Life with a newborn is hard work. Between breastfeeding, mom-guilt, looming postpartum depression, and a dozen other things that come with a tiny human dependent on its care, it’s all hard enough!
To make it worse, some babies have food intolerance issues that make it even harder. Fussy babies that can’t or won’t fall asleep, frequent spit-up, a plethora of skin conditions seem to be a hallmark of infancy. So how can you tell if you have a typical infant or if something more is going on?
Generally speaking, babies should adapt to new foods and new environmental conditions within 3 – 6 weeks. If your baby continues to have sleepless nights and long crying spells that don’t improve, it is worth a conversation with the pediatrician about the potential for what is referred to as a “TED” baby.
If you and your doctor suspect a food intolerance, one of the diagnostic tools that can help identify the problem is a total elimination diet (TED). It sounds scary, but a TED diet is just a process of selective feeding, trading out one food for another while trying to find the problem.
Related: TED Mama
What is a Total Elimination Diet (TED)
A total elimination diet (TED) is an approach to identify problem foods that are causing digestive or allergic symptoms in a baby or an individual. This diet focuses on stripping food intake down to between five and eight foods and eliminating all high-risk food groups.
Additional food groups are systematically reintroduced over a period to identify which foods cause illness. Food intolerances are a little bit of a mixed bag because the symptoms and causes vary widely between individuals. Some babies have digestive issues like colic, others have inflammatory issues like eczema, and some have allergic responses like hives and anaphylaxis.
Why a New TED Mama Has to Diet
Once upon a time, many babies were labeled colicky as if it was something that happened for unexplained reasons. As we have learned more about gut health and digestion, we have also learned that those colicky babies are suffering gastrointestinal distress. Our modern diet introduces many more opportunities for digestive issues like high-lactose cow’s milk and hard-to-digest eggs.
Some mamas urgently need to identify food intolerance issues because their babies suffer severe and potentially life-threatening symptoms. However, for many more, the symptoms of food tolerance are less severe but persistent sources of discomfort. Identifying and eliminating those foods is important to the health of their child.
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Common Food Intolerances (and symptoms)
Certain food groups tend to cause most of the allergic and digestive issues. For most new TED mamas, focusing on eliminating these food groups and reintroducing them one at a time will help pinpoint the cause of a specific food trigger.
Common food intolerance groups include:
- Tree Nuts
What Does Food Intolerance Look Like?
Food intolerance can cause a wide variety of symptoms in an individual patient. Inflammation, indigestion, and anaphylaxis are the most common. Chronic inflammation in babies most looks like indigestion, frequent spit-ups, and endless crying.
Inflammation of gut tissues is the root cause of this distress. Infants have more digestive issues than older children because their digestive system is still forming, and they are rapidly being introduced to new foods all of the time.
However, if inflammatory symptoms persist for more than 4-6 weeks without introducing any new foods, intolerance may be forming. In more severe cases, inflammation might also look like physical swelling (especially in the joints), chronic fatigue, fevers, and rashes.
Related: Baby Allergies
Digestive issues like an inability to break down lactose in dairy products are another common intolerance. If the gut doesn’t produce enough enzymes to break down lactose, it can lead to painful gas and bloating. Eliminating dairy, especially from cow’s milk, can help alleviate these symptoms.
And, finally, the most serious intolerance on the list is allergens. Allergies occur when a child’s immune system decides that a food product is a danger and tries to neutralize the danger by attacking it. The immune system response can cause unpleasant and sometimes dangerous symptoms like rashes and swelling that can affect airways.
Does Formula Cause Food Intolerance?
If your supply is struggling to keep up with your infant’s appetite, you will need to supplement nutrition. Commercial infant formula, which is synthetically created to match the nutrition of breast milk, is the most widely available option. But many new mama’s shy away from the idea of introducing formula to their baby’s diet.
While the formula is a viable nutrition option for millions of babies, it also causes problems for some. Unfortunately, many food allergies are not recognized until a baby is introduced to formula which contributes to the bad wrap that infant formula gets. So, what’s the deal? Is formula a good choice to supplement breast milk?
And, if not, is there a viable alternative? First, to answer the question of the safety of infant formula, it is perfectly safe for nearly every infant to consume commercial infant formula. This includes an important exception for babies who already have a diagnosed intolerance or allergy to an ingredient in the formula, or babies who require special nutrition as prescribed by their doctor.
Next, to answer the question on alternatives. The growing demand for options from health-conscious mothers has introduced supply networks of donor breast milk to fill the need for healthy alternatives. The supply of donor milk depends on excess milk supplies from nursing mothers that are willing to contribute. Since the donor milk supply chain cannot be run like a dairy farm for the obvious ethical reasons, supply stays limited and prices high.
Mothers choose to breastfeed for health and convenience reasons. The supply is always there and available as long as mama and baby are together. But it takes a lot of work to nurse a baby and time, nutrition, stress, and genetics all contribute to dwindling supplies.
The Centers for Disease Control (CDC) in the United States did a study over six years where they compared the effects of feeding habits on the long-term development of food allergies. While the majority of babies developed food allergies after birth, feeding habits were not the biggest contributing factor. Paternal allergies and maternal smoking during pregnancy were both statistically more significant among the identified causes of the study.
What we learned from this study is that using mixed feeding methods (or supplementing with formula) does not statistically cause more food allergies. Although there is an insignificant link, the need to meet an infant’s nutritional needs far outweigh any risk of developing food allergies because mixed feeding methods were used.
Risks of a Total Elimination Diet
A total elimination diet is pretty extreme for a TED mama, and should only be explored under the care of a doctor. Nursing mothers must get enough calories from various food sources, and it can be hard to maintain that calorie count when you are trying to avoid so many different foods.
Plus, in addition to meeting caloric intake requirements, the diet needs to provide balanced key nutrients by focusing on replacing nutrients in items that have been removed from the diet. For example, if cow’s milk is the primary source of calcium in the diet and milk is eliminated, a new calcium source should be provided.
Benefits of a Total Elimination Diet
An elimination diet is a useful tool to eliminate common sources of discomfort. The main benefit is that a new TED mama might finally be able to figure out why your baby is a little extra fussy and make them more comfortable.
Using an elimination diet, you can treat symptoms like:
- Stomach pain
- Skin rashes
Related: Elimination Diet
How a TED Mama Breastfeeds
The main thing to keep in mind when doing an elimination diet is that you have to replace key nutrients with other sources that are also non-irritating. Each phase should last at least two weeks to allow sufficient time for any symptoms to clear up before reintroducing any foods.
Phase One – Cleanse
Cleanse the diet by removing all high-intolerance food groups. Focus on range-fed turkey and lamb for protein sources. Stick to potatoes, sweet potatoes, and rice for sides. And replace all dairy with rice milk. Check your labels and take a calcium supplement if needed.
Phase Two – Reintroduction
Once all symptoms of cleared, you can begin reintroducing one food group at a time. Keep a detailed log of what is consumed and when and what symptoms are present. It may not be noticeable at first glance, but these records will help you identify the cause if there is a food intolerance. Introduce food groups at least four days apart (but preferably closer to two weeks) so that you have time to recognize and correlate any symptoms.
How Are Food Allergies Diagnosed in Infants?
Allergy-related disorders are commonly diagnosed chronic diseases in infants and children. As many as 4-6% of children suffer from food allergies. Two things are true of food allergies and infants. First, new allergies often develop after birth. And, second many new foods are introduced during infancy and it is common to look for an association between a new food and a new allergy.
But the thing to remember is that just because there appears to be a correlation, does not mean that one causes the other. For example, in the case of food allergies and infants fed a mixed diet of breast milk and formula, or breast milk from the mother and a donor, it is hard to say what causes the allergy. One line of thinking wants to blame the artificial ingredients in the formula. Another thought is that the difference in antibodies present in the mothers milk and the donors milk may be a factor.
Allergic reactions can range from a mild upset stomach to life-threatening anaphylactic shock. And the really scary thing is that reactions can worsen with each exposure. Children who once had a seemingly minor reaction to peanut butter can blow up like a balloon the next time they are exposed. So it is important to take all allergic reactions seriously and seek an accurate diagnosis.
This is where allergy testing can help. A doctor may order an allergy test for your infant if any of the following are present:
- Chronic Rhinitis (inflamed or irritated nasal passages)
- Known adverse reactions to a food product
- New or worsening skin rashes, eczema, or contact dermatitis
- Chronic Cold-Like Symptoms
If allergies are suspected, a special doctor called an allergist will perform appropriate testing. Depending on the reactions reported, this may include skin testing or blood testing. Using skin testing (which is common for environmental allergies), the doctor will use microdose exposure to test the body’s reaction to the stimulus and observe an allergic reaction. This test is performed in the safety of a clinical setting and uses the smallest sample sizes to limit reactions to a minimally observable level.
If the clinical tests fail to identity an allergy and the symptoms persist, a more radical approach may be recommended. This radical approach is the TED diet that we have been discussing and it is meant to test a variety of foods in small groups in an attempt to narrow down the culprit. But the TED diet takes a fair amount of self-control and presents some potential nutritional and health risks. So, again it is important to work with a medical doctor.
Should Breastfeeding Mothers Work with a Dietician?
With as much thought that new mothers put into the nutrition their baby receives, it only makes sense that they might consult a registered dietician. But when is the best time for a consult? Should a dietician work with a new mother before lactation begins or after there is a problem?
Actually─both can be really helpful. A dietician can help a new mother focus on foods that will boost lactation and balance nutrients. They can also advise on appropriate nutritional supplements and identify good and bad foods as they apply to most breastfeeding mothers.
And, because the mother received early intervention to meet their dietary needs for breastfeeding, it may make it easier to identify allergens if problems develop. If you already know that your child has a food allergy, working with a dietician may provide mixed results in terms of supporting nutritional needs. It comes down to finding the right dietician whose specialty meets your needs.
The Bottom Line
A TED diet can be another source of stress for new mothers. Instead of approaching this diet as a restriction, try to see it as a diagnostic tool that will help solve the problem rather than create new ones. You and your baby won’t be on the TED diet forever, just long enough to rule out a food intolerance. And remember, meeting your infant’s nutritional needs is the most important part, so make sure you are working with a professional before making any changes to your diet while breastfeeding.
Get the support that TED Mamas need for their TED babies! You don’t need to face this new difficult journey alone! Ray of Solace provides one-on-one wellness coaching for new a TED mama struggling with issues surrounding nutrition and postpartum. Contact Ray today to learn more.