Does my baby have an allergy? Probably not.

For babies who are only getting your milk (no formula), food allergies are quite rare.   If your baby is fussy or having more mucousy, watery, and green stools or having a big increase in spitting up, it's possible that baby is reacting to inflammatory cells which are part of your immune system which is shared via your milk.  These inflammatory cells can be released when you consume a food that you don't tolerate well, are exposed to an allergy, you have inflammation from recent illness, and/or hyperlactation (too much milk production).  

However, sometimes these symptoms are completely unrelated to what baby is eating and more related to how effectively baby is feeding, oral function, and overall development and movement. 

Screening for other causes and doing a full examination of baby and your feeding is necessary to get to the root cause of the symptoms.

There are also some normal stages that baby goes through which can stress us parents out! For example, around 4-10 weeks many babies experience more drama with pooping.  The easy stooling of the early newborn period is replaced with a grunting, fussing, farting, and sometimes crying baby who seems to be struggling to poop.  When they do finally poop it looks normal liquidy, soft, muscous, and/or seedy.  We call this dyschezia.  It is simply baby learning how to relax their pelvic floor while pushing with their abdomen.  Belly massage, movement, holding baby in a squatting like poop position can really help! 

We also know that around 6-8 weeks, mucous in our lower digestive tract starts to increase.  This is a good thing as another layer of defense from our immune system is activated.  Since babies poop a lot and sometimes in several, ahem, movements in a row it can be totally normal to see some mucous in poop.  After vaccines the immune system is activated (YES! This is the goal!) and we will sometimes see more green or mucous stool for a few days to a week.  We also see this after any illness even if baby didn’t have a lot of other symptoms, we can see poop changes that go back to normal after a few days.

What about spit up? There is a pattern of normal spit up patterns for babies.  Most babies don’t spit up much until 2-4 weeks and then they might start to have a bit more regurgitation. This is because they are eating more and the sphincter at the topo of the stomach acts like a pressure valve to let out extra milk and air.

I know you are burping your baby, so keep doing that.  And also think about reducing over feeding.  For babies getting bottles, keep it under 4 oz (120 mL) and try not to put pressure on their belly after feeds (roll side to side for diaper changes, for example). If you are noticing spitting up after most feeds, it is a color other than clear to milky or pale yellow and chunky – let your pediatrician know right away!

If it looks pretty normal (like digested milk or clear) but it’s happening a lot, please come see me so we can investigate what might be going on with baby.

Back to the immune system and inflammation

When we do see an increase in these immune cells called "inflammatory cytokines" the detective work really begins as we try to determine what is causing this inflammatory response!

The solution may be to reduce or remove the things which activate your allergic response and immune system.  Sometimes this is a food but it can also be other environmental triggers.  An extensive elimination diet is not always needed not to mention it can be complex, difficult, and expensive! 

Start with the most likely culprits (ask yourself, have you been eating a food that you didn't tolerate before pregnancy?  Do you tend to get seasonal or environmental allergies?  Have you been ill, had mastitis, or get lots of clogging and engorgement?)

Treating the known problem can include some of the below options:

• Some anti-histamines can help reduce the overproduction of the inflammatory cytokine calls.  Certirizine (Zyrtec) is one of these over the counter medications and is acceptable during lactation.  Ask your provider if this is a good option for you.

• There is some evidence that probiotic supplements for babies can help reduce these reactions in baby and help improve watery, mucousy, green stools.  Jarro Dophilis Baby or Infant, Garden of Life for Baby, SFI Ther-biotic, Nordic Naturals, and Early Life Flora are all good quality products for young infants.

• Adding anti-inflammatory foods into your diet can be really helpful.  See below for more details about this. 

• Some parents will take digestive enzymes with meals and snacks if they suspect they are having trouble digesting a certain food.  This can improve digestion and lessen the increase of inflammatory cells.  Nordic Naturals Flora Digestive Enzymes, SFI Health Digestive Enzymes, & Garden of Life Raw Enzymes Women (multivitamin and probiotic product) are good quality options which parents can take.  You can discuss this option with your provider.

• If you have breast inflammation (clogging, mastitis, engorgement) then addressing that problem can help improve baby's symptoms.

Dietary Changes to Reduce Inflammation – start slowly to reduce GI discomfort!

Diets which focus on whole grains, fresh fruits, green vegetables, and dish are shown to lower inflammation and may reduce risk of developing some forms of mastitis (breast inflammation which can become infectious).

Vitamins A, E, & D, selenium, copper, zinc, choline, beta-carotene, and Omega 3 fats can help you recover from mastitis symptoms. Pre-biotic foods (those containing starches which feed beneficial bacteria) are also particularly helpful in preventing mastitis and speeding up recovery.

Prebiotic foods include, among others:

• Dandelion Greens

• Vegetables in the allium family, like garlic, onions, shallots, scallions, and leeks

• Chicory Root

• Jerusalem Artichokes

• Unripe bananas (try them blended into smoothies)

• Whole Oats and other whole grains

• Apples

• Asparagus

• Legumes

• Blackberries, raspberries, marionberries

• Chia and Flaxseed (grind these and mix with water, yogurt, or milk prior to consuming)

Naturally probiotic foods like yogurt with live cultures, kefir, kombucha, kimchi, saurkraut and others can also boost your gut microbiota and reduce inflammation associated with mastitis.

What is choline?

Choline is a component of several larger molecules that are important in the development of the fetal nervous system, including the brain. Choline is an essential nutrient that is critical for gene expression, neurotransmission, making membranes, and tissue expansion.  Choline is vital to metabolism, cell structure and integrity, memory, muscle control, transportation of fats, and ensuring a healthy nervous system.  Choline supplementation is associated with reduced mastitis risk and can be useful in reducing inflammatory symptoms.

People who are lactating are recommended to consume 550 mg of choline daily throughout the first year postpartum, 100 mg more than what is recommended during pregnancy. A breastfeeding parent needs extra choline to meet their own needs as well as that of her growing baby. Choline content of breast milk can influence infants' circulating choline levels. One study even suggests that choline supplementation during pregnancy and lactation reduces inflammation in breastfeeding women postpartum.

Many people find that an additional supplement outside of food sources allows them to reach the RDA.

Adapted from: NIH Office of Dietary Supplements. Choline: Fact sheet for health professionals. https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/.

References:

Basım P, Özdenkaya Y. Can Traditional Fermented Food Products Protect Mothers Against Lactational Mastitis. Breastfeed Med. 2020 Mar;15(3):163-169. doi: 10.1089/bfm.2019.0261. Epub 2020 Jan 24.

Afeiche MC, Iroz A, Thielecke F, De Castro AC, Lefebvre G, Draper CF, Martínez-Costa C, Haaland K, Marchini G, Agosti M, et al. The Dietary Inflammatory Index Is Associated with Subclinical Mastitis in Lactating European Women. Nutrients. 2022; 14(22):4719. https://doi.org/10.3390/nu14224719

ABM Protocol #26