Breast Refusal Due to Maternal Diet
Aged five months, baby ‘Krystal’ had changed dramatically from the peaceful breastfeeder she had been up until about eight weeks old.
Things had become so bad that her mother ‘Angie’ was seriously thinking she’d have to stop trying to breastfeed. Angie said that each daytime feed was a battle, with Krystal fussing, complaining, crying, pushing away from the breast and ‘generally acting as if I’m trying to poison her!’
‘And yet,’ Angie explained, ‘if I’m not trying to breastfeed her, she smiles and is her usual, happy self! And she’ll happily drink my milk from a bottle. The only time she’ll breastfeed normally now is through the night. I just don’t understand it at all!’
Pictured above, Krystal performed just as badly as her mother described, not even wanting to go near the breast, turning her head away, screwing her lips and eyes shut, pushing away from her mother and complaining loudly. Nothing was going to induce her to breastfeed. Then she happily drank a bottle of her mother’s expressed milk. It was all pretty devastating for Angie!
Krystal had two or three rather gassy, runny mustard yellow bowel motions every day. Angie’s impression was that these were normal for a breastfed baby. She also thought that Krystal’s hiccupping several times a day was normal. Actually, beyond six weeks of age in a fully breastfed term baby it is normal to see no more than one mustard yellow bowel motion, and it should be the consistency of toothpaste. Hiccups continue as long as bowel motions are abnormal, and appear to be linked to lower gut disturbance.
After a discussion about the likely connection between Angie’s diet, Krystal’s bowel motions and feeding behaviour, Angie was more than ready to try some changes to her diet to fix the problems.
Five days later, Angie was thrilled to see Krystal breastfeeding through the day again, albeit with a bit of wriggling and fussing which steadily subsided as time went on.
Constant Vomiting and Unhappiness in a Fully Breastfed Baby
‘Jenny’ described three months old ‘Thomas’ as her ‘velcro baby’ because she couldn’t put him down without him ‘crying pitifully, as if he’s been abandoned’. Thomas spent a lot of time being carried about on her hip or upright against her in a baby sling. He did not settle well, usually having to feed to sleep. At night, he slept with his mother so that both of them got a better night’s sleep. He still woke a lot, but breastfeeding quickly soothed him back to sleep.
Thomas had small frequent vomits, a trigger-happy startle reflex, and farted a lot. Thomas’s father commented that Thomas could fart as loudly as a man! Bowel motions were a few days apart, but very runny, brownish and sometimes quite smelly and offensive – some also had strings of mucus in them.
Usually Jenny didn’t like cow milk products much, but had been surprised when pregnant that she not only enjoyed drinking milk and eating cheese, she really craved them and had a lot throughout her pregnancy. She’d had asthma and eczema as a child, then dermatitis and throat infections as an adult. These were indicators of Jenny’s own likely allergy history.
She later reported that without cow milk products and eggs in her diet, the difference in Thomas was amazing. He stopped vomiting, smiled ‘all the time’, fed less frequently but more peacefully, and stopped grunting and startling. ‘Suddenly, he’s happy just to be near me without always needing to be held!’ Thomas was also able to drop off to sleep without always relying on a breastfeed to do so.
Suddenly, he slept better and for longer than previously. She had thought it would be OK to have some processed foods and drinks in her diet, but quickly found that Thomas’s tolerance for these things was ‘almost non-existent’.
Over time, Jenny was pleasantly surprised to find that she benefitted from her dietary changes too – her dermatitis cleared up and she stopped getting throat infections altogether. She also said she felt generally healthier and more energetic than she’d ever felt before – ‘and that’s with a baby!’
Resolving eczema in a fully breastfed baby
Despite often being covered in weeping, itching eczema, four month old ‘Kevin’ was usually a surprisingly happy baby.
His mother ‘Roxy’ had cleverly worked out how to wrap his arms using his body weight to hold them in place so that he couldn’t constantly scratch himself (pictured above). If he scratched, he was capable of doing so until he was ‘red raw and bleeding’. His skin had been clear and normal until he was a month old, but had been a source of great anxiety ever since then.
In particular, Roxy worried over the continuous cycle of treatment Kevin needed to keep his skin relatively free of eczema. At this point, she had to treat him several times a day with corticosteroid creams to heal the most recent event. Scars and dry healed patches of skin can be seen on Kevin’s legs in the picture above.
Each time Roxy thought she could stop treating Kevin with corticosteroid creams, his eczema abruptly flared back into life. And he’d had repeated courses of oral antibiotics for his constant skin infections. It was unending, a miserable cycle that deprived Kevin of the normal use of his hands. She was also anxious about side effects from the drugs.
Two weeks after removing all problem foods from her diet, 80% of Kevin’s eczema cleared without the need for simultaneous corticosteroids. Roxy was thrilled and continued her dietary exclusions happily for the next 18 months until Kevin weaned from the breast. To start with, she found that it took six weeks for Kevin’s gut to heal and from then on, his bowel motions were completely normal. From runny brownish yellow, they became just one every day or two, semi-formed and mustard yellow.
As a toddler, Kevin tended to have small eczema breakouts from time to time that were easily controlled as long as Roxy gave him daily doses of probiotics free from food allergens.
Unable to Tolerate Solids Until After
‘Cindy’ was concerned that any attempt to give solids to eight month old ‘Peter’ was an utter disaster. Every time he had anything other than her milk, he rapidly deteriorated into a very unhappy baby needing to be constantly held. His sleeping pattern became non-existent, so she spent a lot of time trying to comfort him through the night. Half a teaspoon of any food was enough to have him wailing for hours day and night for the next four days! It was exhausting for both of them.
Lively Peter was healthy and a good weight. He was not especially interested in solids, but Cindy thought that he should be having other foods by this age. She felt that she was ‘doing something wrong’ that he was still exclusively breastfed. She was surprised to hear that actually, the recommendation to start babies on solids after six months of age is a guideline, not a directive. It recognises that babies are physiologically ready for foods other than breast milk at differing ages because of wide variations in their maturation rates.
Although there has also been some anxiety over babies’ iron reserves needing to be boosted by solid foods beyond six months, it appears to be a more likely issue for babies who are formula-fed. Babies who need to be exclusively breastfed beyond nine months should be monitored over time by a paediatrician, but very few of these children have any problem with iron insufficiency unless they have a history of bleeding from the bowel.
Cindy was mystified why even cooked pear – generally considered a failsafe food, incapable of triggering allergy reactions – caused Peter as many problems as any other food she’d tried him with. However, his bowel motions were typically as pictured above. At the time this one was photographed, Peter had not had anything other than breast milk for almost a month. These motions were clearly abnormal for an exclusively breastfed baby – three or four of them daily, runny, gassy, often mucousy, always dark brown and usually offensively smelly.
Abnormal bowel motions indicate abnormal gut conditions and damage to the gut lining that is typical of the impact of food allergies. Although gut infections also cause the same symptoms, these are rare in breastfed babies, especially while they are exclusively breastfed. (Nonetheless, it is worth medically excluding infection as a cause of the trouble.)
It appears that even failsafe foods such as cooked pear are not well tolerated by a damaged infant gut, often causing as much distress for the baby as foods he is allergic to. However, when all food allergens are removed from the mother’s diet, healing rapidly repairs the damage, typically between three and six weeks, depending on how much damage has occurred. Bowel motions steadily normalise as healing progresses, along with other welcome improvements to the baby which are usually obvious from the first week.
In this case, Peter improved dramatically once his mother excluded foods from her diet that he did not tolerate. His bowel motions became normal in colour, frequency and smell after six weeks of this. However, he remained unable to cope with any solids at all until after his first birthday. Not until he was about twenty months old was he finally able to eat most foods without any problem, with the exception of those he was allergic to.