Starting solids with a food intolerant baby

Starting solids with your baby is usually exciting and fun. It marks the beginning of weaning from milk to family foods and is a major milestone in your lives.

The spectrum of approaches to introducing solids ranges from ‘baby-led weaning’ to spoon feeding. Baby-led weaning is a more child directed approach and involves allowing the baby to select their own food, usually from the family foods at the table. Spoon feeding involves offering the baby a purée on a spoon, with the most popular first food being rice cereal.

Unfortunately, for some mamas introducing solids is a time fraught with fear and trepidation. If your baby suffers from reflux then it’s possible you already know about their food intolerances. Perhaps you’ve eliminated the offending food proteins from your diet or your baby is on an elemental (amino acid) formula like Neocate. In most cases the big offenders are dairy and soy, but even if you steer clear of the identified food proteins the introduction of solids can still be a time of major reflux flares and night wakings.

The key is to go slowly. Start with one food at a time, for at least 5 days, and keep a strict food diary to record any reactions (including, if you’re breastfeeding, what you’re eating). If you choose to use the baby-led approach ensure that baby is only accessing one food (a range of options will come later – for now just try to be patient).

Another thing to remember is that reflux babies usually have a very sensitive gag reflex, so only offer small amounts of food and don’t be alarmed if baby appears to gag on everything! It just takes time and familiarisation and you mustn’t force them to eat anything lest they develop an oral aversion.

With regard to what food to introduce first: remember the mantra ‘every baby is different’. Just because rice cereal worked for the lady down the road or your Great Aunt Nell doesn’t mean it will work for your baby. In fact, rice cereal can be the worst thing to introduce first to a food intolerant baby! It can also be the trigger for ongoing constipation issues with some toddlers because it slows down their gut motility. Conversely, for babies with reflux that isn’t caused by food intolerances it can be great as it helps the stomach contents to stay settled.

In our case, A started with homemade chicken stock (broth) made from simmering the bones of an organic chicken in water for four hours. I had read about the healing qualities of bone broth and I knew that A’s gut needed healing.

The first lot of broth went really well. She loved it and had no reaction at all. The second time I used the bones of a BBQ (rotisserie) chicken from my local supermarket because we’d eaten the chicken for dinner. It was a free-range chook but it was a total disaster. Poor little A broke out in a rash around her mouth and very quickly showed signs of intestinal distress – extreme flatulence, mucous in her stools, frequent night wakings and irritability. I’m pretty sure those chickens are basted in soy, so that was a silly move on my part.

The second food we introduced was butternut pumpkin (squash). This also went well with no reaction. Zucchini came next and provoked a big reaction so then we tried swede (rutabaga), which was fine.

We continued to trial foods, adding one new one per week (carrots – fine; banana – epic fail; etc) until we had a solid list of meats and vegetables and a few fruits. We avoided grains for quite a while with A because we wanted to be as kind to her gut as possible. I mixed slippery elm and probiotics into every single purée in order to soothe and fortify her gut and all was going quite well, even if at a seemingly glacial pace. We retrialled zucchini with success and gradually began to add more and more variety, including gluten-free bread and rice.

At eleven months it was time for me to return to work and this is when things got tricky. Our beautiful day care centre has an in-house ‘chef’ who prepares morning and afternoon tea and lunch. I gave the centre A’s list of safe foods, and they dutifully stuck to it, but we found that when we picked her up at the end of the day she was STARVING. I was pumping milk for her at work but she was refusing to drink it at day care and my supply was dropping. On top of this she was miserable because she wanted to eat what the other babies were eating.

We stuck it out for another five months, introducing a new food each week until at 14 months we had an appointment with an immunologist who basically told us to remove all restrictions from both of our diets. The day care centre was overjoyed and A was no longer hungry at the end of the day. We transitioned pretty smoothly to a normal diet but after a few weeks we noticed that sleep started to become elusive again and the reflux was back.

I’m now at the point where A is seeing an osteopath again and we’ll try four sessions with him before I try restricting her diet again. My instinct tells me it’s still food intolerances, but the thought of putting her on a restricted diet at 20 months fills me with dread.

I would love to hear anyone else’s story – please comment below! Did you try the GAPS diet with your LO? Or the Failsafe diet (as I did)? Did your LO grow out of their intolerances without intervention?

IMG_1833.JPG

Finding the light in the tunnel

IMG_1807

People always talk about the light at the end of the tunnel, as if the destination is all that matters. Get through this dark place, focus on coming out the other side, and everything will be okay. Don’t think about the tunnel – just get through it!

What I’ve come to realise though, is that the ‘tunnel’ is a fundamental key to growth and resilience. In other words, my struggle helped me to find my strength.

For mothers there is so much emotion and guilt bound up in our decision-making. Particularly when facing adversity we feel as if every choice we make is wrong! We convince ourselves that we’re screwing it up somehow and keep reinforcing our belief that it’s all too hard and we’re not good enough.

Learning how to let go of negative beliefs and accepting all of my feelings (even the bad ones), helped me to realise that the hardest, darkest periods in life can teach you so much about your ability to cope, to problem solve and to bounce back.

But these difficult times also have the potential to change you, often fundamentally, and make you question some of the values and norms you once held. If you can go with the flow, accept change and evolve, you’ll find that you come out the other side a better person.

Of course as with anything worth doing in life, ‘practice makes perfect’. I’m certainly not yet at a point where I can serenely sail through setbacks, but I no longer wallow in misery and self-pity.

Horrible things do happen in life. Some of these things are indescribably awful and require targeted, professional help to resolve and heal. Generally speaking however, I believe you can choose to let difficult situations destroy you, or you can find the light in the tunnel that allows you to see and appreciate how strong and resilient you really are. You’ll be able to say to yourself: ‘I can figure this out. I’ve been through this tunnel before!’ Accept that what you’re going through is hard right now, but know that it is ultimately going to make you stronger.

Everyone’s hard is hard

IMG_1805-0

Quite often when I was in the depths of hell with my reflux baby, people would make helpful remarks, like ‘you’re lucky your baby doesn’t have [insert terminal illness]’ or ‘just think of those poor mothers in [insert war-torn/famine-stricken country]’. I understand the sentiment. People were trying to reassure me that it could be worse. First world problems aren’t really that bad, right?

But the fact is for me, then and there, it couldn’t be worse. What I was going through was harder than anything I’d ever been through. There were days where I literally wanted to throw myself under a bus rather than continue dealing with it. The psychological distress I was experiencing was acute, and trivialising it by putting it lower on a scale of 1 – 10 in comparison to others simply made me feel guilty about my struggle.

Everyone’s hard is hard and every struggle is contextually unique. Comparing your struggle to another person’s does nothing to make the situation easier. It is not a practical way of approaching the problem. Whilst it may give you some perspective in the short-term, at the end of the day you won’t move through your struggle until you can acknowledge and accept it for what it is. Once you accept that you are struggling and that this is simply a normal part of the swings and roundabouts of life then you’ll find it much easier to start looking for solutions. If you waste your time and energy convincing yourself that it’s not as bad as what others are going through then ultimately you will just wear yourself down and find yourself going around in circles.

If you are currently struggling with a difficult situation – stop, take a deep breath and allow yourself to feel all the feelings. Accept that what you’re going through is hard. It won’t last forever but while you’re in the middle of it you need to be kind to yourself. If someone assures you it could be worse tell them what you’re going through is very hard for you right now and you need support to get through it. This is nicely summed up by one of my favourite quotes: ‘be kind, for everyone you meet is fighting a hard battle’ (Ian MacLaren). To this I would add, ‘…that you know nothing about’.

The best you can is good enough

IMG_1792.JPG

Although it’s hard to see it in the moment, doing the best you can really is good enough. So many of us struggle with the universal fear that we’re not good enough or that we’re not trying hard enough to overcome our difficulties. We compare ourselves to others and set our standards in line with their achievements. We form beliefs about ourselves and then set about finding proof that these beliefs are true, whilst ignoring or distorting information to the contrary.

Take, for example, my struggle to breastfeed N. The standard and expectation I had set myself was that I would be able to breastfeed my baby. I had researched it thoroughly and knew beyond doubt that it would provide her with the optimal start in life, not to mention being free, convenient and natural. So when things didn’t go to plan I firmly believed that I had failed as a mother. I continually sought to confirm this belief by finding examples of women who’d gone to greater lengths than I had to breastfeed and comparing their experience to mine. If anyone tried to tell me that I had done my best or tried harder than others I ignored (‘they don’t know what they’re talking about!’) or distorted (‘but that woman is nothing like me!’) this information because it didn’t suit the purpose of confirming my belief.

Every time I gave N formula I felt like I was poisoning her. I lurked on hardcore breastfeeding forums where other mamas raved on threads about exclusive pumping and how they would rather die than let a drop of formula pass their baby’s lips. I called the Australian Breastfeeding Association, who were kind and supportive but also firm in their approbation of ‘artificial baby milk’. I ignored my doctor who suggested that ‘breast is best, except when it isn’t’ and also reassured me that the most important thing a baby needs is a happy mama. I looked for a breastmilk donor, despite feeling extremely squeamish about the idea. I read story after story about women who had overcome latching issues and weight gain problems and went on to breastfeed exclusively and I completely ignored the fact that every woman and baby is unique and there is no single solution.

This kind of behaviour is unrealistic and unfair but worst of all it’s counterproductive. In trying my hardest to do the best by N, I sacrificed myself in the process and ended up with postnatal depression. It wasn’t because I couldn’t breastfeed her – it was my belief that I hadn’t tried hard enough.

The people you compare yourself to when you’re setting your standards are comparing themselves to others. Everyone you meet is fighting their own inner battle that you know nothing about, so it’s foolish to assume that someone else is better than you or tries harder.

Focusing on confirming the belief that you’re not good enough leaves you with less time and energy to enjoy the things you’re actually good at and that make you happy. Lori Deschene, founder of the amazing Tiny Buddha, says ‘we can’t hate ourselves into a version of ourselves we can love.’

It’s important to realise that you can actually change your beliefs (thank you, Jess Lowe!) and you don’t have to believe your negative thoughts about yourself. The first and most crucial step is awareness. Once you’re able to identify the beliefs you hold you’re more than halfway towards changing them. The next step is to shift your perspective, without judgement. It’s not so easy to do this because so many of our core beliefs about ourselves have been deeply ingrained since childhood. It requires a fair amount of unpacking and a lot of practise with defusing negative thoughts.

In my own example, I shifted my point of view and focused on progress rather than perfection and was able to see how far I’d come and how much I’d achieved. When I threw myself into doing things I enjoy (like writing!), I had less time to ruminate on my negative thoughts. Instead of comparing myself to others who might have tried harder I wrote down my story and reflected on how very hard I had tried.

Ultimately, if you’ve tried the best you can, the best you can is good enough. Maybe Thom Yorke meant it to be ironic but it works for me.

Elimination diets

If you have a reflux baby and you’ve decided to go down the route of investigating possible food intolerances through an elimination diet you will need all the support you can get. It is a long, hard road and friends and family just do not understand how hard it is nor how strict you have to be. It’s not like going on a diet to lose weight, where you can have the odd piece of chocolate and get back on the wagon tomorrow. If you’re doing this for your baby then the tiniest slip-up can leave you with 24 hours of no sleep and tinnitus from the screaming.

Essentially, you have to remove all the likely offending foods from baby’s diet until you get to ‘baseline’ or a symptom-free baby. Most commonly, all traces of dairy and soy are eliminated from the diet for between two and three weeks. This means watching their nappies carefully until most or all of the mucous is gone. Stools have a lag effect because mucous is a symptom of gut damage and this takes time to heal. After this time the baby should become markedly more settled and the persistence of mucous in stools should start easing. Once your baby has been at baseline for two weeks you can start to very gradually reintroduce foods until you’ve identified the culprits. If baby reacts to something, remove the food from your diet again and wait several days before trying a different food. If symptoms do not settle within a reasonable timeframe you could then embark on a full elimination diet removing all allergy causing foods and/or food chemicals.

There are many different elimination diets out there. When I first set down this path I followed the Dr Sears Elimination Diet, which basically consists of eating nothing but pears, potatoes, sweet potatoes and rice for two weeks. I followed it pretty religiously, except that I also ate zucchini. I noticed after two weeks that Ada’s symptoms had improved dramatically. She was so peaceful! The only problem was that I was literally starving to death and if I had to eat another lamb chop I was going to hurt somebody. So I chucked in the towel and went back to eating everything except dairy. This was a huge mistake because I very quickly undid all of my hard work and went back to having a super cranky baby all over again!

The second elimination diet I tried was the Royal Prince Alfred Hospital Failsafe Diet. This one was developed by allergists at a leading hospital in Sydney, Australia and is accompanied by a handbook and a cookbook. It is also the one that accredited practising dieticians and nutritionists (in Australia) are familiar with, so you’re more likely to get support from health professionals to follow it.

I followed this one strictly for two weeks, and while we didn’t get the same reduction in symptoms as with the Dr Sears diet I was a much happier mama for having a little variety in my diet. Because it was more sustainable I was able to stick it out for 10 months, during which time I gradually reintroduced foods into my diet until we had narrowed A’s intolerances down to dairy, soy, wheat and egg. As you can imagine I wasn’t left with a huge range of food choices and I ended up eating a lot of meat, fruit and vegetables! I also lost 24 kilos but that most certainly was not my motivation.

During this time we also commenced solids with A, which is a separate story (coming soon!)

As an aside, ‘all traces of dairy’ literally means just that – check packets for the words ‘contains milk‘, do not eat things which have been baked with milk, do not eat things that might even contain the barest smidgen of cow’s milk protein. So many people fail with the elimination diet because they didn’t realise they couldn’t just cut out their usual cappuccino and yoghurt and everything would be fine.

I would love to hear from anyone who’s been through an elimination diet for their baby. Please post your experience below and your best tips for any mamas considering attempting it!

Does my baby have food intolerances?

If your baby has reflux or is having difficulty sleeping it is worth asking some questions about possible food intolerances. In many cases, reflux can be a major symptom of the food intolerance/s and once you identify and eliminate the offending food you can usually eliminate or significantly reduce the reflux.

First of all it’s important to note that infant reflux generally stems from one or all of the following triggers:

  1. Anatomical/structural – baby has a weak or immature oesophageal sphincter that simply allows food and stomach acid to spill up into the oesophagus (and often beyond!)
  2. Aerophagia – baby has a poor latch and can’t form a complete seal on the breast or bottle, either due to a tongue-tie, lip-tie or both. This means that baby is sucking in air along with milk, creating significant gastric discomfort and often reflux.
  3. Food intolerances/allergies – adults suffer from reflux symptoms as a result of food intolerances, so why not babies? When a food intolerance is present the proteins in the offending food damage the inside lining of the intestinal tract and the body reacts accordingly. In reflux babies Milk Soy Protein Intolerance (MSPI)is the most likely cause. It is thought that about half of reflux babies have a cow’s milk protein intolerance, and about half of these again also have a soy protein intolerance.

NB: There are other triggers (e.g. dysphagia, delayed gastric emptying, pyloric stenosis, eosinophilic oesophagitis) but these are less common and I don’t have any direct experience with them. In addition, while some babies simply have ‘anatomical reflux’, others (such as A) have all three of the aforementioned triggers!

For this post I’ll be focusing just on food intolerances.

Many health professionals claim that it’s highly unusual for babies to react to food proteins through breastmilk and that the baby is more likely to be suffering from colic (which is code for ‘I don’t know why this baby is so unhappy’). However, studies are increasingly finding links between the food ingested by mama and the gut reaction of the baby.

Symptoms of food intolerance in babies

  • spitting up or vomiting
  • persistent mucous in stools with or without stringy bits (the mucous will ‘bridge’ the folds of the nappy)
  • diarrhoea, loose and watery stools, frequent stools
  • ‘burny poos’ – persistent acidic stools
  • profuse painful wind, and lower abdominal pain
  • strange, persistent rashes or unexplained eczema
  • persistent nappy rash and burnt bottom
  • crying
  • fussing
  • grizzling and generally unhappy
  • squirming constantly
  • refusing to feed or constantly seeming hungry
  • upset digestion
  • ‘failure to thrive’, slow weight gain and underweight
  • insomnia and inability to settle
  • red cheeks and ears which can come and go and feel hot to the touch
  • sandpaper-like roughness on the upper arms

Note that many of the above are also symptoms of reflux, teething and various other bubba ‘grievances’. Most food intolerance reactions occur in the lower gut, specifically stools, abdominal pain and wind. If you suspect your baby is reacting to a food it is critical that you see a knowledgeable health professional to discuss. 

What might your health professional suggest?

Obviously babies can’t tell us if they feel yucky after eating a certain food and it’s even more challenging when you’re breastfeeding because the reactions can be so delayed. Therefore if you’re going to go down the elimination diet route on behalf of your baby you’ll have to become a little bit forensic (more information about elimination diets here).

Whilst allergies can be diagnosed through either a skin prick test or a blood test, intolerances are much trickier. In adults intolerances are usually diagnosed by undergoing an elimination diet wherein the most likely offending foods are removed from the diet for a period of two to three weeks and then reintroduced gradually to determine which are the trigger foods.

If you’re bottle-feeding your health professional may suggest that you try a hypoallergenic formula, and failing that may suggest an amino acid formula where the proteins are fully broken down.

Your health professional may also suggest that baby’s symptoms are being caused by other factors, such as an overactive or forceful letdown (if you’re breastfeeding) or temporary lactose intolerance after illness.