Breastfeeding and lactose, dairy, food intolerances and allergies

Lactose is the number one sugar in breastmilk. It is the protein in cow’s milk that is difficult to digest for some babies. Human milk has human protein. It is easily digested by the stomach and absorbed in the intestines. The protein of cow’s milk is shaped different and not easily absorbed by the stomach and intestines as it’s designed to be absorbed by calves. It can sometimes make babies gassy or have poops that have bloody or mucous in them. Cow’s milk sensitivity or allergy can cause colic-like symptoms, eczema, wheezing, vomiting, diarrhea (including bloody diarrhea), constipation, hives, and/or a stuffy, itchy nose. Which can also be signs of other things. You could always try decreasing your dairy intake. Baby’s symptoms will usually begin to improve within 5-7 days of eliminating a problem food. Baby may not improve immediately, however, especially if the reaction is to a food that has been a regular part of your diet. Sometimes symptoms get worse before they begin to improve. It usually takes 2-3 weeks to see an improvement.

If baby is sensitive to dairy, it will not help to switch to lactose-free dairy products or put your baby in formula, which is cow protein based.

While culture may dictate what you can and cannot eat while breastfeeding, science does not. Most babies have no problems with anything that you eat. It’s generally recommended that you eat whatever you like, whenever you like, in the amounts that you like and continue to do this unless you notice an obvious reaction in your baby.

There is no list of “foods that every nursing person should avoid” because most of us can eat anything we want, and because the babies who are sensitive to certain foods are each unique – what bothers one may not bother another.

Babies’ guts are also constantly developing. So what bothers them as a newborn may not bother them the closer they get to a year.

Unless there are known food allergies in your family history or your baby is having severe reactions to what you think you may be eating, there’s no need to restrict what you eat. Remember: fussiness and gas is normal for a young baby, and is not usually related to foods you eat. If your baby is sensitive to something you are eating, you will most likely notice other symptoms in addition to fussiness, such as EXCESSIVE spitting up or vomiting, colic, rash or persistent congestion, crying inconsolably for long periods, or sleep little and wake suddenly with obvious discomfort. Other signs of a true food allergy may include: rash, hives, eczema, sore bottom, dry skin; wheezing or asthma; congestion or cold-like symptoms; red, itchy eyes; ear infections; irritability, fussiness, colic; intestinal upsets, vomiting, constipation and/or diarrhea, or green stools with mucus or blood. Fussiness that is not accompanied by these other symptoms and calms with more frequent nursing is probably not food-related.

Sabotaging your milk supply: working mothers who pump

The number one method to sabotage your milk supply when you go back to work is a caregiver who over feeds your baby. 

Scenario one: Baby is given a full bottle and takes 5 ounces in five minutes. Baby then spits up half the feeding and caregiver tries to give more to “keep it down”. Caregiver tells mom baby is fussy and has reflux. Baby gets put on Zantac and rice cereal.

Reality: there are several factors going on in that scenario that will sabotage a working mother’s milk supply. First, babies are not supposed to take five ounces in a feeding. Their stomach is the size of their fist and should only be taking 1-3 ounces per feeding through the first year of life. Their stomach can only hold so much and if it’s past capacity, the only place for it to go is up. I can eat a whole cake, but I shouldn’t. As an adult, if I overeat I get uncomfortable, too. I either take peptobismol or put on my stretchy pants to wait for the pain to subside. Then I don’t eat that much again.  Babies fuss and spit up for the same reason. We’re over diagnosing babies with reflux that are being fed too much or too fast.

Scenario two: Caregiver gives a baby six ounces every feeding, 3 times while mom is gone, every time the baby cries or wants to suck. Baby appears fussy and wants to suck all the time.

Exclusively breastfed babies should consume 25-35 ounces across each 24 hour day and approximately 20% of their calories should be taken over night. If you do the math, that’s a little over an ounce an hour, or 1-3 ounces every two to three hours. And in accordance to what the baby needs, mom will make that volume. So if caregiver is feeding 6 ounces three times in an 8 hour shift, you’re expecting mom to pump 18+ ounces. In reality, her body will most likely make 6-10 ounces which would be the amount she would make if she were home with her baby. In a few days of over feeding the baby, mom becomes discouraged that she’s not making enough and pretty soon she’ll start supplementing with formula

Babies also want to suck for a variety of reasons: comfort, pain, bonding, nutrition, pleasure, etc. Babies use mom as a pacifier without actually drinking. When babies are away from their mommies is very stressful, so their way to soothe is to suck.

Scenario three: Baby is given 4 ounces and chugs it down in five minutes. Baby is happy to chug down high volume and the caregiver thinks baby is just a piggy and really hungry. Baby occasionally coughs and chokes and milk comes out her mouth.

Reason: Babies have a swallow reflex that is with them at birth. When liquid reaches the back of the throat it triggers the swallow reflex. Babies are obligated to swallow otherwise they will choke or let the milk pool out of their mouths. When you see a baby chugging down milk really fast, it’s not usually because they are starving, but because they are trying to keep up with the flow of the bottle. As I said in an earlier post, there’s really no such thing as nipple confusion, but flow confusion. At the breast, other than during active let down in the first few minutes of active feeding, the baby controls the flow of milk by how they suck. In bottle feeding, the bottle will flow because gravity always wins. Caregivers need to be taught paced bottle feeding. Using a slow flow nipple, feeding baby in side lying, and frequently tilting the fluid away from the nipple to slow the baby from drinking so fast gives the baby more oral control and time to appropriately eat.

There are two kinds of receptors in the stomach: stretch and density. It should take a baby 10-20 minutes to eat from a bottle. This is also how long it takes the stretch receptors to tell the brain that the stomach is full. I can eat a whole pizza really fast, but I shouldn’t. Babies can eat a large volume really quickly, but they shouldn’t. Not only is it not developmentally appropriate, but pretty quickly the high volume needs will sabotage mom’s opinion of her perfectly healthy milk volume. She’ll turn to all kinds of milk makers: cookies, teas, herbs, etc and eventually if she’s discouraged enough she’ll turn to formula, when in reality if the caregiver would slow down feedings and give the rigjt volume, every one would be happy.

Happy pumping!!