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:
- 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!)
- 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.
- 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
- 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.