Unplanned Reactions: allergy or intolerance in babies?

If a baby is unsettled and a poor sleeper, an allergy or intolerance to something in mum’s diet and passed on through breast milk could be the underlying cause, writes Joy Anderson.

Your baby is awake and crying again for another breastfeed! Even if carried all the time, he or she will still cry. Other babies, you know, don’t seem to be this demanding. How come you drew the short straw in the unsettled baby stakes?

Does this sound familiar? In some cases, these problems could be caused by what you eat. You don’t have to eat lots of ‘junk food’ and artificial additives for this to happen. Food intolerance can arise from eating the healthiest foods, such as dairy products, wheat, fruits, and vegetables.

Let me start by telling you about my difficult journey of discovery as a mother and then go on with what I have learned since.

When my firstborn was barely days old, I asked myself the question posed above – how come I drew the short straw in the unsettled baby stakes? My son had dreadful colic from day three of his life, all day, every day, for five full months. I was told it would stop in three months and felt very cheated when this didn’t happen. I had so desperately wanted this baby, yet now I wanted to ‘give him back’! He had suddenly made my life a living nightmare.

What I didn’t know at the time was that my baby’s misery (and mine!) was being caused by food intolerance, from substances in foods I was eating coming through my breast milk. I started to get a clue when I found that anything I ate containing cocoa made him even worse, starting 30 hours after I ate the food. However, even if I avoided cocoa, he still wasn’t ‘normal’.

I also had too much breast milk, caused by the frequent feeds my baby wanted due to his pain. He fed for the comfort of the sucking; I don’t think he ever got to the point of actually being hungry. He didn’t gain weight as normal and was not back to his birth weight at three weeks. He also had symptoms of lactose intolerance: very frequent bowel motions, often explosive.

I have since learned that there is a lot of confusion between lactose intolerance and food intolerance, especially when they occur in breastfed babies. Some people wrongly think that they are the same thing.

Some babies appear to have lactose intolerance but are putting on weight well. This simply means that they are getting too much breast milk. Often, mothers think they don’t have enough milk because the baby is so unsettled, but if the baby is having lots of bowel motions each day and passing urine more than about 10 times a day, this is oversupply.

If the baby appears to have lactose intolerance and is not putting on weight, this is usually caused by damage to the lining of the intestine, perhaps from a bout of gastroenteritis, a food allergy or food intolerance. Lactose intolerance just means that the baby doesn’t have enough of the enzyme needed to digest lactose, the sugar in milk. If this is caused by damage to the digestive tract, then the aim should be to find out what is causing the damage, not just to avoid lactose. Fix the cause of the damage, and the lactose intolerance will fix itself. Breastfed babies who show symptoms of lactose intolerance should always keep breastfeeding, except in the rare case where the baby is losing weight.

You may see now that a baby can have both food intolerance and lactose intolerance. This leads to more confusion if the baby is reacting to dairy products in the mother’s diet. Dairy products have both dairy protein and lactose in them. It is the protein that is causing the problem. Some mothers are told to avoid lactose in their diets, but this cannot affect their baby, as the lactose in breast milk does not come from the mother’s diet; it is made in the breast itself. However, if the baby is reacting to the protein by avoiding dairy products, his or her mother might still have hit on the solution to the problem by chance.

The range of foods that can cause food intolerance is wide. It can include artificial colours, flavours and preservatives, but can also include groups of natural food chemicals called salicylates, amines and monosodium glutamate (MSG). These are the substances in foods that make them tasty. In addition, some whole foods can also cause trouble, with the most common being dairy products, soy and wheat. Any of these can affect a sensitive breastfed baby through the mother’s breast milk.

Salicylates are common in many healthy foods, especially fruits and vegetables. They are also present in high levels in herbs and spices. They are higher in less-ripe fruits and in the skins of fruits and vegetables.

Amines are formed when proteins break down, so they are found in fermented, ‘matured’, or aged foods. They also increase in fruits as they ripen. Examples of foods high in amines are tasty cheese, very ripe bananas, and aged meats. Chocolate is also high in amines.

MSG enhances the flavour of food. In addition to being added to some foods, MSG occurs naturally in many tasty foods, such as soy sauce and tomato products. A number of foods are high in all three of these chemical groups, such as mushrooms, tomatoes, grapes, processed meats, yeast spreads, stock cubes, wines, and sauces.

When someone is allergic to a food, they have to strictly avoid even traces of it. This is different for people with food intolerance, where a little bit might be okay, but if they eat too much, they get a reaction.

It is also useful to know that it can be hard to distinguish between reactions in breastfed babies due to allergies and those due to intolerances. Allergic reactions are much more subtle when a baby is exposed to the allergen via breast milk and are similar to reactions caused by food intolerance.

In food intolerance, the substances seem to have a drug-like effect on the nervous system, so they are very different to the immune-system reactions of an allergy. Common symptoms of food intolerance in adults and children are stomach aches, diarrhoea, constipation, reflux, irritable bowel syndrome, mouth ulcers, rashes, headaches, low mood, aches and pains, sleep disturbance and behaviour problems in some children.

All spices have high levels of food chemicals, especially salicylates. The presence of these chemicals in the breast milk when the baby is mildly sensitive to them may be enough to cause problems. Some babies are even more sensitive, so everyday healthy foods might be too much because of the amounts of salicylates coming through the milk. A similar pattern can occur with dairy products, soy and/or wheat products.

Some mothers can solve their babies’ problems by avoiding too many foods with artificial additives and also foods that are very ‘tasty’ and highly coloured.

A dietitian with a special interest in food intolerance, particularly in babies, can help a breastfeeding mother investigate her diet through an individualised plan for an elimination diet lasting about four weeks. If the baby settles during that time, the mother will then ‘challenge’ the baby by eating selected foods high in just one type of food chemical. This is repeated with different types of food, and the baby’s reactions are noted. This knowledge also helps when the baby starts eating solid foods.

There are lots of reasons why babies cry or don’t sleep well. One factor that may affect some breastfed babies is the mother’s diet. Professional assistance from a dietitian with a special interest in this area can help a mother minimise how much she needs to restrict her diet and ensure that she is getting all the nutrients she needs for herself and her baby.

Joy Anderson is a volunteer breastfeeding counsellor and lactation consultant. She is also an accredited practising dietitian.

Illustrations by Gregory Baldwin