Breastfeeding a Baby with Food Allergies

Breastfeeding a Baby with Food Allergies

You have been exclusively breastfeeding your baby since she was born with no issues. She is tolerating your milk, growing appropriately, and hitting the important milestones. Once your baby reaches 4-6 months of age, it may be time to start introducing solid foods.

While this milestone is a cause of excitement to families, it can also induce some anxiety if a parent has ever had experience with a baby or child with a food allergy. Six million children in the United States have a food allergy, and food allergies have more than doubled over the last generation.

So what advice should a nursing mom take when breastfeeding her baby with a food allergy? Along with the guidance of your pediatrician, experts now recommend that babies should be exposed to small amounts of potentially allergenic foods early and often to build up a tolerance and expose your baby early in life. Recent research suggests this actually reduces the risk of your baby developing a food allergy, regardless of whether there is a family history of allergy. 

There are also situations where a breastfed baby may present with food allergy symptoms even before she is fed solid foods. This would be a result of mom eating a protein from her food that causes a reaction in her baby. This happens most often with milk, soy, and egg proteins. 

What causes food allergies in breastfed babies?

Unfortunately, the true cause of a food allergy is not clear. We do know that the chances of a baby developing a food allergy are higher if there is a family history of food allergy (a parent, both parents, or a sibling have a food allergy).

If a baby has an allergic reaction after eating something, her body is having a negative response to a specific protein in a food. Her body is essentially telling itself that this protein that she ingested from a food is “foreign” and will trigger a response as a result. The response may include vomiting, hives, or other unwanted and possibly scary outcomes. 

While we can’t predict whether a baby will develop a food allergy, we do know that there are certain risk factors associated with developing a food allergy. As mentioned previously, having a family member with an allergy or allergies is a risk factor. Other risk factors of developing certain allergies include delivering a baby via c-section instead of a vaginal birth and baby being exposed to tobacco smoke. 

What Factors Could Reduce the Risk of Your Breastfed Infant Developing a Food Allergy

  • Being around pets in the home and growing up on or by a farm with livestock have been shown to reduce the risk of developing allergy in children.
  • Exposure to certain beneficial bacteria called probiotics may play a role in allergy risk reduction. Data is suggesting that mom’s microbiome during pregnancy may play a role in your baby’s risk of developing certain allergies. Therefore, mom may want to consider taking a probiotic supplement or making a point to eat probiotic-containing foods while she is pregnant.
  • Breastmilk contains natural probiotics as well as other factors that may protect your baby from developing allergies. This is one of the many reasons why exclusive breastfeeding is recommended.

Can food allergies be passed through breastmilk?

A baby needs to be exposed to a protein once and then may have an allergic reaction the second time the baby is exposed. Baby can become exposed to a certain protein via food or via breastmilk. Food allergies aren’t passed through breastmilk per se, but certain proteins that come from mom’s diet may pass through the breastmilk. That protein may sensitize the baby to have an allergic reaction to that same protein later. 

If a baby has a known allergy to a certain protein found in a food, mom should make a point to avoid that protein in her diet until baby has weaned off of her breastmilk.

The fact that proteins can be passed through breastmilk should not deter a mother from breastfeeding her child. A baby could also potentially have a reaction to cow’s milk-based formula or soy formula. While breastmilk can potentially pass a triggering protein to baby, it also provides baby with many immune-protecting factors like immunoglobulins and probiotics that will likely benefit her for the rest of her life. 

Signs and symptoms of a food allergy in a breastfed baby

There is a common group of signs and symptoms that usually manifest in a breastfed baby.

Allergic symptoms may begin within minutes to an hour after ingesting the food. The following are the most common symptoms of food allergy. Symptoms may include:

  • Vomiting
  • Diarrhea
  • Cramps
  • Hives
  • Swelling
  • Eczema
  • Itching or swelling of the lips, tongue, or mouth
  • Itching or tightness in the throat
  • Difficulty breathing
  • Wheezing
  • Lowered blood pressure

Allergic reactions to milk and/or soy may manifest differently. Some of these symptoms may include: 

  • Excessive fussiness
  • Blood in your child’s stool
  • Poor growth
  • Poor and short feeding sessions

If you have a baby that presents with any of these symptoms, you should contact your health care provider. 

Most Commonly Allergenic Foods

A baby can potentially have an allergic response to any protein. However, approximately 90 percent of all food allergies are caused by the following eight foods, and should be the focus:

  • Milk
  • Eggs
  • Wheat
  • Soy
  • Tree nuts like hazelnuts, cashews, and Brazil nuts
  • Peanuts
  • Fish
  • Shellfish

Additionally, allergy to sesame protein is on the rise.

Most children will have an allergy to more than one food.

The good news is that many children will outgrow their allergy as they grow older. 

Should I stop breastfeeding if my baby has a food allergy?

Short answer: No! Women should make their best effort to continue to breastfeed for as long as mother and child desire. According to the World Health Organization, “mothers worldwide should exclusively breastfeed infants for the child’s first six months to achieve optimal growth, development, and health. Thereafter, they should be given nutritious complementary foods and continue breastfeeding up to the age of two years or beyond.” There is no caveat indicated in the World Health Organization’s statement to stop breastfeeding if an allergy manifests.

Mom should continue to breastfeed but avoid the triggering protein in her diet and in her child’s diet. Families should also be aware of any nutrient gaps that may occur as a result of eliminating a food from the diet. This should be discussed with the family’s doctor or registered dietitian-nutritionist. For example, if milk proteins are being avoided, calcium supplementation may be indicated depending on which other foods are being included in the mother’s or baby’s diet. 

To reiterate: a mother should not stop breastfeeding based on the sole reason of her baby having a food allergy. 

What can I do to prevent this from happening to my baby?

In the past, families were told to avoid the highly allergenic foods mentioned previously until the baby is two years old. Once that recommendation was implemented, allergy prevalence grew. Interestingly, the increase in allergies was not observed in countries that do NOT avoid highly allergenic foods like peanuts and soy. 

Data is now confirming that avoiding these highly allergenic foods are actually setting children up to be more likely to develop a food allergy. 

Experts are now recommending that babies be exposed to small amounts of these potentially allergenic foods mentioned above (like peanuts) early and often to build up a tolerance and expose baby early in life. Data is now suggesting that the early and often exposure approach actually reduces the risk of baby developing a food allergy herself, regardless of whether there is a family history of allergy.

Once your baby is eating solid foods, it is advised to feed her a variety of foods. This will expose her to a variety of proteins. If a highly allergenic food is being fed and baby tolerates it well after a few exposures, that same food should be offered often to continue to build up the tolerance. Thereafter, it will hopefully reduce the risk of developing an allergy. Only a small amount of the protein is needed for adequate exposure (approximately 2 grams in some cases). Fish and eggs can be easily mixed into a traditional baby food puree. A teaspoon of peanut butter can be mixed into your baby’s oatmeal with little risk.

These steps for exposure to various allergenic proteins should be discussed with your baby’s pediatrician before trying this at home. There are some powders that are available for purchase that are tasteless. These are made of small protein particles to expose your baby to that particular protein. As your baby gets older, make a point to prepare foods made of varying foods often. Try not to feed your child the same thing over and over again. Variety is key.

Allergies are a valid concern for many families. Thankfully, expert panels like the American Academy of Pediatrics and the American Academy of Allergy Asthma and Immunology are in consensus. They agree that exclusive breastfeeding followed by exposing babies to potentially allergenic proteins early and often may reduce the risk of baby developing allergies herself. Having an expert consensus should allow families to have the confidence to follow these evidence-based recommendations. 

REFERENCES

American Academy of Pediatrics. AAP Clinical Report Highlights Early Introduction of Peanut-Based Foods to Prevent Allergies. https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Clinical-Report-Highlights-Early-Introduction-of-Peanut-Based-Foods-to-Prevent-Allergies.aspx

American Academy of Allergy Asthma and Immunology. Prevention of Allergies and Asthma in Children. https://www.aaaai.org/conditions-and-treatments/library/allergy-library/prevention-of-allergies-and-asthma-in-children

Children’s Hospital of Philadelphia. Top 8 Food Allergies in Kids and What Parents Need to Know. https://www.chop.edu/news/health-tip/top-8-food-allergies-kids-and-what-parents-need-know 

Immune Tolerance Network. Clinical trials investigating how to best prevent Peanut Allergy. http://www.leapstudy.co.uk

US Food and Drug Administration. What You Need To Know About Food Allergies. https://www.fda.gov/food/buy-store-serve-safe-food/what-you-need-know-about-food-allergies

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