‘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.