A few weeks ago, I posted about my experiences so far with breastfeeding and my son’s suspected food intolerances. He was really fussy and his diapers were characteristic of having a reaction to food, so I started eliminating foods from my diet in an effort to try to rule out the triggers.
At that point when I posted, I had been “off” of dairy and soy for a few weeks (those are the two most common foods that cause issues, and together the condition is often referred to as MSPI – milk soy protein intolerence). I had also more recently cut out eggs, beef, and fish. Once I had eliminated those other foods for 2 full weeks, we went back in for an appointment with our pediatrician who tested two diapers again – and unfortunately, both came back positive for traces of blood.
However, the ped said that looking at the diapers themselves, he didn’t think they looked too bad – the appearance didn’t seem to indicate any severe level of intestinal inflammation. In addition, our little guy is growing great and has been SO happy and rarely fussy since I’ve cut out all these foods. He also stopped fussing after feeding, which could be related to the eliminations or starting him on reflux medication (or a combination of both). In other words, he’s thriving in every way with the exception of having non-normal looking diapers.
But our ped wanted to check with a pediatric GI doctor to get another opinion, which I appreciated. I asked the following questions for the GI doc. I’m including his input and my thoughts…
{Disclaimer: I am not a medical doctor. While I am a Registered Dietitian, these thoughts are in no way meant to be medical or nutritional advice. This is an informative post about my experiences and thoughts. If you have questions about your child’s health or what to do for food intolerences, please consult your doctor or dietitian for a personalized consult.}
Q1: Am I doing more harm than good in continuing to breastfeed if we cannot pinpoint every trigger food?
He feels the answer is no, and I should continue breastfeeding. While this isn’t a clear cut case, he doesn’t personally think it’s a major concern with slimy diapers (even if they are testing positive for microscopic traces of blood) as long as we are not seeing visible blood AND our little guy is growing well and is happy. If we start seeing visible blood, he gets super fussy, or has problems growing – that’s when we would be more concerned. Breastfeeding offers so many benefits that it likely outweighs any potential negative effects from foods that might be causing some irritation. This made me happy to hear, but part of me still does worry!
Q2: Would it be beneficial to try an infant probiotic?
The GI doc said it could be beneficial to try, but didn’t think it was 100% necessary. The RD in me sees the benefit in trying it, as more and more research is showing that they can be helpful for a variety of issues in babies. My only concern is that supplements are not well regulated, so it makes me a tad nervous to introduce something new into his system at a young age. I think if I research some manufacturers and find a good option that is trustworthy, I will try to introduce one and see if it improves his diapers at all (which would indicate an improvement in intestinal irritation).
Q3: Should I eliminate more foods?
The GI doctor said he thought it would be very extreme to eliminate anything else. I decided from a personal and professional angle that I thought it would be worthwhile to try eliminating the other two major allergens – wheat and nuts – to see what happens. I figured it’s only 2 weeks to see if there’s an improvement, and if there’s not, then no harm is done except making it a little tougher for me to plan dinners for a few weeks.
Q4: What are the long term implications of these types of intolerences?
The GI doc confirmed what I found out when I started scanning the research (I spent hours on pub med!) – there is not much out there on these types of food intolerences where babies are otherwise thriving. I think in general we are going to see a LOT more on the relationship between gut health and overall health in coming years, so my guess is that we should see more research on this in the future. The GI doc said most babies grow out of these intolerences as their digestive system matures, which is great, but there could be some longer term implications for allergies/asthma/etc. It’s just somewhat unknown at this point.
Q5: Recommendations moving forward?
If the current eliminations are not improving the appearance of the diapers, he thinks it’s probably okay to start adding in one food at a time over the course of 2-3 weeks. If there is no change in anything – i.e. he doesn’t get fussy, we don’t start seeing blood, etc – then we can probably assume that food is okay or he has gotten used to digesting that protein. The GI doc and ped recommend leaving dairy/soy out for a considerable amount of time, with those being the last to be introduced back in down the road (likely b/t 6-12 months, but might take longer).
So based on all this, here’s our status on everything right now:
- I’m currently free of all the top 8 allergens plus beef – so no dairy, soy, eggs, fish, shellfish, peanuts, tree nuts, wheat, and beef. As of this Friday, that will be 2 weeks off of the most recent eliminations (wheat & nuts) with longer amounts of time off everything else.
- I plan to start reintroducing foods one by one, as recommended. Wheat will be the first one I reintroduce, since it was the most recent one eliminated and also the one I find I struggle most with (of course, if this prompted any symptoms, then I’d immediately cut it out again). I’ll then continue with reintroducing foods one-by-one every 2-3 weeks. After wheat, I’m thinking either fish or nuts. Nuts are a more common allergen so it might be worthwhile to wait on that a little longer, but I also use them much more frequently than fish so I’d appreciate being able to reintroduce them sooner. I’ll make that decision as it gets closer.
- Because dairy and soy are frequently the most common foods that cause issues (MSPI), those will stay out of my diet the longest. It will likely be when he is in the 9-12 month range that we try reintroducing those. However, I may decided to try reintroducing soy lecithin and soy oil earlier than that, since those typically do not cause issues (I’ve cut both out for now to be super cautious).
- I’m trying to stay on top of keeping a food log to see if there are any other associations that jump out at us – but nothing has jumped out at me so far. It’s hard because if he has a fussy day it could be something as simple as he’s growing or overtired – yet I immediately think “was it something I ate?!”. That kind of overanalyzing can drive you crazy, so I’m trying to keep perspective on that.
- I’ll be sharing a round-up post in the next week or so with lots of allergen-friendly meal ideas that I’ve been cooking, which I’m sure could help any other moms out there struggling with this or anyone who has dietary limitations or allergies! I’ve gotten quite creative. I’ve already shared a few of my own recipes that I’ve developed, including the yummy gluten-free egg-free dairy-free chicken fingers that I posted about yesterday.
Share with me: Have you ever had to eliminate foods for dietary reasons? Was it a struggle? What allergen-friendly recipes do you love?!
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Hi! I was very happy to stumble upon this post, even though it is a couple years old! I am also a dietitian and had my first baby at the end of July. The first few weeks were fine, but then he started getting really fussy while nursing and became colicky with slimy mucus diapers with streaks of blood. He is now 5 months old and we are still trying to figure it out. I related so much to some of the things you wrote, such as how a “fussy” day could be related, but it might just be normal baby behavior!? We have seen a pediatric GI specialist a couple times and he is stumped as well. I have been off dairy and soy for over 3 months now and have also done trials of eliminating eggs, rice and oats. He still has streaks of blood with most poopy diapers, so it is very frustrating that I am going through all this with no improvements (it is especially difficult for me as I am vegetarian and cutting dairy and soy takes away most of my protein, as you know!). My son is growing very well, though, despite all of this! He is a big boy and has always been >90th percentile for length and weight. He is wearing 12 months clothes at 5 months. So, the doctor has told me that he still thinks breast is best because he is thriving. We have a follow up next month and he plans to take a blood sample to rule out anemia. He says if he is anemic, he would like me to try Nutramigen formula. I am curious to know how your son is doing now? Thanks so much for this post.
Hi Cassie!! So great to hear from you and sorry for taking a few days to respond – the holidays, ya know? 🙂
So the good news on my end – my son outgrew everything a little after a year. After the two week trial completely top 8 free that I mentioned in this post (he was a little over 2 months old at that time), I added everything back in one by one over the next two months except eggs/dairy/soy. I kept those three out until he hit a year. I then started with introducing through myself first, then would move on to him – and did eggs, then soy, then dairy. He drinks milk like a champ now (he’s almost 3!) with no adverse effects whatsoever.
We never really saw blood after the two month mark, so that was at least helpful on my end (even though it still tested positive for microscopic traces) – I imagine it’s tough if you’re still seeing it!! One thing our ped GI did mention was possible sensitivities to corn – we didn’t think it was an issue so I never experimented with a trial elimination, but that could be something to keep an eye on too?
If you do have to go the formula route, definitely check for insurance coverage – I know they can be expensive but some insurance carriers cover it.
I’m glad your little one is thriving otherwise and wish you so much luck – I know it’s such a frustrating situation!! Feel free to email me (chrissy {at} snackinginsneakers.com) if you want to chat more.
We are going down this road too. We have slimy diapers with occult blood and a strong vinegar smell. I’ve cut out the top 8 for the past month, corn for the past two weeks, and I just started a total elimination diet this week (only eating chicken, quinoa, pears, potatoes, and zucchini). We have our first appointment with a GI this week, and I copied your questions down as they look really helpful in guiding the conversation. From my research, it looks like my little dude has FPIAP, did your GI ever give you a diagnosis? I’m so glad to see that he grew out of it, fingers crossed we will too!
Hi Lis – sorry for taking a few days to get back to you! Had my wisdom teeth taken out this week so I’m behind, haha. We never got an “official” diagnosis but we figured it was just a non-IgE allergy or intolerance. GI was more relaxed than I expected; essentially they just made me feel better about doing what I was doing and didn’t pressure me to do anything else. I felt good about that! I hope your appointment goes well and I hope you figure out what’s going on with your little guy. If it helps, I started a second site called Dairy Free for Baby which is focused on dairy free allergies — but I note the allergens in each and some are top 8 free or free of a few extras. If you’re able to add some stuff back into your diet, that site might be helpful at that point!
Hi Chrissy,
So happy I stumbled upon this entry as my little 10 week old girl is struggling with the same. Her ped suggested MSPI so I cut dairy, soy, egg, and corn to be safe. While we did see pretty immediate improvement in stool, we are not seeing 100% improvement and I have been on this diet for a month now. I even trailed with API diet for a week and didn’t see anything different. I still see visible blood and mucous in her stool which alarms me, of course. I did try giving her Alimentum formula the same day she was diagnosed since ped sent us home with samples. She drank about 2 ounces and projectile vomited about 5 minutes later and then went limp (I almost called an ambulance!) Very traumatizing so she now won’t try again and I don’t blame her! She isn’t overly fussy at all, does not get rashes, and has been gaining weight. It seems, like your son, her only symptom is questionable stool. We have her first GI appointment next week and my list of questions looks almost identical to yours! My question is.. did you ever end up using a probiotic for baby or yourself? If so, how did he do and what brand did you use? Thanks so much for your insight!