Food Sensitivities in Breastfed Babies

In my lactation practice I am seeing more and more babies with food sensitivities (allergy and intolerances). In Australia, ten percent of babies have food allergies 1, also these numbers don’t include intolerances (non IgE mediated reactions). Unfortunately, many mothers and their uncomfortable babies are dismissed by the medical system, especially if they are gaining weight (or “thriving” – not my definition of thriving!). What tends to get ignored, is the impact on both mum and baby’s wellbeing and enjoyment of breastfeeding.  

These are all signs and symptoms of food sensitivity that I have seen in babies:

  • hives
  • rash
  • nasal congestion
  • eczema
  • cradle cap
  • low weight gain
  • unusual bowel motions (excessive number of stools or mucus or blood in stools)
  • vomiting /reflux after feeding
  • excessive hiccups or gas
  • high-needs baby
  • constant sucking
  • difficulty getting baby to sleep
  • colic
  • grunting
  • attachment difficulty / shallow latch / twisting away from the breast
  • breast refusal
  • tight jaw muscles

Food allergens cause irritation to the gut lining, causing inflammation and discomfort. This can lead to babies taking smaller feeds at the breast, fussing and sometimes refusing to feed much at all, leading to low weight gain. Low weight gain can also be caused by impaired nutrient absorption in the bowels. Other babies gain lots of weight because they have an increased need to feed for comfort.

Before trialling an elimination diet, it is a good idea to see a lactation consultant (IBCLC) or someone who is experienced in this area. An IBCLC will do a full assessment ruling out other possible causes of discomfort or breastfeeding problems (eg. lactose overload, supply issues, tongue tie). A doctor can do a thorough check to rule out medical issues such as UTI, GORD etc. Bodywork can play a role. As a craniosacral therapist I can treat unresolved physical and emotional tensions in the body that may be contributing to unsettled behaviour.

After other causes have been ruled out, the first step is to trial a dairy elimination diet for 2-3 weeks. Cow’s milk protein is the most common cause of food allergy and intolerance in babies. Some mums choose to eliminate soy as well, as many babies who are sensitive to cow’s milk protein are sensitive to soy too. If babies are sensitive to dairy, mothers should see improvement after 3-4 days of starting the elimination diet. Stools may take longer to return to a normal consistency. Parents will have to carefully read ingredient lists on packets of processed foods to ensure there is no hidden dairy. Removing cow’s milk from mother’s diet often makes a significant difference. For some mothers this is an easy venture, for others (myself included) it was near impossible. Accidental slip-ups can happen and often there are other foods causing reactions. In these cases I refer mums to a dietitian experienced with helping breastfeeding families. Mothers who need to continue any long-term elimination diet, including dairy-free, should also have their diet checked by a dietitian.

Other factors to keep in mind that can negatively impact bowel function in babies include maternal or infant antibiotics, and the oral rotavirus vaccine (that babies receive at 2 & 4 months). Discuss these medical treatments with your doctor if you have a food sensitive baby. Exclusively breastfed babies are protected from rotavirus through breastfeeding and the vaccine is non-compulsory.

As a mother of a breastfed baby who was sensitive to cow’s milk protein I know the impact food sensitivities can have on breastfeeding, emotional wellbeing and sleep. Parents may be tempted to switch to formula, but breastmilk is still the milk of choice for these babies, providing good bacteria (probiotics), a large range of prebiotics to develop a healthy microbiome, many protective factors, stem cells and gentle exposure to other potential allergens. Most formula is derived from cow’s milk protein, though there are specialised formulas for babies allergic to cow’s milk protein. These are often expensive and taste terrible. There may also be the temptation to enrol in sleep school or hire a sleep consultant, though food sensitive babies do tend to fail sleep school! This also doesn’t help remove the cause of the baby’s distress.

It is a difficult road caring for and breastfeeding, these babies. There is a lot of self-doubt (feeling you are getting parenting or breastfeeding wrong) and an overriding feeling of helplessness. Parents need support and empathy, not to be dismissed or given advice to space feeds or switch to formula.

Here’s my tips to get through the day with a food sensitive baby:

  1. Keep on boobing!
  2. Don’t worry about routines, forming bad habits, or feeding too much.
  3. Do what ever is easiest for you in each moment.

Remember this too shall pass.

  1. *Article inspired by Robyn Noble’s webinar – Recognising Allergies in Breastfed Babies.  

Resources for mothers:

Tongue-tie and Breastfeeding

A tongue-tie (ankyloglossia) occurs when the connective tissue (frenum) under the tongue causes restriction in the tongue movement or function. It occurs in 2.8 – 10.7% babies, more often in boys and can be hereditary.

Anterior tongue-tie occurs when the frenum is attached at the front of the tongue, close to the tip. When the frenum is attached further back, or behind the mucosa, the term posterior tongue-tie is used. This term does not have consensus and the topic of posterior tongue tie (and lip tie) is a controversial one. Research is limited and opinions are divided.

Photo courtesy of Monica Hogan & David Todd

Signs & Symptoms

A baby with tongue-tie may not be able to poke the tongue out beyond the gum line / lips;  and /or may not be able to lift the tongue, or move it side to side. The tongue tip may look notched or heart shaped. This may interfere with correct attachment at the breast, leading to some of these problems:

Mother:

  • Nipple pain and damage
  • Low milk supply
  • Blocked ducts / mastitis
  • Early weaning
  • Frustration, disappointment and discouragement with breastfeeding

Infant:

  • Baby can’t latch or stay latched
  • Fussiness and frequent arching away from the breast
  • Clicking sound while feeding or spilling (poor suction)
  • Poor milk transfer – frequent small feeds or long inefficient feeds
  • Low weight gain
  • Chewing or chomping at the breast

How to treat:

Frenotomy is a minor surgical procedure performed using scissors. It is quick and the baby will often settle soon after. It can be performed without anaesthesia. Scissors are often used when the frenum is thin and anterior and unlikely to bleed much.

Laser frenectomy is an effective method for “posterior” tongue-tie / submucosal tongue-tie and lip tie that controls bleeding well. This is generally performed by a paediatric dentist or surgeon. Different lasers are used: water-lase is commonly used with infants.

Risks:

Infection is rare. Some babies may become fussy at the breast for a period of time afterwards. Bleeding is common – sucking/feeding straight after the procedure usually resolves this. There is a small risk of reattachment and scarring that may require a repeat procedure. Wound stretches and other oral exercises are often advised for this reason but may distress the baby and lead to oral aversion.

My approach as an IBCLC/bodyworker:

Sadly, I have seen many parents (and babies) whose breastfeeding journeys have been negatively affected due to missed tongue-ties. Babies with feeding challenges need to have an individualised, comprehensive feeding and oral function assessment. An IBCLC can rule out nipple infections and positioning and attachment issues which may potentially avoid surgery. Since becoming a craniosacral therapist, I further understand how cranial nerve compression and tension in the body can also cause similar symptoms to tongue tie. The tongue may be restricted, but not specifically due to the presence of a tight frenum. A couple of sessions of cranio/bodywork beforehand may address these issues and have a positive impact on breastfeeding. A procedure may be avoided or it may become clearer that a release is necessary. Cranio after the procedure can help to resolve any stress and to optimise function.

There is so much controversy, and limited research, around tongue ties, that it can be difficult for parents to know whether to go ahead with a procedure to release a tie – especially with posterior tongue-ties and lip ties. Where there is doubt about the presence of a tongue-tie, cranio is a gentle, less invasive approach than laser frenectomy. But ultimately, treating the tongue-tie can make all the difference to breastfeeding success.

Contact me for a lactation consultation, tongue-tie assessment or cranio pre or post tongue-tie release.

Laryngomalacia and breastfeeding

Laryngomalacia, also known as “floppy larynx”, is a congenital condition where tissues are softer around the voice box and collapse in, partially blocking the airway. These babies tend to present first with feeding difficulties, struggling to transfer milk, and as such, lactation consultants are among the first health professionals to notice it. It may not be until around 2 months that the characteristic squeaky breathing becomes a noticable pattern. I have seen this condition quite a bit in the last few years (and most likely missed this in my first few years of being an LC), I write this article to share my experience as I have found it difficult to find information on the internet that specifically pertains to how breastfeeding looks in these babies.

What to look for:

  • Squeaky noise when breathing in.
  • Noisy when feeding or during sleep or when lying on their backs.
  • Low weight gain.
  • Poor milk transfer (breast and/or bottle); lots of pauses when feeding; long inefficient feeds.
  • Spilling or choking or coming off the breast to breathe.
  • Mouth breathing (babies should breathe through their nose).
  • Pale skin.
  • Weakness eg. floppy arms.
  • Chest retractions – skin sucking in around ribcage eg tracheal tug – when the skin sucks in at the bottom of the neck, between the collar bones.
  • Reflux is common


Breastfeeding can be challenging for these babies, as they understandably prioritise breathing over feeding. They may seem stressed when breastfeeding, stop feeding before taking a full feed and struggle to gain weight. Some babies do better when feeding from a bottle, though others struggle with bottlefeeding too; taking a long time to feed and needing to pause often. Mothers benefit from support from an IBCLC experienced in this area. We have tools to assess milk transfer and can support you with a feeding plan. It can be helpful to do a 24 milk production assessment; weighing the baby before and after feeds for a day, to work out how much extra milk baby needs. Some mothers end up predominantly pumping their milk for their baby. Though, some babies will gain enough weight with smaller, very frequent feeds. Upright positioning or any position that ensures the babies neck is extended (to open the airway) is often better in these babies.

It is important to see a doctor for diagnosis. A GP will likely refer to an ENT (ear, nose, throat) doctor. Most babies improve with time, the condition is usually outgrown during the first year of life. For babies with mild to moderate laryngomalacia, treatment is usually to wait and watch, weighing baby regularly to ensure the baby is taking enough milk to thrive, though I have worked with a few babies with severe laryngomalacia who needed to be hospitalised or have surgery.

Have you breastfed a baby with laryngomalacia? Please feel free to leave a comment below to share your breastfeeding journey so that other mothers may benefit from your experience.

Antenatal lactation consults

Occasionally I am asked to do an antenatal breastfeeding consult. This is a great idea for all women planning to breastfeed, but particularly for mothers having subsequent babies with a history of difficult breastfeeding issues; those that did not breastfeed for as long as they had planned. There is also a huge benefit of this personalised care for women with specific medical problems who suspect there may be supply issues, Having the right information and resources up front can help to optimise milk supply and breastfeeding success.

Forming a relationship with a lactation consultant beforehand makes it that bit easier to obtain help post-partum. Mums can be overwhelmed, exhausted and in pain and can be shocked to find out that there is not a lot of support within the system. This varies depending on place of birth or whether there is a free lactation clinic within the bounds of their locality. Child health nurses do their best but are often time poor and their breastfeeding education varies from individual to individual. Dads/ partners are often the ones to call private lactation consultants when they have reached a dead-end of support for their partners. For this reason it is often recommended that partners also attend breastfeeding education consults so they have the information and tips to provide support.

Having a basic understanding of the physiology of breastfeeding and what to expect from a breastfeeding newborn can make a huge difference to stress levels of new parents. Some private health funds do cover antenatal lactation consults. For a slightly cheaper option the Australian Breastfeeding Association does some great group classes on weekends – I used to teach these myself. Unfortunately you cannot rely on many hospital based breastfeeding classes – the information is minimal and sub par (please correct me if things have improved since I had kids).

If this sounds like it would be helpful, please get in touch to set yourself up for a smoother breastfeeding experience – $130 for 1.5hr consult.

Breastfeeding a baby with cows milk protein intolerance (CMPI) without giving up dairy

My second son was super unsettled. I remember it being one of the most difficult seasons of my life; looking after a screaming, unhappy baby and a toddler. I became suspicious that something I was eating was causing his discomfort. Apart from the constant crying, the only other symptom he had was constant nasal congestion (and significant cradle cap) – no blood in the stools, no rashes. I was quickly dismissed by doctors; told its normal for babies to cry.

Now I know that it was cows’ milk protein that was the issue! I want to share my story as someone who tried and failed to cut dairy from my diet (as a breastfeeding mother) and continued to breastfeed my son for over 2 years. Also to share what worked to lessen symptoms for my son (who is now ten years old, still eats dairy and no longer suffers from chronic nasal congestion). I know this information is helpful to all the breastfeeding mothers and babies that I frequently work with who are navigating this path. There can be a temptation to wean to formula, but formula itself is derived from cows’ milk protein and special formulas are often expensive, taste terrible and may be hard to access.

My sister and I with Chester
Top: My sister and her unhappy nephew. Bottom: Me, my toddler and a new unhappy baby

Cows’ milk allergy (CMA) is taken more seriously by doctors, than cows’ milk protein intolerance (CMPI). CMPI causes discomfort and often the baby is reported to be “thriving” because they are gaining weight. Whereas, CMA has more serious consequences (eg low infant weight gain, skin rashes, hives). And what about lactose intolerance? Is that an issue in babies? Lactose is the sugar component of milk. It is plentiful in human milk too. Eliminating lactose from the diet will not eliminate lactose from breastmilk. It is very rare for babies to have primary lactose intolerance, it’s often not the lactose that’s the problem, but the protein (casein, whey).

There is a lot of misinformation and confusion, even among health professionals. Amidst this confusion, parents of babies with CMPI are unsupported by the medical system. The burden lies with the mother who suffers through those precious early days, her heart breaking over not being able to help her unhappy baby and often no one in the family getting much sleep. In my case, health professionals were quick to offer me treatment in the form of antidepressants, which I refused. With a background in mental health nursing, I knew it was a situational crisis – the answer lay in finding the root cause of my son’s discomfort (and now it’s a passion of mine to encourage all mothers to do this!).

When he was a few weeks old, I decided to trial cutting out dairy from my diet and failed miserably! I normally eat like a bird, so reducing a major food group left me feeling more tired, stressed and miserable than I was already (and hungry!). I would do fine for days then demolish a large bar of chocolate – feeling really guilty. I really craved my morning cup of tea (with milk). I do feel I am strong willed by nature, but not in this department. Joy Anderson* (Dietitian and IBCLC) who specialised in this area, makes mention that the more addicted you are to a food, the more likely it is to be the offending substance.

Time passed and the intensity of those first few months faded as his attention was directed more at the outside world and less on internal sensations. Still the nasal congestion didn’t go – he was a really snotty kid with frequent ear infections (often babies will grow out of their food sensitivities, but my sons stuck around). I was told by another doctor that he had hayfever. It wasn’t an environmental sensitivity, it was food. My maternal gut instincts were confirmed, when at the age of six he told me “Mummy every time I drink milk, I get snotty”.

I am now reflecting on what has worked to reduce nasal congestion for my son over the years (he also found it unrealistic to give up dairy) as I currently implement this strategy in order to treat my dermatitis. If you are finding that dairy is contributing to your baby’s symptoms and are freaking out at the thought of giving it up. Here’s what I found in our case:

  • A2 milk is a lifesaver! My son may get a little bit snotty but he is able to clear it. I feel regular milk causes inflammation (aswell as mucus) that makes nasal passages difficult to clear. A2 milk has a protein that is better tolerated by those who are sensitive to A1 protein (found in most milk products).
  • Butter and cream are mostly fat, with a little bit of milk protein and may be tolerated.
  • Avoid processed foods with milk products in them (e.g. milk solids, skim milk powder).
  • Eat chocolate that is dairy free (e.g.dark chocolate or raw chocolate).
  • Cheese and yoghurt can be less troublesome for sensitive folk (with my son its hit and miss). The addition of enzymes (in cheese) and the fermentation process (in yoghurt) change the structure of the protein making it easier to digest for some.

Cutting out dairy for 2-3 weeks is often first line strategy for suspected cows milk sensitivity. For some mothers it is easy, for others its impossible. Some mothers may be able to get away with a low dairy intake.

*This is my story of my journey and what I have learnt along the way but it may not work for everyone. For more support there are dietitians who work with breastfeeding dyads who can provide individualised advice.


Please contact me if you suspect your baby has a cows milk sensitivity. As someone who has walked the path personally, and worked with lots of breastfeeding mothers with sensitive, unsettled babies, I can support you in working out the cause of your baby’s discomfort. Phone consults, clinic and home visits available.

Other resources:

All Good Things…

After 4.5 years at Baby Steps Health Centre, I have made the decision to leave so that I can focus fully on building Flow Cranio & Lactation. I have thoroughly enjoyed my time working there and am grateful to the team for their support and expertise.

But all good things must come to an end.

If you first met me through Baby Steps please let your friends and family know to book me for lactation support through my business rather than the clinic.

If you, or your baby, have benefited from my lactation or cranio support – please tell your family or friends or other mothers at mothers group. Or consider writing a google or Facebook review.

Thanks for your support xx

Clicking while feeding

Clicking at the breast was the theme for last week. Clicking on its own can be normal and nothing to worry about though its worthwhile seeing an IBCLC if it presents alongside other concerns eg. latching issues/ sore nipples / fussiness at the breast or unsettled behaviour after feeds. Clicking is a temporary loss of suction/seal and can have many causes:
– it may simply be evidence of a baby trying to keep up with a fast flow of milk,
– it may be associated with tongue tie or lip tie
– or cranial nerve compression (the nerves that control the tongue / suck swallow breathe coordnation are not functioning optimally due to compression from birth).
– or may be related to jaw issues (assymmetry, tight jaw etc)
Cranio and lactation support may make a difference.