut milk substitutes really well for any creamy item. Soup, whipped cream, etc.
  • Milk: We substitute unsweetened almond milk whenever anything calls for milk. We also use it in smoothies. I was never a milk drinker of just plain milk so I can’t attest to that. I do really like Califia Farms Chocolate Protein Almondmilk as a treat!
  • Ice Cream: Nada Moo has been my favorite. Luna’s and Larry’s Coconut Bliss is another great brand. Anything made with Cashews is also really good.
  • Yogurt: Forager makes a cashew yogurt that is amazing. Whole Foods just started carrying it recently and before that I hadn’t found one I liked enough to keep buying. Lavva is another new dairy free yogurt on the market!
  • Pizza: This gets its own category because I couldn’t live without it. We have pizza night once a week. We buy the dough at the grocery store and make them ourselves. The more toppings and flavors the better. My husband makes some amazing pizzas! Whole Foods also sells vegan slices and you can order a vegan pizza to go.
  • Cheeses: Miyoko, Kite Hill, and Treeline are a few brands of nut cheeses that I have tried that are delicious!

Eating Out:

  • Let the staff know you have an allergy or food intolerance. It makes them more aware. They often will change their gloves as soon as you say that.
  • Know that there is no guarantee of no cross-contamination. They do their best, but it is possible a little piece of something ends up in your food. You have to be okay with that possibility if eating out.
  • Bring food with you. I pack food everywhere we go: a bar, a PB&J sandwich, leftovers, basically anything we have. Otherwise, I will be hangry!
  • Parties: Potluck? Bring a hearty dish of something you can eat. I have also brought a whole plate of food or a sandwich or salad if I know there won’t be much I can eat.

Places to Eat:

  • Panera: Look at their menu online prior to going.
  • Chipotle: Everything is soy and dairy free except the obvious items (cheese, sour cream, tofu).
  • Honeygrow: Look online before, but the staff is knowledgeable, too.
  • Daily Veg: Everything they have is dairy free!
  • Talula’s Table: They always have at least one sandwich I can eat that doesn’t contain allergens.
  • MOD Pizza: Let them know that you have an allergy or food intolerance and they will take precautions to prevent contact with allergens. They said they do not use soy in their cooking; you can call to confirm about specific items.
  • Harvest Market Natural Foods: There are lots of to go items that are all labeled with ingredients!
  • Whole Foods: All hot bar and salad bar items are labeled and staff in other areas are knowledgeable.

Reference:

Academy of Breastfeeding Medicine. (2011). ABM clinical protocol #24: Allergic Proctocolitis in the exclusively breastfed infant. Retrieved from http://www.bfmed.org/Media/Files/Protocols/Protocol24_English_120211.pdf