Breastfeeding A Baby With Food Allergies, Part 2
In this post, we continue our discussion about breastfeeding a baby with food allergies with Dr. Trill, from Free to Feed. If you haven’t already, be sure to read Part One.
“Do you have a list of symptoms that baby might show that you ask parents about?”
Dr. Trill:
“Yeah, absolutely. I like to break symptoms down into primary and secondary. Primary symptoms being the symptom itself and secondary being like a symptom of the symptom, basically.
“On the outside, the top symptoms that we see for infant food allergies is rashes and eczema. That can be anywhere on the skin, including their little booty. Then, on the inside, on the upper GI side of things, we can have acute reactions, which are a little bit faster reactions, like chronic congestion, reflux, vomiting, gassiness, discomfort, distended belly, etc.
“Then, we get into lower GI issues, which are more chronic, which means it takes a little bit longer for them to occur and it takes longer for them to heal once they do occur. And that can be diarrhea, constipation, mucousy stool, bloody stool, and then the secondary symptoms to those problems.
“Secondary issues then are, for example, if your baby is constantly vomiting, failure to thrive is very possible because they are not keeping enough of the breast milk or formula down. Or if they have the bloody mucousy stool, that’s because of inflammation in the lower GI tract. That means they’re not effectively absorbing the nutrients in what they’re consuming, which means that you can end up with failure to thrive. The cells in the lower intestine are inflamed and they’re not doing their job.
“Another secondary symptom is “colic” – babies are inconsolable. It is not uncommon for us to meet parents who are ragged by exhaustion because their baby cries all hours of the day and night.
“Another secondary symptom that we can end up seeing is feeding refusals and popping off the breast, arching their back in pain. So, any kind of feeding-refusal issues and then, obviously, all of this discomfort can lead to sleep disturbances.
“Most babies do not hit every one of those symptoms. It is less likely for your baby to have every single symptom than it is for them to have them all. And, unfortunately, that’s another place where parents can get dismissed. Or they’ll be like, well, your baby is gaining fine. Or, well, your baby doesn’t vomit or any of these things like, oh, well, it’s just a little bit of blood. So that’s super common for us to hear, too.
“And if you are listening to this, this is not your fault. If your little has food-allergic responses, you absolutely did not do anything to cause this problem. It is not your fault in any way, shape, or form. Non-Ige-mediated food allergic responses are genetic. Even if you and your husband and the rest of the family or your partner don’t have any experiences with food allergies, it’s something that can be recessive that we pass down generation to generation and it’s not something we can control. So 110% not your fault that you ended up on this journey.”
“You’re not a bad parent. There’s so much nuance here for our mental and physical health to think that something that I put into my mouth is going to impact my baby. And the fact that so many facets of our lives are around food and pleasure from food and socialization of food. And you’re not a bad parent if you had a slip and you accidentally ate something or if you did it on purpose, still not a bad parent.
“What tips do you have for parents who have to start going through an elimination diet? I know that some parents don’t like to cook or they don’t have a lot of time to cook. And then food can be expensive if you’re looking for certain allergen-free foods.”
Dr. Trill:
“The good news is that nowadays there are lots of options as far as alternative foods are concerned. And there’s more and more on the shelves every day, which is great. The downside is that those alternatives are super expensive. So some of the things that we’ve done to try to help families, there are some new resources coming out as far as, like, more allergen-friendly restaurants and things of that accord as far as being able to order out if cooking just isn’t your jam, which was perfectly fine. And certainly that’s the hard part, too, because we never plan our life around something like I’m going to have a baby with food allergies, so I need to learn how to cook. Of course, we didn’t plan for that.
“Our biggest recommendation for families is to try to keep things as simple as you can. Some of the things you can batch cook. Make it easier and make big servings of and freeze. The number one thing is as many whole foods as we possibly can, as minimally processed as we possibly can.
“Over the course of elimination, we work with families through what their baby’s magic combo is. We work with them through elimination and diet strategies, as well as reintroduction strategies. Because I am of the mindset that you should never, ever remove something for the sake of removing it.
“I hear a lot of information floating around that’s often conflicting about how long it takes for whatever food you’re eliminating to be gone from the parent’s body and milk. I’ve heard different theories that it doesn’t actually take that long, but it’s more that the babies that the baby’s gut takes a while to heal. What are your thoughts on that?”
Dr. Trill:
“What I found is that’s not actually true, which now, looking back, I’m sure we can all giggle at the craziness. That doesn’t even make sense. It doesn’t even make sense for us to be like, if I eat a piece of cheese today, it’s going to be in my breast two weeks from now.
“The truth is, once we consume a protein, it’s going to spike in concentration a few hours after ingestion and steadily plummet from there, usually gone within 24 hours.”
“We have to actually physically remove the breast milk from the breast in order to remove the protein from the body after it’s transferred to the breast. So if we’re nursing on a fairly regular schedule, our breast milk is going to spike pretty quickly and then steadily plummet from there. Often we see that it’s usually gone within 8 hours, but 24 hours is our typical window that we say because some are going to be faster, some are going to be a little bit slower based on your metabolism. So what this means then is not only do we have our timing for our transferability, but then there’s the timing for babies reactivity. And just like you kind of alluded to, that’s where some of this misinformation gets kind of spread and not quite understood, is that okay if we transfer in 24 hours and then we have two different types of reactions that we talked about a little bit ago.
“We talked about acute, which is fast. Right. So those vomiting responses are going to happen within a few hours of ingestion from baby. So that means that if I ate something at noon and I’m peaking, transfer it to my baby’s vomiting by four, it’s pretty stinking fast, right. So those acute reactions, those upper GI or fast rash responses are pretty fast for consumption. And then on the back end of baby, if we have a chronic reaction, let’s take a little bit longer. The sweet spot for the amount of time that it usually takes from baby and drawing it from your breast milk is usually about six to 8 hours is when we’ll start to see the blood response or the mucous response, diarrhea, things like that. So six to 8 hours is the sweet spot. But it can take up to 48 hours, especially if baby is not stooling very frequently. So, forgetting like a baby who stools every other day, we have to wait to get the goods. So, we may not see the blood response until 48 hours post baby ingestion. So that’s the full three days for reactivity from when we consumed it potentially for those babies who do not stool every day.
“The longest that we typically see is a three-day response. Most often, we see it within the same day of ingestion. And then we usually give a couple more days for impact. So most of our elimination diet strategies we do for about five days. So we do the three days for peak and transfer and reactivity timing and then a few days for impact for us to see is their improvement. And the really big confusion comes from the fact that baby has to heal, right? So if baby is bleeding when stooling, they literally have a wound in the gastrointestinal system. Their GI tract is bleeding. So there are little wounds in the gastrointestinal system. And those take time to close and heal.
“The reason why this is important is because if you tell parents that when they eat something, it’s going to be in their breasts for weeks on end, the amount of stress that that causes unnecessarily because it’s not true – it is astronomical. What that means for me is that if I accidentally drank that latte from Starbucks, that my breast milk is now poisoned weeks, and that my baby is going to get that particular protein in my breasts for weeks on end, which is not true. And it also tells parents that they have to start over.
“If baby reacts, okay, we know the timing for reaction, and then we should start to see healing after that. And if baby doesn’t react, then it either didn’t transfer or baby’s not reactive anymore or whatever it may be. But it puts so much stress on the parents to say, like, if you make a mistake, you’re going to hurt your baby for weeks and weeks and weeks, and it’s going to be in your body for weeks and weeks and weeks. And you can’t breastfeed for weeks and weeks and weeks. But there are so many other options when you actually share the true data behind transfer and clearance.”
“That reminds me of another thing that I see often on your Instagram about the stress and anxiety. And you talk about how some parents can actually develop PTSD from trying to breastfeed with an elimination diet. Can you talk a little bit more about that?”
Dr. Trill:
“Yeah, absolutely. So there’s a huge physical health part, our nutritional needs, making sure that we’re getting in all the nutrients that we need so that our body is complete, so that our breast milk is complete. But well attached to that is our mental health. And having so much stigma around the shame and the guilt. And what did I do wrong? And being up at 2:00 am with both of your children, you’re all crying, right. And already being in a postpartum state where our hormones are freaking everywhere and many of us are already dealing with other mental health issues after we’ve given birth. Parents can really, truly feel like they are scared to put something into their mouth. I am afraid of my food. I am petrified of the next diaper that I’m going to open. Is it going to be full of blood?
“You have given us so much great information! And I love your energy and your passion. I love your website and your Instagram. So much information is given on there. You have a subscription, too, right?”
Dr. Trill:
“Yeah. We have a food-allergy-support package that’s a full year of personal content for navigating each side of each piece of your journey with one-on-one consult baked into it, and deep dives with experts like IBCLCs, registered dietitians, and Naturopathic doctors so that you can navigate each side of your journey. You also get plugged into our food-allergy community, which is filled with fellow warriors that are in the midst of this and you can chat with them and have a real sense of community.
“So where can people find you if they want to connect with you and learn more about you?”
Dr. Trill:
“Yes, absolutely. So definitely check out the website freetofeed.com. You can find the consult there and the food allergy support packet there and all of the other crazy things we have going on and then certainly on Instagram. So Instagram is where I am most active.”