Is Your Baby Food Sensitive?
It is a joy for parents to have a normal healthy baby. Unfortunately not everyone is so lucky. Some parents have to cope with a baby who seems distressed, cries often, or is obviously unwell. With many people talking about allergies and food intolerance, it is not surprising for parents to ask themselves if their baby is food sensitive.
What symptoms do food sensitive babies get?
Food may be a factor in diarrhoea, tummy pain, irritability, difficulty settling, poor feeding, sleeplessness, and excessive activity, as well as in eczema, asthma, sinus, and even reflux.
Which babies are most likely to be sensitive?
Those babies most likely to be food sensitive are in families with others who have allergic-type symptoms. These symptoms do not need to be reactions to specific foods - it is merely the presence of such symptoms that makes food-sensitivity much more likely. If anyone in the family has or had eczema, migraine, irritable bowel syndrome, hayfever, asthma, hives, or has a known reaction to a food, the chances are significantly increased that food-sensitvity may be a factor.
When should I consider if my child is food sensitive?
Some of these problems are part of the normal ups and downs of infancy. There are very few babies who sleep like angels, and never seem restless or irritable! However, when such symptoms are causing the baby or the family a certain amount of distress, and have been present for some time, then it is worth the effort to find out if there is a solution.
If a problem is significant, the first port of call should naturally be the family doctor. It can be a wonderful relief if investigations are made, and you are told that there is no major medical condition present. However, you will still want help in addressing the problem symptom itself. An investigation of food sensitivity may well prove helpful.
Alternatively, the baby may suffer from a mild case of several of the above symptoms. There may be some colic and irritability, a little trouble with the baby not settling and not sleeping well, and getting an occasional rash. While you may not feel the baby's discomfort demands medical investigation, you may still wonder if the baby's comfort or sleeping habits may be improved. Ask other mothers you know for tips and talk to your child health nurse. Again, in this case, diet-investigation may prove beneficial.
How does food-sensitivity show?
Sometimes food-sensitivity shows clearly. Since babies usually have cow's milk and other foods introduced one at a time, a child who has a clear reaction closely connected to a new whole food can be helped quickly. Alternatively, a child who is given a paediatric syrup and reacts badly may also prove easy to assist (though such reactions are sometimes attributed to whatever problem the paediatric syrup was supposed to fix!).
Generally however, sensitivity is less than obvious, because many babies do not react until several days after the problem food has been introduced, or when there is a built up to a certain threshold from different problem foods. In these cases food-sensitivity can be detected through a process of elimination of many suspect foods and subsequent re-introduction.
What can be done if you decide food-sensitivity may be present?
Once the presence of food sensitivity seems possible, it is wise to keep a written record of symptoms and foods introduced with the baby's age. It becomes difficult to remember events later, especially as progress is often complicated by other happenings in the family. This information on changes in food and symptoms provide leads in what I call "diet detective work", so professionals can begin to clarify what substances to check on, and you will feel more secure in your request to investigate food sensitivity.
Now is the time when the serious detective work can begin. Your doctor may suggest a dietitian who will help you design an initial "family detective diet" of minimally suspect foods to see if diet is involved in baby's problems. Or, if you feel confident working on your own, you can purchase my book, "Are you food sensitive?", which outlines the process in a detailed, step-by-step fashion, and has sections referring specifically to food-sensitivity in babies. You will find the detective work will get broader as you learn to watch out, not only for foods, but for smells, flavoured or coloured medications or vitamins, and other factors.
Sometimes well-meaning relations, friends and professionals imply that you should not consider food sensitivity, as they think it is just an idea that is fashionable but without substance. This is not true! If you think your baby may be food sensitive do persist. Or if you know someone who would like to investigate diet in their baby do support them.
The Family Detective Diet:
Diet therapy is not just having general information on a sheet of paper. You need professional help in the confusing area of replacing one food with another, and in planning what exactly to eat in the family, especially as food sensitive babies are individuals and can be very fussy eaters. Sometimes it is necessary to completely exclude foods, but fortunately the intake of some foods may just need decreasing. Small amounts of these decreased foods, with the freely allowed foods, can give sufficient variety. Once your baby has been on the "family detective diet" for four weeks, and the symptoms have decreased, diet therapy emphasises gradual reintroduction of low risk foods over the oncoming months. As important as the initial step of finding out that baby is food-sensitive, this step is equally significant, as carefully controlled and monitored reintroduction of foods can ensure that baby is on the least strict diet possible. In this way the family can be sure that they are not going to a lot of effort to totally exclude a food, when it might be managed in small doses, or when it is cooked a certain way. If diet does not appear to have made any difference reintroduce all excluded foods and additives for seven full days to clarify if diet has no role.
The Total Body Load:
The addition of additives and suspect whole foods to environmental factors, creates a "total body load". When all are reduced sufficiently to decrease symptoms they can gradually be reintroduced. The diet may need to be used more strictly in Spring when coping with pollen, or when teething or infections are present. On the bright side the diet can be relaxed when such factors are not present.
Smells that may be problematic include all perfumes such as those in laundry items, air fresheners, and perfumed insect repellents, as well as paint, varnish or petrol, in fact, anything which smells, even natural flowers and herbs.
Medications for babies are usually given as syrups which are usually coloured and flavoured. Of course the illness producing the need for the medication can make baby irritable, but it is important to report any additional changes to your doctor after medication is begun. Also note in your 'detective book' whether changes coincided with overtiredness, changes in weather, or stress in the family. One way to look at food sensitivity is to consider that food may be an aggravating factor in the child's environment, so if stress is present, diet and family stress may both need to be addressed.
The Diet changes over time:
Food-sensitivity does change over time, especially in the first years. The good news is that tolerance usually increases with age! It is good to see two to three year olds tolerating carefully controlled amounts of food that did produce adverse symptoms in infancy. On the other hand, sometimes the problem food can remain the same, but the type of symptom aggravated can change. Many mothers who come for diet investigation when there are concentration problems in a school age child, having put up with behavioural problems in preschool, ear aches as a toddler, and colic in infancy, say how they wish they had known that they could have begun investigation several years earlier.
Remember: in food-sensitive people, diet aggravates the underlying tenancy. If diet investigations are begun in infancy when reactions are clearer, the family can learn what foods the child manages. Too many mothers are told the baby "will grow out of it" when diet would have greatly decreased the inital problem, and then been important in later years.
What if baby is not getting enough to eat?
A natural concern of most parents when beginning investigation for food sensitivity is ensuring that baby is still well fed. In the effort to find out what is causing a problem it is easy to look mostly at what should be excluded and not notice sufficiently what is left in. Sometimes families become more and more worried about foods until there are very few left. If this occurs, we then have the problem that baby is even more distressed because of hunger. With professional help this need never occur, as there are always alternative foods to be found, and small amounts of problem foods are often tolerated with specific cooking methods.
Since milk is so important, especially in the first six months, it deserves special consideration. Milk should always be considered as suspect if at any time the baby, or a close relative has or had a reaction to it. It is also important to consider what solids may have been introduced into the baby's diet so that a milk is not blamed for the symptoms when they may be due to some other food.
Breast-feed if possible:
Just as we know that breastfed babies benefit from the variety of flavours that come through breast milk, food sensitive babies can have adverse reactions to those flavours and other chemicals. Allergens also come through breast milk. It is important to realize that a mother does not need to give up breastfeeding if her baby is distressed in some way. The solution is for Mum to go on an elimination diet suited to her. It is very important that professional help is used to ensure that Mum is eating well enough for her own needs, as well as for adequate milk production. All babies, especially distressed ones, are most helped by a caring mother who takes the time to look after herself and ensure she is not getting run down. Foods eaten can be gradually expanded first by Mum having advice about how she can trial foods via breast milk, and later by a planned introduction of solids for the baby.
Allergy to Cow's milk:
If you suspect your baby is sensitive to cow's milk, discuss your concerns with professionals before making any changes. Any cow's milk formula must be replaced with another suitable infant milk. Sometimes a change from one formula to another helps.
Use of Goat's milk:
Some mothers try goats milk using a goat milk formula, so the deficient folic-acid vitamin is replaced. The protein in goat's milk is not very different from cow's milk, so the adverse symptoms that occurred with cows milk often reappear around six weeks after use is begun. On the other hand if goat's milk formula is tolerated, then cow's milk can later be gradually reintroduced.
Lactose intolerance is a reaction to the milk sugar. This is different to a milk sensitivity. If lactose intolerance is suspected discuss this with your doctor. Note that lactose intolerance only produces gut symptoms.
There is a new infant formula recently available on the market: Nan from Nestle. It is a milk formula but the protein is partially broken down [hydrolysed]. Each baby is different. This formula may be very useful for some. Others may need to change to a completely different protein and trial a soy formula, and some will have to progress to a fully hydrolysed formula. A generation ago when there was no soy milk available, babies with symptoms on cows milk were given powdered milk, with some reduction in symptoms. This was because in those days powdered milk had been heated and this improved tolerance. Nan has been hydrolysed more than boiling achieves, and it is made as an infant formula, so is a new option to try.
Soy milk is the preferred option where the baby is allergic to cows milk. Soy milk should be given as an appropriate soy infant formula. A change to soy solves the problem for many infants.
Fully Hydrolysed milks:
Some babies are allergic to both dairy and soy. Do not despair! It is important to work with professionals in the "diet detective work". The baby can progress to a fully hydrolysed formula.
Vitamins and Minerals
Some people ask about the role of vitamins and minerals in food sensitivity. These nutrients can be supplied in a normal diet. Food sensitivity is not due to a deficiency of nutrients, so adding them in is not a solution. In fact it can become another confusing factor in the detective work of things which could be affecting baby, especially as most are flavoured. Also we are not sure that the usual vitamin doses are correct for food-sensitive babies.
When food-sensitivity exists, a change in the diet can seem like magic. But it is rarely an easy treatment. It takes time and effort to keep going over a long time, and it is not easy to cope with food being offered by well-intentioned relations and friends. However, so long as the problem symptoms are minimised, mothers report that the baby's increased comfort more than balances the additional effort. Sometimes parents forget how bad the situation used to be and relax the diet. It can be quite therapeutic for them to suddenly be reminded!
The general recommendations with regard to food sensitivity are:
- Do not exclude any food from a child's diet without good reason, preferably clarifying this with professional help;
- When you have had help planning an elimination diet take care to exclude all of the suspect foods for a full four-week period, so you have a good diet baseline from which to start trialling new foods;
- Remember diet detective work also includes the environment. Attention to the "total body load" may show when the diet needs to be more strictly adhered to and when it can be relaxed.
- You are unlucky if the exclusions have to be forever! Most babies improve in their tolerance. Seek professional help for continual new ideas and gradual broadening of the diet. Carefully managed reintroduction of low suspect foods can occur over time, so the diet can be as practical and easy as possible.
There is still much that is unknown about food sensitivity. Perhaps that is why it is so fascinating. Those working with food sensitive children can understand why food-sensitivity took so long to be recognized, and how different every child is. The problems may be solved easily, or you may benefit from help from professional help. If you suspect that your baby is food sensitive, go and talk to your health nurse, or doctor, and ring a dietitian. Some dietitians specialize in this area of diet therapy, so you can solve the problems faster. It is so good when symptoms improve!
Joan Breakey Dietitian / Nutritionist October 2001
Summary of a study of food tolerance in infants
Dietitian/Nutritionists: Joan Breakey and Kathryn Fergusson
There is an under-identified group of distressed infants who would benefit from dietary investigation. Research has shown clearly that infants and babies are the most likely group to exhibit strong reactions to certain food chemicals and whole foods. Infancy is a good time to investigate food, as families are used to the idea that they have to be careful with introducing foods to very young babies. A small change in food can make an immediate difference, and this can make food-sensitivity easier to spot. Unfortunately, this is not always the case! In some babies the symptoms may be caused by a gradual accumulation of suspect foods and food chemicals, and this can make it difficult to see which foods might be troubling the baby.
Although food-sensitivity generally becomes less acute with age, it is still very significant in the years of infancy, so diet can be an effective treatment of many different symptoms, from eczema, hives, diarrhoea, and colic, to irritability, sleep problems, hyperactivity and asthma.
Food-sensitivity is most likely to occur in children whose families have an atopic history (this means they have allergic symptoms - like hayfever, eczema or rashes). Therefore, for children in such families, who have any of the above symptoms, investigation of food-sensitivity is an important avenue for treatment.
This paper is a report on a study dealing with food-sensitivity in infants. The aim of the study was to find what foods were best tolerated by young, food-sensitive children. It shows the importance of finding a tolerated milk, understanding what whole foods to consider from the family sensitivity history, and which additives and natural chemicals to consider. It also outlines important environmental factors that may affect sensitivity. The results of the study reinforce the dietary investigation process for babies outlined in Chapter 8 of my book "Are you food sensitive?"
Aim of the study
To provide detail on foods most likely to be tolerated by young food-sensitive children.
Sample - Sixteen children, ten boys and six girls, from nine months to four years, comprised all children under age four (average age twenty-three months) seen by a specialist dietician in private practise over the course of twelve months. All sixteen children presented with a variety of distressing symptoms which had responded to an individual elimination diet.
- Diet was used to investigate a variety of symptoms including irritability, colic, vomiting, diarrhoea, eczema, hives, rashes, sleep problems, and asthma.
- Most children had more than one symptom at presentation. The mothers had had appropriate medical investigation and had often been told that "the baby would grow out of the symptoms", but it had not.
-The study focussed on foods tolerated by the children, as they reintroduced foods one at a time. Foods to be reintroduced were those already suspected might be tolerated. For instance, pear and mango were reintroduced to the diet, rather than high-risk fruits such as apples or tomatoes, which are well-known problems for food-sensitive children.
- Description of the diet - The diet excluded additive colour, flavour and preservatives, natural salicylates and amines, and natural and added monosodium glutamate. It also limited or excluded any whole foods [such as dairy or wheat] known or suspected of producing reactions in the family. As well as foods, environmental factors suspected of causing reactions in individual families were also minimised. These factors included smells, perfumes and perfumed products, contact dye on skin, and inhalant allergens.The full detail of the diet is available in the book 'Are you food sensitive?'
Data collection - all mothers were sent
questionnaires requesting detailed information on foods their
infants did, or did not, react to.
Analysis - Statistical tests were used to see if there were any relationship between tolerances and other factors.
All parents returned the questionnaire. Following is a summary of foods tolerated in the sixteen young food sensitive children. Note that where a food is noted as tolerated in a certain proportion, the percentage given applies only to those children who tried that food. Most important foods were trialed by the majority of respondents.
Breast milk was always tolerated when the mother was using her elimination diet. Where the baby was no longer being breast-fed, pre-digested milks were well tolerated in those intolerant to both cow and soy milks. Soy milk was tolerated by a quarter of respondents, while cow's milk was fully tolerated by only an eighth.
Other protein foods
It was not necessary to exclude all the whole foods commonly implicated in allergy, such as milk, soy, wheat, fish, peanut and other nuts. A useful guide to which whole foods should be minimised or excluded was found to be intolerance in the infant as well as intolerance in any first degree relative, (that is brothers and sisters, parents, aunts and uncles and grandparents). Chicken, turkey, lamb, veal and beef were tolerated in most. Fresh pork and fish were tolerated in half the children. Shell-fish were suspect in about three-quarters. Eggs were suspect in nine of the fourteen children who tried them, but well tolerated in the other five. Peanut butter was similar; suspect in seven and tolerated in six.
Fats Dairy free Nuttalex margarine was well tolerated.
Fruit Fruit was not well tolerated. Peeled pear and Nashi fruit were the only fruit tolerated by over ninety per cent of respondents. Mango, pawpaw and just-ripe banana were tolerated by three-quarters of the group.
Vegetables Well-cooked peeled potato was well tolerated. Mild carrots [baby carrots and those that taste well when raw] and butternut pumpkin were tolerated in almost three-quarters of the children. Just-ripe broccoli, peas [no mint] and choko were tolerated in half.
Medicines Almost all children reacted to flavoured paediatric syrups. Note that paediatric syrups have fifteen times the amount of flavour as colour, so exclusion of colour does not decrease reactions.
Environmental factors As well as reacting to foods and food factors, most infants reacted to environmental factors. Over sixty per cent of parents reported intolerance to perfumes, over seventy to perfumed soaps, and over half were sensitive to washing powders. Other factors also increased children's sensitivity, four in ten responded to windy days, flowers and/or high pollen plants, family stress made a difference in almost half the cases, and one third of parents reported that teething exacerbated symptoms.
Correlation between diet effort and amount of
There was a strong correlation between whether the mother felt the diet was manageable and worthwhile, and the degree of reduction in severity of the child's symptoms.
No infant was sensitive to whole foods only, or to natural or added chemicals only. Environmental factors were also important. All families need to attend to all factors at first so that distressing symptoms are relieved. Mothers feel confident when minimizing or excluding foods known to be a problem to some family member.
Finding a tolerated milk is the first priority. It is important for mothers to know that no baby reacts to the breast milk itself, but can be reacting to additives, natural chemicals, or allergens coming through the breast milk. Breastfeeding can continue if the mother is happy to go on the diet. Unfortunately some professionals feel this would be too much effort for the mother. Mothers should be given the choice, as breastfeeding has many benefits. (For more detailed information on finding a tolerated milk, see "Is your Baby Food Sensitive?" elsewhere on this site)
When managing food reintroduction in very food sensitive babies, foods should not be thought of as just "allowed" or "not allowed". The diet can be more liberal with regard to natural chemicals if foods are allowed with qualifications. For example "just ripe" bananas and broccoli, "mild" carrots and "mild" [butternut] pumpkin are generally well tolerated.
Where mild allergy to whole foods is present, foods are better tolerated if only used in small amounts, and well-cooked, e.g. eggs or dairy are better tolerated in home-made baked goods. Where severe reactions to whole foods are known, the mother is quite happy to be appropriately strict, and in these cases the food is completely excluded.
This study showed a correlation between the degree of reduction in the child's symptoms and the mother's positive attitude to diet. This shows the importance of lowering sufficient suspect foods at the first appointment so that symptoms do decrease and the mother can see sufficient return for her effort.
It is important to consider dietary investigation in any children who exhibit eczema, hives, diarrhoea, colic, irritability, sleep problems, hyperactivity and asthma. Infancy is an excellent time to investigate food-sensitivity. If intervention is delayed, there is a high likelihood that problems, in one form or another, will continue for many years, eventually necessitating dietary treatment.
Successful dietary treatment has three components:-
1. Lowering natural and additive chemicals; the diet need not be as restrictive as only "lamb, rice and pears", and can be expanded to include the mild-flavoured foods tolerated here - butternut pumpkin, mild carrots, just-ripe banana, dilute mango nectar, white sweet potato etc.
2. Individualisation of whole foods; whole foods such as milk, soy, eggs and fish should only be considered for elimination if they are thought to produce an adverse reaction in the infant or an immediate relation. Complete exclusion may not be necessary; limiting the amount of suspect foods, or cooking them well, may be enough;
3. Incorporation of environmental factors. That is, lower 'the total body load' of suspect food chemicals, additives, whole foods and environmental factors. This results in a broadly based, but less strict, individualised diet.
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This page was last updated on: 7 December 2001