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Expert Q&A

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Should I breast-feed a baby with food allergies?

Asked by S. Siva, San Jose, California

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I am exclusively beast-feeding my 4-month-old baby, who was diagnosed with allergic colitis at 3 months. I have been off dairy and soy for eight weeks now. We still see blood specks in his poop. He is gaining weight, albeit very slowly. Question, is it beneficial for me to be on an elimination diet and figure out what he is allergic to or is a hypoallergenic formula the answer? Has any research been done on this? My baby won't take those formulas and I am torn on what to do. Is breast-feeding detrimental in this case or will he outgrow it eventually in six months or a year? Please advise.

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Living Well Expert Dr. Jennifer Shu Pediatrician,
Children's Medical Group

Expert answer

Thank you for your question. I am glad you are concerned about your baby's health and nutrition. I applaud you for breast-feeding your baby and hope there will be a way for you to continue since there are numerous benefits. Breast milk and formula intolerance and allergies in babies can be very tricky to diagnose and treat, and it is important to make sure any changes in the diet are safe for both mom and baby. I recommend talking with your pediatrician for guidance in changing your diet or that of your baby since drastic changes in nutrition or calories may have harmful effects.

I consulted with Drs. Luqman Seidu and Maz Rezvani of Allergy and Asthma of Atlanta, Georgia, who advise families in this situation to investigate infant feeding problems in a thorough, stepwise fashion.

• First, review the blood in your baby's stool with your pediatrician and make sure there aren't any tears or other problems with the anus (such as skin tags or fissures) involved.

• When eliminating dairy and soy, be sure to check food labels for hidden ingredients such as casein and whey to avoid inadvertently and unknowingly transmitting these milk proteins to your child through the breast milk.

• If your baby has other signs of allergy, such as eczema, it may be helpful to see an allergist who deals with infants. Consider whether you may be unintentionally ingesting another food such as peanuts or eggs that are transmitted to the baby and causing colitis (gut inflammation) and bleeding. If there are issues such as poor weight gain, a pediatric gastroenterologist (GI doctor) might be better to initially address this problem.

• Skin testing or allergy blood work in babies as young as 2 or 3 months of age may help identify food allergies. Certain types of food allergies are often outgrown by age 5 and sometimes even by 1 year. Avoiding the offending foods (regardless of whether allergy is confirmed by skin or blood testing) can help breast-feeding babies.

• If a fully hydrolyzed or elemental formula (sometimes also called "hypoallergenic") is the treatment course that is selected, the baby may be resistant to the new formula at first but will usually learn to accept it. If there is not an urgency to switch formulas, one option to discuss with your doctor is mixing the new formula with the old one and gradually increasing the amount of new formula in order to transition the baby more gently.

Feeding problems in babies can be very worrisome for parents, but fortunately they often improve with time. I wish you the best of luck.

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