Joy Anderson BSc (Nutrition) PostgradDipDiet APD IBCLC ABA breastfeeding counsellor
It has been known for a long time that foods the mother eats can affect the make-up of her breastmilk. We know that flavours from your diet go through breastmilk1, but food proteins2 and other food chemicals3 do as well. If your baby is allergic or intolerant to traces of foods from your diet, then he may have adverse reactions.4
This is different to lactose intolerance, as lactose is a major component of breastmilk and is made in the breast; it doesn’t come from your diet. However, a baby may develop secondary lactose intolerance as a result of allergy or intolerance to foods coming through the breastmilk. For more information, see the Lactose intolerance and the breastfed baby article.
Can you reduce the risk of allergy?
If you have a family history of allergy, try to make sure he is exclusively breastfed for at least the first 4 months and preferably 6 months, to reduce the risk that he will become allergic to foods.5 There is not enough evidence that you avoiding foods in pregnancy or breastfeeding will reduce the risk of your baby becoming allergic. Unless your baby is already reacting, then don't restrict your diet.6
Your baby should start solids at around 6 months, mainly as he will need a new source of iron and zinc in his diet.7 As far as allergies go, it is thought to be best to introduce the major allergenic foods as soon as possible, provided your baby is not already showing reactions to the particular food.8 These foods include cows’ milk, soy, wheat, eggs, nuts and fish. It is also best for your baby to continue breasfeeding as new foods are introduced as a way to reduce the risk of allergy.9
Could it be something other than food?
Before assuming your unsettled baby is suffering from a reaction to food and you consider altering your diet, it is really important to rule out other potential causes first. These include low milk supply, lactose overload from too much milk (see the Lactose overload in babies article) and medical conditions, including gastro-oesophageal reflux, although this can be also associated with food allergy or intolerance, especially to cows’ milk.10
Consider whether it might even be just normal newborn baby behaviour, as your little one adjusts to life outside the womb - see Cluster feeding and fussing babies and Fussy periods. Also, does your baby have any other symptoms as well, like a rash or odd-looking poos? Have your baby checked by your doctor in case there is anything medical that is causing your baby to be unsettled. It could be something as different as an ear or throat infection and nothing to do with your diet.
If you have ruled out all of these causes and would like to check if it is your diet, it is important to consult a health professional before changing your diet. Particularly when you are breastfeeding, you need your nutrients and if you start avoiding foods, you will need to make up for what you are missing by eating different foods. A dietitian familiar with food intolerances would be the best type of health professional to guide you. You don’t need a GP referral to see a dietitian, but your GP may be able to recommend one. Or check out the ‘Find an Accredited Practising Dietitian’ page on the Dietitians Association of Australia website.
What is food allergy?
There are different types of food sensitivity in babies, including food allergy and food intolerance. The term 'allergy' usually refers to reactions that involve the immune system. In this case, a small amount of an allergen (in this case food) can trigger a major reaction.
Allergic type reactions can occur either fairly quickly after a feed, such as vomiting/reflux or a rash, or occur hours or days later, such as blood in the bowel motions or eczema. The most common foods causing these reactions are the same major allergens listed above (cows’ milk, soy, wheat, eggs, nuts, fish).
What is food intolerance?
Reactions caused by food intolerance do not involve the immune system and might be quite delayed, such as appearing 24–48 hours or more after your baby was exposed to the food. There is also a ‘dose-effect’, where a small amount won’t cause a reaction but a larger amount might, so a more graded effect.
A baby with food intolerance reacts to food chemicals coming through the breastmilk from his mother’s diet.3 These include food additives and natural food chemicals found in everyday healthy foods — usually the substances in foods that give them flavour — as well as potentially in some staple foods, such as dairy products, soy and some grains.
Common symptoms in breastfed babies
Although food-intolerance reactions do not involve the immune system, as allergy does, the symptoms in breastfed babies may be fairly similar. The symptoms of food allergy or food intolerance commonly include colic/wind in the bowel; gastro-oesophageal reflux; green, mucousy bowel motions; eczema; and a wakeful baby who appears to be in pain. Some babies possibly have both food allergy and food intolerance.
Starting solids if your baby is allergic or intolerant
If you find your baby reacts to foods in your diet, you may need to be extra careful when introducing solids. Reactions after eating foods directly can be more serious than when the baby was reacting through breastmilk. If you think your baby is having allergic reactions, it is vital to consult your doctor before introducing the more risky foods listed above. As well as advice regarding your diet, a dietitian can also assist with advice on solids for your baby.
Breastfeeding: and reflux booklet
Breastfeeding: and reflux combines the experiences of many families with the latest research into Gastro-oesophageal Reflux in babies.
1. Beauchamp GK, Mennella JA 2009, Early flavor learning and its impact on later feeding behavior. J Pediatr Gastroenterol Nutr 48 Suppl 1:S25–30.
Hausner H, Bredie WL, Mølgaard C, Petersen MA, Møller P 2008, Differential transfer of dietary flavour compounds into human breast milk. Physiol Behav 95(1–22):118–124.
2. Kilshaw PJ, Cant AJ 1984, The passage of maternal dietary proteins into human breast milk. Int Arch Allergy Appl Immunol 75(1):8–15.
3. Swain A, Soutter V, Loblay R 2011, RPAH Elimination Diet Handbook. Sydney: Allergy Unit, Royal Prince Alfred Hospital.
4. Hill DJ, Roy N, Heine RG, Hosking CS, Francis DE, Brown J, Speirs B, Sadowsky J, Carlin JB 2005, Effect of low-allergen maternal diet on colic among breastfed infants: a randomized, controlled trial. Pediatrics 116(5):e709–715.
5. Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH, Bahna SL, Beck LA, Byrd-Bredbenner C, Camargo CA Jr, Eichenfield L, Furuta GT, Hanifin JM, Jones C, Kraft M, Levy BD, Lieberman P, Luccioli S, McCall KM, Schneider LC, Simon RA, Simons FE, Teach SJ, Yawn BP, Schwaninger JM 2010, Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-Sponsored Expert Panel. J Allergy Clin Immunol 126(6 Suppl): S1–58.
ASCIA Guidelines - infant feeding and allergy prevention 2016 Accessed from URL: https://www.allergy.org.au/patients/allergy-prevention/ascia-guidelines-for-infant-feeding-and-allergy-prevention 27/5/17
6. de Silva D, Geromi M, Halken S, Host A, Panesar SS, Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Cardona V, Dubois AW, Poulsen LK, Van Ree R, Vlieg-Boerstra B, Agache I, Grimshaw K, O’Mahony L, Venter C, Arshad Sh, Sheikh A 2014, Primary prevention of food allergy in children and adults: systematic review. Allergy doi: 10.1111/all.12334.
Kramer MS, Kakuma R 2006, Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev 19(3):CD000133.
7. National Health and Medical Research Council 2012, Infant Feeding Guidelines, Canberra: National Health and Medical Research Council.
8. Anderson J, Malley K, Snell R 2009, Is 6 months still the best for exclusive breastfeeding and introduction of solids? A literature review with consideration to the risk of the development of allergies. Breastfeed Rev 17(2):23–31.
Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH, Bahna SL, Beck LA, Byrd-Bredbenner C, Camargo CA Jr, Eichenfield L, Furuta GT, Hanifin JM, Jones C, Kraft M, Levy BD, Lieberman P, Luccioli S, McCall KM, Schneider LC, Simon RA, Simons FE, Teach SJ, Yawn BP, Schwaninger JM 2010, Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-Sponsored Expert Panel. J Allergy Clin Immunol 126(6 Suppl): S1–58.
9. Grimshaw KE, Maskell J, Oliver EM, Morris RC, Foote KD, Mills EN, Roberts G, Margetts BM 2013, Introduction of complementary foods and the relationship to food allergy. Pediatrics 132(6):e1529–1538.
10. Iacono G, Carroccio A, Cavataio F, Montalto G, Kazmiersky I, Lorello D, Soresi M, Notarbartolo A 1996, Gastroesophageal reflux and cow’s milk allergy in infants: a prospective study. J Allergy Clin Immunol 97: 822–827.
Vandenplas Y, Rudolph C, Di Lorenzo C, Hassell E, Liptak G, Mazur L, Sondheimer J, Staiano A, Thomson M, Veereman-Wauters G, Wenzl TG 2009, Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). Pediatr Gastroenterol Nutr 49(4):498-547.
© Australian Breastfeeding Association May 2017
The information on this website does not replace advice from your health care providers.