Why do I feel flamed?
I am hypersensitive I'm sure. Call it sleep deprivation. Dd does not sleep, and I am WAY tired. After I "cheated" and had some real food over the last few days, my infant has been miserable. I have not had longer than a 30 minute stretch of sleep for 3 days.
ALSO, as a larger source of grumpiness, I had to choose between nocate for my currant infant who has MFPI OR eating an extremely limited diet that consists of nothing more than peaches, buffalo, and wild rice. BUT, because I am so dedicated to nursing I have been willing to do that for more than 9 months, despite the fact it makes me cranky.
PLUS, during the seven years I've been dealing with my own kiddos with majorly severe food allergies I've read just about everything out there and then some and pestered just about every doc and holistic practicioner in my town.
Its a sore spot, the food allergy issue. But, I don't think I was objecting so much to being challenged, as the WAY I was challenged. One or two of the posters (and it doesn't matter who) more or less came right out and accused me of posting BAD and possibly dangerous?? information.
I'm paraphrasing but what I GOT was:
Boy, there are THINGS on that list that are WRONG. Shouldn't someone edit this so people aren't mislead?
Wouldn't it have been far more friendly and helpful to have posted something like:
'Gosh, that is an interesting list. Are you sure about XYZ information because I have heard differently. Do you mind sharing with me where you got your information? I really want to make sure nursing mothers get the best possible information!!'
I bet I would have responded a LOT differently. Wouldn't you have??
It is the difference between "debate" where there is a winner and a loser, and "reaching understanding" where we all win. I don't want to debate, but I'd be glad to try to reach an understanding. But, that requires putting down the dueling pistols, or the dueling experts, so to speak.
Anyway, I promise not to let my sleep deprivation get the better of me. So, I changed my mind and I'm back, and I’ll even stop moping now even though I'd KILL for a DQ sundae like the one being advertised behind me on TV RIGHT NOW!!!!
Beyond this, call "flame" a poor choice of words. I actually am not really offended since I am pretty hard to offend. I just wasn’t sure I wanted to take the time to respond in detail mostly because it seemed the response to my post was, shall we say, inordinately harsh?? And, because I am a busy SAHM of three who is really sleep deprived and was not expecting such controversy.
Anyway, here goes a long, long, long, answer. Bear with me:
Firstly, it is helpful to understand the definition of “allergy”. At ONE point different food induced responses were called variably “intolerance, allergies, or sensitivities” depending on their symptomology. But, allergists these days simply refer to ANY negative immune response to a food as an allergy. These responses can be IgE mediated, or the more typical food allergies we hear about (like to peanut) or they can involve other parts of the immune system and, consequently, other areas of the body. There is a wealth of information out there on allergy in general, but these review articles are pretty good summaries. I choose these articles because they are readable, and available on line in full-text form. BUT you can find hundreds of recent articles on food allergy backing up a lot of the physical symptoms I listed.http://pediatrics.aappublications.or...ode=pediatricshttp://www.aafp.org/afp/990115ap/415.html
To pull out a few key points: Only a small subset of food allergies, those typically associated with IgE antibodies show up on traditional allergy tests. So-called “true” food allergies, the ones that can result in typical anaphylaxis, are present in about 8% of the pediatric population. It is NOT uncommon for a child with documented gastrointestinal food allergies to test negative on RAST or skin testing. Also, the kinds of allergies that cause lower GI discomfort, gassiness, colitis, and cramping are usually not the kind that show up on food allergy tests.
Because there are no convenient medical tests for the other kinds of food allergies, and their symptoms can be varied and uniquely effect each person, there are no clear numbers for the percent of the population who have non-IgE mediated allergy. HOWEVER, we can get a clue for how high these numbers when you read studies like the following. The first one indicates that REFLUX is caused or worsened by cow’s milk allergy in at least 50% of all cases of reflux. Other smaller studies show even higher percentage of causality.http://pediatrics.aappublications.or...ode=pediatrics
Colic is well known to be associated with cow’s milk and other proteins in mother’s milk.
So, is food allergy rare? Given the prevalence of colic, reflux, and true food allergy in the pediatric population I’d say rare is really not a correct designation.
So, how about my dreaded list of food allergy symptoms: To start, here’s some lists, similar to mine, from a few well-known references. My list was synthesized from these sources AND others, and put in non-medical terminology. I’ve also used experience as a lactation consultant to come up with additions to these lists, but I think you’ll see that nearly every thing on my lists are backed up in these references. In fact, I exclude SOME things on the list because (in my experience) these are generally not present in exclusively breastfed infants before they are given solids directly. I have also excluded some symptoms also because, in my experience, they tend mostly to be found in older children past the first year.
|From “The Nursing Mother’s Companion 5th Edition” page 150-151
If your baby pulls away from the breast crying and refuses to nurse, don’t assume he is ready to wean. There are a number of possible reasons for this behavior but when it persists it can frequently be traced to certain foods in the mother’s diet to which the baby is sensitive. Typically this behavior starts when the baby is two weeks of age. He may also act fussy and have very frequent, sometimes greenish, stools. Other symptoms may include gassiness, redness around the rectum, a mild rash anywhere on the body, or a stuffy nose. Fussiness while nursing and refusal to nurse may occur sporadically or may increase as the day goes on. Although baby refuses the breast, he may eagerly take breastmilk from a bottle
(That last sentence sounds a LOT like bottle preference, does it not??)
Here’s a list from the same reference about symptoms of “reflux” from page 155. If you read the description Huggins goes on to associate reflux with food allergy in many if not most cases. Since we already established (see studies above) that a great deal of reflux is caused by allergy, the symptoms lists will overlap.
|Symptoms of this problem can include sudden or inconsolable crying, arching during feedings, refusing the breast or bottle, frequent burping or hiccoughing, bad breath, gagging or choking, frequent throat inflammation, poor sleep patterns, slow weight gain, frequent ear infections…”
Some babies with reflux will seem to want to eat all the time and may grow very fast.
(Sounds like cluster nursing doesn’t it??)
|Other babies may not only cry after and in-between feedings, but they fuss at the breast and may refuse nursing altogether. Oddly enough they may take that same milk from a bottle that they would not take from the breast.
(Again, there is that pesky bottle preference).
|Some babies seem to suffer more with lower belly discomfort than with regurgitation and heart burn. Besides crying these babies symptoms may include gassiness; stools that are very frequent or green, mucas, or even bloody; and redness around the rectum. A baby may have a stuffy nose or a rash on her face and upper body. She may want to nurse all the time.
(There is that cluster nursing again.)
|From “Breastfeeding and Human Lactation (2nd edition) by Riorden and Auerbach page 656.
Vomiting may be accompanied by chronic diarrhea, colic, colitis, excessive crying, reluctance to feed, and poor sleep patterns. Eczema, uticaria, a severe diaper rash, and excessive pallor may also be present. Individual infants may respond differently to allergenic foods.. […..] one infant may develop diarrhea, colic, or GI problems; another may respond through his central nervous system and become irritable or hyperactive; and a third may have dermatological symptoms such as urticaria or eczema.
“The list of allergy symptoms is long: an allergic child may have rhinitis, otitis media, coughing, asthma, conjunctivitis, nausea, vomiting, anorexia, and frequent respiratory infections.
|From "Breastfeeding: A Guide for the medical profession (5th edition).” By Ruth A. Lawrence (Page 626.)
Symptoms associated with food allergy include asthma, urticaria, and rhinitis as well as colic and failure to thrive with chronic respiratory and gastrointestinal disease. [….] Sleep disturbances have been reported in a series of children evaluated with a prospective double blind crossover design. Another symptom reported in two siblings was insatiability despite adequate weight gain. This was confirmed by history and reproducible reaction to dietary elimination and subsequent oral challenge.
(Insatiability is a baby who seems to want to nurse all the time, and looks a LOT like “cluster nursing”.)
|IgE-mediated reactions can include symptoms in the upper gastrointestinal tract such as nausea, vomiting, reflux, refusal to eat, and eating ravenously; lower GI symptoms may include blood in stools and diarrhea. IgE-mediated disease can also cause respiratory symptoms such as wheezing and perpetual congestion; atopic dermatitis, eczema, and various rashes; an extreme reaction is anaphylaxis which leads to cardiovascular collapse and shock. Symptoms of non-IgE-mediated allergic disease (or cow's milk colitis) are usually limited to the lower GI tract, causing diarrhea and blood in the stools. The presence of symptoms outside the gastrointestinal system generally indicates IgE-mediated hypersensitivity.
From the Sears website:http://www.askdrsears.com/html/4/t041800.asp#T041803
Notably, here is the list of some of the behaviors some of which really would only be readily apparent in an older child, but would show up as fussiness, crankiness, and “high needs” in an infant.
sore muscles and joints
From beloved Kellymom:http://www.kellymom.com/babyconcerns...ity.html#signs
|If a breastfed baby is sensitive to a particular food, then he may be fussy after feedings, cry inconsolably for long periods, or sleep little and wake suddenly with obvious discomfort. There may be a family history of allergies. Other signs of a 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.
I want to note, however, that I actually don’t agree with her that food allergies and sensitivities in breastfed infants are rare. As I said above, something that includes 8% of the pediatric population, and also MAY include a large percentage of infants who have “colic” or “reflux” may not actually be very “rare”.
And from another place in her website:http://www.kellymom.com/nutrition/so...s.html#allergy
|Following are some reactions that may help you recognize an allergy in your baby:
Skin rashes (for example, a sandpaper-like raised red rash on the face), eczema, hives
Runny nose, stuffiness, constant cold-type symptoms
Red itchy eyes, swollen eyelids, dark circles under the eyes, constant tearing
Diarrhea, mucousy stools, intestinal upset
A red rash around the anus
Generally cranky behavior, fussiness, irritability, colic
Vomiting or increased spitting-up
Poor weight gain due to malabsorption of food
I included on my list only the symptoms that seemed to be most common in the breastfeeding mothers I was in contact with who were exclusively nursing their infants.
BUT, LOTS of lists including most everything I have on my list, right?? In fact, many of the symptoms on my list are on nearly every one of the other lists.
Oh yeah, AND lots of respected sources USE lists as a way to help a mom and/or figure out what MIGHT be happening with her infant. So, I guess lists are not inherantly mis-leading??
OK, now on the MAIN points of disagreement. I don’t think people were really disagreeing with MOST of the list, especially the physical symptoms that are pretty well documented. I suspect that MOST of the disagreement really falls to TWO main points I list under behavior. The sleep information, btw, shouldn’t even be in dispute. Poor sleep patterns are mentioned in just about every list of food allergy symptoms. And, if you want a good sense of what constitutes “normal” sleep there are a number of excellent books that review sleep cycles and patterns in young children. You can look up the stats yourself or how long an infant generally sleeps and by what age, and what infant sleep cycles look like.
So, the two MAIN issues of disagreement seem to be “cluster nursing” and “wanting to be held all the time” (the high needs personality).
Firstly, the “cluster nursing”. I think it is important, even critical, to have a definition of what clinically constitutes cluster nursing.
Cluster nursing is a period of VERY frequent nursing, generally at night or in the early morning that is typically followed by a period of deep sleep. Cluster nursing is most apparent in the first few days after birth, at 3 and 6 weeks, and during other growth spurts in an older infant. And, this is a very loose definition. In fact, Riorden only uses the term “cluster nursing” to refer to the nursing pattern present in very young infants in the first 2-4 days of life when they are establishing milk supply. In her close to 800 page textbook, which is often seen as one of the “bibles” of lactation information, cluster nursing is not mentioned one other single time other than in the immediate neonate period.
But, MOST importantly, cluster nursing is something that happens in a normal infant WHEN that infant is gaining normally, is generally content at other times of the day, and does not exhibit other clinical signs of colic or reflux.
The PROBLEM here is that cluster nursing is used in a general way to describe any infant who is nursing frequently for extended periods of time. Unfortunately, inexperienced lay counselors often call things "cluster nursing" and tell them not to worry when; in fact, mom has an actual problem. It is inadvisable to tell ANY mother that cluster nursing is “normal” unless you have asked her for additional details about baby’s weight gain, general behavior, sleep patterns, and health, and stooling pattern. ONLY when everything else seems fine should you jump to the conclusion that the behaviors is innocuous "cluster nursing". This is simply good LC practice. Assume that there PROBABLY is no issue, but make DARNED SURE you have the entire picture before offering an assessment.
Here are some issues that can “CAUSE” that very frequent nursing often referred incorrectly as cluster nursing.Low maternal milk supply:
A mom who has low supply can have a baby who seems to want to nurse ALL the time. This constant nursing is generally worse in the evenings when low supply tends to be most apparent. The main way to distinguish this is that the so-called “cluster nursing” lasts all day, and is accompanied by sub-normal weight gain.OALD and oversupply:
A mom who has hyperlactation syndrome often has a baby who seems to want to nurse all the time. This occurs because baby is rapidly filled up on lactose rich foremilk, which dumps rapidly into the intestines leaving the stomach empty. Baby will often then “feel” hungry again after a short period of time and want to nurse. This is differentiated from “cluster nursing” because baby usually seems colicky or gassy much of the day, may have green frothy and frequent stools, and may gain weight excessively rapidly in the early weeks (upwards of 2 ounces a day).Colic/reflux/food allergy:
I don’t think I need to repeat the references above, but both these disorders are associated with very frequent nursing often incorrectly, but commonly, called “cluster nursing”. Most of the food allergy lists contain “constant nursing” which can be mis-represented as cluster nursing. So, I’m not sure THAT should be in debate either. Obviously, many reliable sources indicate that a baby who seems to want to nurse all the time might be symptomatic of a food allergy.
I actually think it is far more dangerous to simply tell some mom “oh don’t worry, cluster nursing is normal” than to have some mom see “cluster nursing” on a list of POSSIBLE symptoms of food allergy. But, yes, if it is semantics that is causing the main issue here, I’ll gladly remove the term “cluster nursing” from my list and replace it with “long periods of constant nursing where baby does not seem satisfied at the breast”. The reason I used cluster nursing is because it is the way moms describe this KIND of pattern of nursing in their own words.
The second area of “concern” is the description of an allergic baby vs the so-called “high need” baby. In other words, this paragraph:
|- Fussiness: seeming to always want to be held, and are rarely content when on their own. They often hate the carseat. The fussiness may not be soothed even by carrying, holding, or rocking. When younger, they might have been diagnosed with "reflux" or colic. They may have a definite evening colicky period starting at about 2-3 weeks of age that expands gradually to encompass more and more of the day as baby gets older.
And, yes, “high needs” babies often want to be held all the time and are very attached. And, yes, many of the behaviors of allergic babies overlap with the “high needs babies” BUT, and this you can only take from my personal experience, food allergies look a LOT like the description of “high needs” babies Sears gives. So, how can you tell the difference? An allergic baby usually has other confirming symptoms of a physical nature, and will dramatically improve in mood and irritability when the food allergens are removed from the diet.
THIS, is harder to back up with medical research papers because main-line medicine tends to dismiss behavioral connections to food sensitivity. But, you don’t have to look hard to find annecdotal evidence supporting the idea that food allergens can make a baby needy and miserable, and eliminating the foods can make a world of difference in baby's outlook and mood and level of contentness AND, everyone knows what a colicky baby and a refluxy baby looks like. So, clearly since food allergies are related to those issues, then food allergies can cause behavior issues. Even all of the list above include one or two behavioral signs of food allergy. Why should it not? A uncomfortable baby is going to exhibit all the same kinds of behaviors an ADULT shows when they are in discomfort: neediness, irritability, etc, etc.
Does that mean that all ‘high need’ babies are allergic?
Does that mean that “high need” babies have a pathology?
I, in fact, have THREE BABIES/children who are BOTH high need AND allergic. And, I can tell you that it actually is not hard to separate the behaviors in my children that result from food issues, and the behavior that is driven by their intense personalities.
Oh yeah, and THIS is from the Sears website:
|Our daughter-in-law, Diane, shared her experience as a colic detective: "At three weeks of age Lea started to cry all day long. She would awaken in the morning fussing, and by late afternoon it would turn into uncontrollable screaming fits. There was no way to calm her down. After a few sucks at my breast, she would throw her head back, arch her back, and start screaming. Within three days of eliminating all dairy products from my diet, her colic greatly improved. I'm glad we didn't just accept that she was 'colicky' and that 'some babies just cry all the time'.
In MY experience a LOT of so-called high need fussy infants improve dramatically when the problem foods are eliminatd from the diet. Apparantly, Dr. Sears agrees as well.
AND, what about bottle preference? Well, it is pretty clear that breast refusal is a common result of food allergy. More than one list mentions that above. AND, just as listed in Huggin’s book, these babies OFTEN will take the milk from a bottle. Voila, bottle preference. Incidentally, other causes of bottle preference are low maternal milk supply, ear infection, stuffy nose, sore throat, and mouth sores, and teething. In most cases, a fast flow nipple IN AND OF ITSELF will not cause bottle preference unless baby also has some other involved factor. With a WORKING mom who is pumping and bottle feeding a great deal, the most COMMON cause of bottle preference is low supply. COULD bottle preference BE a result of the faster flow of a bottle. Yes, it is possible, but I doubt it. I rarely have come across a mother/baby dyad where some OTHER factor was not contributing to, or causing, the preference. This is from my CLINICAL experience, btw. There simply aren’t any studies out there on late-onset bottle preference. Lots of people have their own OPINIONS, but there isn't a single study out there about this particular issue. SO, we all rely on our clinical experience.
Anyway, so WHO AM I? Well, you may or may not care since I am really trying hard NOT to post as any kind of so-called expert. (Thus my apology for the way I introduced the thread). I am a mother of three allergic infants the oldest of whom is seven. I am the member of an active group of breastfeeding mothers who are dealing with infants with food allergies. I am a lactation consultant with 5 years experience and the co-host of an expert moderated breastfeeding board co-hosted by Kathleen Huggins the author of the “Nursing Mother’s Companion”. I was trained by Kathleen, and have worked closely with her for the last 5 years. I also helped her edit the most recent edition of her book. If you look closely and are curious you can find me referenced there. In the five years I have been Kathleen’s co-host we have fielded probably 10,000 questions from nursing mothers, many of them about allergy, reflux, and colic. Because of my personal experience, and the experience of these mothers, I have become a quasi-specialist in nursing allergic infants.
So, after ALL that I do stand by my assessment that, in my clinical experience babies who waken unusually frequently with NO longer sleep stretches often are uncomfortable for some reason. When the sleep problem persists before the typical periods of time for infections, cold, teething, etc, food sensitivities are VERY often to blame. MOST babies, even young babies, will sleep at least a three hour stretch from a young age (and yes you can back this up with sleep research, look around). Babies who wake every 1.5/2 hours all night long, night after night, are being bothered by something. The something CAN be many things (low supply, teething, illness, ear infection) but is VERY often food sensitivities especially when the behavior persists and other causes have been ruled out.
So, some of the above is from my clinical experience, and some from personal experience, and it doesn’t really matter to me if you “agree” per se. You are free to disagree, to read up, to explore, and even to find OTHER clinicians who disagree with me. We all have unique perspectives. And, in the end I don't WANT anyone to just out an out agree blindly. Either what I posted make sense to you, or it doesn't. You may NOT agree with me, but it isn't "wrong". Some issues having to do with lactation and/or food allergy don't come DOWN to "right" or "wrong" which is why there are all kinds of ways you can gather information out there INCLUDING boards like this one.
And, last but not least, as a MOTHER of three beautiful attached children, and not as a clinician, I do NOT think it is unreasonable to expect a young infant to be content on the floor or in a bouncy chair for 15-30 minute stretches a couple times a day. Most babies are. Even SEARS (Mr AP) admits that "most babies" are NOT "high needs infants". A baby who cries the MOMENT you set them down for any reason could just as easily be an uncomfortable baby as a high needs baby. AND, we all deserve the chance to use the toilet without having to balance a baby on our lap even if baby has to be RIGHT THERE on the floor in a bouncy.
Peace and a good night to you all.