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Elimination Diets & Breastfeeding

Apr13

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Today’s Bounce Back topic is brought to you by the Misdirected Googlers who erroneously end up at my blog after searching for “list of foods can’t eat while breastfeeding” or “is it safe to eat (insert some junk food I ate a lot of while pregnant) while breastfeeding.”

The answer to that last question is almost always yes. A nursing mother’s list of dietary don’ts is much smaller than the pregnancy list — in fact, other than excessive mercury, caffeine and alcohol, you really can eat and drink ANYTHING you want. YAY! And while we all probably know someone who put herself on a strict elimination diet while breastfeeding in an attempt to isolate food allergies or sensitivities in her newborn, the truth is that this is thankfully very rare. Most babies have no problem with anything related to mom’s diet, and even if they DO, it’s a short-lived, temporary bout of fussiness and does NOT require you to swear off whatever category of food you ate for dinner after one long night of fussiness and gas and spitting up.

I had nights like this, though: when Noah was brand-new I noticed that he became very irritable and gassy and urp-y after I drank a few glasses of orange juice. (That was me trying to be all healthy.) He didn’t sleep a wink that night. Ezra had a similar experience after my mother-in-law made the most bracing, acidic tomato soup I have ever tried to choke down in my life. I ate just enough to be polite and we both suffered for it that night.

But neither of my babies actually had any type of allergy or REAL sensitivity to orange juice or tomatoes or even acidic foods in general. It was more of a first-time fluke when they were very tiny. I thought, with Noah, that even one instance of a possible food problem meant I needed to swear off of it completely, so I did. By the time I had Ezra, I knew better and went on to enjoy lots of spicy or acidic foods later on, once his tummy was a bit more mature.
I knew better the second time because I read this article from kellymom.com about the difference between an allergy, a sensitivity and a total false alarm. And also this one, about the (incredibly persistent) idea that a baby’s gas always stems from What Mom Ate. It doesn’t! It just flat-out doesn’t.

All of this is to mostly just say: DON’T PANIC. Don’t rush to blame a fussy baby on yourself and a late-night indulgence of some chips and salsa. And don’t immediately think you need to choose between breastfeeding and a severely limited diet because of a seemingly-connected bad reaction really early on. MOST babies are just fine with everything you eat. And of the ones that aren’t, MOST babies will very quickly outgrow their sensitivities.

A “sensitivity” to something in your diet usually entails excessive spit-up, colic (hours and hours of unexplained crying), rashes, and nasal/sinus congestion. If the symptoms don’t seem to go away on their own, eliminating suspect foods can help, although kellymom recommends reintroducing the foods back into your diet after a few weeks or months (depending on *how bad* that initial reaction was). Many mothers find that a little digestive maturity on the part of their baby and maybe a little more moderation from them usually solves the problem on its own.

Now, if it’s an actual allergy, generally you’ll know, because it’s a LOT more than plain old fussiness and gas: you’ll see things like a rash, hives, eczema, sore bottom, dry skin, wheezing or asthma, congestion or cold-like symptoms, red, itchy eyes; ear infections, irritability, fussiness, colic, intestinal upsets, vomiting, constipation and/or diarrhea, or green stools with mucus or blood. Awesome. Dairy products are the most common allergic culprits, and anything that you or a family member are also allergic to, but still are rare.

So if you’re new to breastfeeding, don’t feel like you need to treat cow’s milk like the new peanuts and swear off it “just to be safe.” (And yes, I met a mother who did exactly that and basically eliminated everything that she’d heard kids might be allergic to [milk, eggs, nuts, soy, etc.] while nursing. No, there was no extensive history of food allergies in her family, she was just sort of crazy.)

If you still think there’s a problem, be sure to read EVERY WORD of the kellymom article, because it’s really helpful, particularly if you’re trying to figure out just what you need to eliminate. (For example: milk protein sensitivities are not lactose intolerance, though it’s a common misconception that switching to a lactose-free milk will solve the problem.) Even if you haven’t noticed any problems with your baby, it’ll provide good ammunition for the first time someone tries to chide you in public for eating spicy foods with an extra helping of garlic.

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About the author

Amalah

http://www.amalah.com
Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy's daily mothering adventures at Amalah. Also, it's pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.


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18 Responses to “Elimination Diets & Breastfeeding”

  1. Courtney Apr 13 at 11:43 am Reply Reply

    Sadly, my baby’s sensitivity seems to be with caffeine. Since there *are* issues with migraine medications and breastfeeding, I self-medicated with an espresso drink from Starbucks at about 5:00 one night. The poor guy was up all night, thrashing around – clearly tired, but not able to sleep that well.
    A month or two later, I tried again – this time a half-caf, a good eight hours before bedtime. Same result. Sad news for me!
    The good news is that I did find out Imitrex is OK with breastfeeding – you can’t nurse for 12 hours after taking it, but that’s better than a lot of the other options (or taking nothing at all).

  2. Angela Apr 13 at 1:16 pm Reply Reply

    My daughter was definitely sensitive to me eating dairy; she would spit up like crazy after I ate pizza or mac and cheese or whatever. No other symptoms, just excessive spitup, which went away when I stopped eating dairy. So I mostly stopped eating it, but would try it every month or so to see if she had gotten over it. Finally when she was 6 or 7 months old she didn’t react any more. Thank goodness, because parenting a newborn was hard enough without having to avoid ice cream.

  3. Julia Apr 13 at 3:31 pm Reply Reply

    This is such good, sensible advice. I’ve always eaten everything while breastfeeding my babies with nary a problem, and I think most mother/baby duos fall into this category. There is so much anxiety and fear-mongering about what nursing moms can eat and I think it contributes to this idea that breastfeeding is not compatible with regular old life, which for most human beings out there it totally is. I know the allergies and sensitivities out there are real and I am so glad we can figure out ways to deal with them, but I feel like it is much more rare than people think.

  4. Caitlyn Apr 13 at 9:37 pm Reply Reply

    my baby does seem to be sensitive to tree nuts – we got a few days of extra fussiness and spitting up on two separate occasions – one after i made granola, and one after i bought a jar of granola. maybe i’ll try them again in a few months.

  5. Kate Apr 14 at 7:12 am Reply Reply

    I have a ton of food allergies, and my doctor continuously points out that it’s the tendancy to be allergic, not the specific allergy, that is passed on. For instance, I have a soy allergy, but my son can eat soy all day long and be fine. I, on the other hand, can eat eggs–and those cause him to break out in welts.
    I was also listening to an article on NPR that discussed why some kids grow out of their allergies and some do not. If you do discover that your child has an allergy, many pediatricians recommend that you don’t rechallenge again until the age of 3; in fact, consistently rechallenging every few weeks or months can actually make the allergy worse. Give the kid’s system a chance to grow up and see if they grow out of it (but know they might not).
    You can also have your child tested for food allergies, but it’s important to remember that unlike pollen or mold allergies, these tests often give false negatives. Food allergies are hard to test because the child may not be allergic to the food itself, but instead allergic to whatever the food is broken down into during digestion. So even though your child comes away with a clean slate on a food allergy test, if you notice a pattern of rashes, hives, runny nose, etc., whenever they eat a certain food–have them stop that food.

  6. Olivia Apr 15 at 8:32 am Reply Reply

    Great advice, and I’m sure a few new mothers will breath a sigh of relief after reading this.
    With no history or allergies or food sensitivities for me or my husband, I have eaten anything I’ve wanted while breastfeeding. Maybe some of my baby’s spitting up could have been lessened if I eliminated some foods, but I never took the time to try it. Now that she is a year old, she favors spicy (and I mean quite hot) foods, over blander dishes.

  7. ReeCh Apr 15 at 2:27 pm Reply Reply

    Re: the Imitrex comment. Two different pediatricians have OK’d me taking Imitrex and breastfeeding with no wait period. (Never heard of having a wait period.) So check with your own doctor first before stopping breastfeeding because of Imitrex. Cuz taking care of two infants with a migraine SUCKS!

  8. Kim Apr 16 at 3:23 pm Reply Reply

    And sometimes babies just can’t handle their mother’s milk. I eliminated everything, and still, no dice, he can’t handle it. Trust me, I tried and tried and TRIED, but it makes him miserable. I’m still pumping with the hope he will eventually be able to digest my milk, but for the foreseeable future, he’s on soy formula.

  9. Mouse Apr 16 at 6:19 pm Reply Reply

    I’m off wheat anyway for my own sensitivity. Now I’ve taken out nuts and am slowly reintroducing dairy–OK with some yogurt, not with larger amounts of milk protein. Will try nuts again after the milk reaction abates. It’s a pain to eat around these ingredients, but I didn’t change my diet with our first son, and there were some really bad nights with the colic. I prefer the less screaming this time around.

  10. Natalie Apr 17 at 7:59 am Reply Reply

    Unfortunately, my little girl falls into that very rare category. She is intolerant to both dairy and soy. If I eat even the smallest bite it is followed by extreme gas and green, mucousy, bloody stools. I really needed to read this article though, because her intolerance has led to me going through phases of extreme paranoia about everything that I eat. I just hope that if we are blessed with another baby he or she doesn’t have the same issues. I don’t know if I can do another year of this. It isn’t so much the giving up of food I mind, it is the paranoia.

  11. Jen Apr 17 at 4:42 pm Reply Reply

    Great article! I think we all have a tendency in the early days to assume that every little baby reaction MUST be the result of some Mom action.

  12. a Apr 18 at 5:30 pm Reply Reply

    Thanks for this. It’s challenging enough trying to maintain weight and nutrition while caring for a new baby; the elimination diet thing just makes it harder by putting everything tasty and convenient off-limits. Don’t make things harder on yourself “just in case”– the best mom is a well-fed mom!

  13. Crystal Apr 19 at 12:42 am Reply Reply

    I’d like to STRONGLY encourage any mom who thinks their baby has a food allergy to take them to a pediatric gastroenterologist. They can perform a one minute re-agent test on a poop diaper to see if there is microscopic blood in the stool…the biggest indicator that something is a genuine food allergy. They can help you figure out what the right course of action is for you and your family.
    Now, I live in a city with world class hospitals and schools (Boston) so just in the hospital we’re affiliated with there were at least 10 pedi GI docs to pick from…all within a 20 to 30 minute drive. I know this isn’t the case for everyone, but if it is a possibility it will save everyone a lot of time and effort.
    The four most common food allergies are
    1–Dairy
    2–Egg
    3–Nuts
    4–Soy
    My daughter was always a problem feeder…and they diagnosed her with reflux.
    But she didn’t gain weight…which made a food allergy a more likely cause (real food allergies often cause Failure to Thrive conditions). We hadn’t thought of it before because there were no rashes, no visible blood in her stool, none of the more common signs that weren’t otherwise “reflux” signs.
    But when they did the re-agent test, it was clear that we were dealing with a food allergy.
    First I cut dairy…but there wasn’t an improvement. So I was told to cut all four of the most common allergens from my diet. I couldn’t do it. Cutting dairy had already made me miserable (do you KNOW how many foods have dairy…stuff you would NEVER think of…mcdonald’s french fries among them) AND I’d lost some supply (I was pumping because of other issues).
    It was too much. So I stopped giving Elanor my milk.
    The first formula we tried didn’t cut it. She ended up on an all amino acids formula for 6 months.
    BUT…just because you DO have a food allergy at 5/6 months does NOT mean it’s forever. At a year we started introducing the allergens and it’s been totally fine. We were supposed to wait until she was 3 to introduce nuts, but she got into peanut butter multiple times and nothing happened (as a side note we always had benadryl in the house and knew the dosage at any given moment in case of an allergic reaction) and she has been now certified food allergy free.
    But, yeah…to get back to my original point..there are docs who can help you solve the mystery and not make yourself unnecessarily miserable food-wise. If you can, I encourage you to see one.

  14. Courtney Apr 20 at 8:48 am Reply Reply

    @ReeCh – thanks for the info! I will have to look into this more. I would love to be able to take the medicine and forget about it (instead of pumping and dumping and using up some of my stash to get through the 12-hour waiting period).

  15. Melissa Apr 20 at 9:40 pm Reply Reply

    My experience has been the opposite of this column. I know 5 babies born in the last month, and 3 of them have sensitivities. All of them to dairy, and one of the three to a few other things as well.
    Originally I’d have agreed with Amalah, that this is overblown. But when my son was two months old, I mentioned to our pediatrician that he seemed to have really loose stools every other day or so. She suggested trying to cut out dairy, just to see how it went. I thought it was unlikely, given that his symptoms were so mild (and it wasn’t the green, musousy stools I’d heard about, or blood in the stools) and since I have zero food allergies, but I tried it anyway. It did seem to clear up, but again, I thought probably just coincidence. When I stopped BFing, the pediatrician said to go ahead and try regular formula, which would give a clear indication of whether or not he had a dairy allergy and then we’d know for sure if the special formulas (which taste and smell gross and are very expensive) were necessary. He threw up three times that night (and we’re talking full on throwing up, not spitting up). So …. yeah, dairy allergy.
    And I wish I’d figured this out earlier, because now all of the milk I pumped and froze those first two months is completely useless.

  16. Stephanie Jan 27 at 10:27 pm Reply Reply

    I dreamed of being one of those breastfeeding mothers who downed whatever she wanted without feeling guilty. Sadly, this has not been my experience. My baby is has an extreme dairy and soy intolerance as well as egg. I went of dairy in the first few weeks. It helped a little but baby was still up ALL NIGHT every night screaming, writhing and arching her back. She took 20-30 minute naps. When I was ready to throw myself off a cliff someone told me that most babies who are sensitive to dairy are also sensitive to soy. Since cutting soy out, I have a different baby. She sleeps. She wakes up happy. She doesn’t have man-sized toots. Her intestines aren’t bleeding. It’s been a long hard road to get where we are but at 11 months I think we are figuring this all out. This article is helpful to the average mom with the average baby, but may be misleading to families with serious food allergies and sensitivities. As a side note, half her cousins are milk intolerant as well.

  17. Katherine Jun 01 at 2:45 pm Reply Reply

    My first baby had colic. He also had loose rust colored stools, despite being breastfed. I eliminated dairy to help with his supposed acid reflux and it was like magic.  New baby. No colic. Normal poops. We figured out it was the protein, not the lactose that he had a problem with, which is more of a pain to avoid. When he was about 18 months I carefully reintroduced dairy. I made clarified butter, since no lactose or milk protein, and cooked foods with that. Then I let him have little bits of yogurt.  Then cheese, etc.. Now he can eat dairy, but doesn’t really have a taste for it. He did, however, like coconut milk and I did breastfeed him until he was 20 months old, so I am not concerned about him not drinking the recommended cow’s milk until he was two. I currently have a  6 week old and she she has a little gas, but seems to tolerate anything I eat. Sure, some things can make her more gassy than others, but her poops are normal, plentiful and she is packing on the pounds. My son had a food allergy he seemingly outgrew and my daughter, so far, doesn’t.
     

  18. Shannon Jun 20 at 3:23 pm Reply Reply

    I’m one of those moms who stumbled upon this article while googling elimination diet – HA!  I was fortunate enough to breastfeed my first two children with no issues at all.  Then my third came along – showed up three weeks early (i.e. immature digestive system), her father is different from my other children and has a family history of food allergies, and so on.  After four weeks of being completely clueless as to why our child screamed at the top of her lungs for six or more hours a day, wasn’t gaining any weight, and so on – I finally decided to try eliminating dairy.  Because of articles similar to this one, I was reluctant to even try, believing the implication that it’s basically “impossible” for the baby to be allergic – but it wasn’t going to actually hurt anything to cut dairy from my diet, so I tried it.  And it worked.  Within a day there was a huge improvement and over the next few weeks, she improved even more.  If there was any doubt, it was eliminated the one time I had a tiny sprinkle of parmesan cheese and she was sick again for three days straight.

    The difference between us and all those other people who mythically believe their baby has an allergy is that we had multiple symptoms.  In addition to the colic and severe gas (as if they aren’t bad enough), our baby had diarrhea, congestion/cold-like symptoms, hives for about an hour after nursing, and green poop with mucous.  I’m going to blog about our experience with allergies in breastfed babies to throw a few articles about the “other side” (those who actually do have a food allergy) out there into the google search pool.  I really, really, really wish I had found more “positive” information that encouraged trying an elimination diet (at least in those who have several symptoms).  

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