|This baby looks delicious (http://nomnommonster.com)|
Fearless Husband and I have embarked on a 2-week “cleanse”, meaning we are only eating whole, organic, mostly raw foods. Meaning mommy is without her little helpers, Sugar and Caffeine. Meaning mommy is ornery.
Thus, I hope you’ll pardon the snarkiness which I’m sure will creep in to the following post. I’ve been trying to hold back lately, in the spirit of creating a kinder, gentler, more “professional” FFF, but the lack of food is bringing me back to my obnoxious roots. And it certainly doesn’t help that the study I’m about to dissect is about weight gain in babies (chubby, delicious babies… not that I’d ever eat a baby or anything, being vegetarian and, you know, not a cannibal. Unless the baby was dunked in chocolate… or rolled up in a nice fluffy tortilla….oh my god, I need sugar….) which is one of my biggest pet peeves.
I stumbled upon the study in question via this article, Bottle Feeding Linked to Rapid Weight Gain in Infants, Possible Obesity Risk. Great title, right? The article is correspondingly anxiety-provoking:
In a surprise twist to the “breast is best” debate, bottle feeding, and not just formula feeding, increases the risk of rapid weight gain in infants, leading to an increased risk of obesity later in life, says a recent study published in the Archives of Pediatrics & Adolescent Medicine...The results of the study indicate that breastfeeding, and not just breast milk, is best for babies. Infants who were exclusively formula fed by bottle gained only between 71 and 89 grams more per month than infants who were exclusively fed human milk by bottle. Furthermore, weight gain was negatively associated with the proportion of breast milk feedings but positively associated with proportion of bottle feedings among the infants who received mostly human milk…. In other words, bottle feeding, and not just formula feeding, puts children at an increased risk for rapid weight gain during infancy and for obesity later in life. Breastfeeding, and not just breast milk, is best in terms of maintaining a healthy weight.
I think it’s a rather daring leap to take self-reported data that shows differences in the rate of weight gain in the first year of a child’s life, and use it to justify the message that “Feeding at the breast needs to be the first feeding choice for babies. When feeding at the breast is not always feasible, supplementing breastfeeding with expressed breastmilk is a good alternative, but special attention is needed for infants’ internal feeding cues while bottle-feeding,” which is exactly how the study authors capped off their conclusion. Where is the discussion of why weight gain in the first year is bad?
Interestingly, the researchers also found that “Infants categorized as consuming ‘human milk by bottle only’ and ‘nonhuman milk by bottle only’ gained more weight than infants fed at the breast only, but there was no such bottle effect observed among infants categorized as consuming ‘human and nonhuman milk by bottle.’” They hypothesize that:
“…(t)his might be owing to the fact that infants in this mixed feeding category were more likely fed at the breast previously than the other 2 groups (data not shown). Our previous study suggests that infants fed at the breast develop a better self-regulation of milk intake, which may be carried over even after feeding is transitioned from breast to bottle. Similarly, mothers who previously breastfed might better recognize infants’ cues of hunger and satiety, which may last even after they stop breastfeeding.”
I view this as a prime example of the Achilles heel of infant feeding research. When your internal bias is strongly in favor of one outcome, it’s too easy to extrapolate. First of all, how did they come to the conclusion that the women feeding both breastmilk and formula by bottle breastfed longer than those feeding exclusively breastmilk by bottle? Perhaps this came from additional survey findings, but since we don’t see this data, I’m going on the assumption that this was simply the authors’ hypothesis. I think it is an equally plausible explanation that women who are feeding both breastmilk and formula by bottle (this is a group with no physical breastfeeding, remember) were exclusive pumpers, just like the other group, who decided to add formula in at some point. As a former exclusive pumper, every drop you pump is worth it’s weight in gold. If anyone’s going to be “encouraging” a baby to finish what’s in his bottle, wouldn’t it stand to reason that it would be the woman who worked her ass off to provide it’s contents? Perhaps the mixed-feeding group didn’t feel as much pressure to make sure that their babies got every last drop, which helped reduce the risk of overfeeding. (PLEASE note that I am in NO WAY insinuating that all exclusively pumping moms overfeed their kids. I don’t think this, at ALL. I am simply providing an alternative hypothesis that I believe is equally plausible to highlight the tunnel vision so prevalent in this area of research.) Alternately, maybe the act of exclusive pumping makes milk less “filling” in some way (the researchers do briefly discuss hindmilk versus foremilk, which can get a bit screwy with pumped milk, especially if you are combining milk from different pumping sessions) and adding a bit of formula helped the mixed-fed babies feel more full. Regardless, my point is that there are other rational (and perhaps more interesting, in terms of future research) explanations than the one provided by this study’s authors.
You’ve all heard my rants on this before, but I am seriously sick of studies that examine weight gain in babies and attempt to use it as fodder for the childhood obesity hysteria. I read another article about a separate study today, which correlated c-sections with later obesity in infants, and felt the same frustration. This article questioned why, as the rates of c-sections have gone up, so have the rates of obesity. I think this is like asking why the rates of autism have gone up along with the rates of breastfeeding. It’s ridiculous. Childhood obesity is high in this country because our kids eat like crap and sit in front of screens all day. It’s hard to change these behaviors, when you’re on a limited budget, living in areas with poor food options, and working all day to keep a roof over your kids’ heads. And being a little heavy isn’t even a bad thing, as long as you are eating healthfully and moving your body – some folks are genetically predisposed to being a little more fluffy. It’s about overall health, not body weight, and much of the conversation around weight gain and body size seem to ignore all of these considerations in favor of overreaching studies that attempt to pin blame on individuals, while refusing to see them as individuals.
And speaking of that, I’m about to shut down my screen, go drink a glass of spinach and kale juice, and dream about eating crap. Crap is delicious. Which is why is is so much fun to blame our propensity towards pudge to the way our mothers birthed and fed us.
Those of you who haven’t been following this blog since the beginning may not know this, but my son Fearless Child (FC) has a dairy allergy, which went undiagnosed for the first few months of his life. Having his insides assaulted on a daily basis made him grumpy – so grumpy that he screamed bloody murder for about 20 hours a day. And yet it took us over a month of elimination diets, doctor visits, and late-night consultations with Dr. Google to figure out what was going on. This was partly because FC’s symptoms were slightly atypical, but more so because as new parents, we were utterly confused as to what was “normal” newborn behavior and what necessitated medical intervention.
There’s a good deal of information on dairy intolerance in babies on the Web, but not much specifically geared towards bottle-feeding parents. This is unfortunate, as those of us feeding our kids in this manner actually have a really simple way of figuring out if food issues are at play – and yet so many of us struggle for months, feeling increasingly frustrated and hopeless with our inability to comfort or feed our children adequately.
I always hesitate to offer what might be construed as medical advice, since there’s far too many hacks out there doing just that. So before I continue with this post, let me reiterate: I am not a doctor. I haven’t even played one on t.v. (Does anyone still get that reference? Or does it make me sound old?) The following information is what I have culled from my own research, talking to pediatricians and pediatric GIs, and from my own experience as the mother of two kids with feeding issues.
Oh, and one more note: I am going to use the terms “intolerance”, “sensitivity”, and “allergy” interchangeably here, even though these three things are entirely different. This is because until you see a physician, you won’t know which of the three you are dealing with. My purpose with this post is to help you realize when something is amiss, and to assist you in navigating a medical system which often ignores the power of parental intuition and knowledge of one’s own child. You’ll have to see an actual MD to get a true diagnosis… and I don’t meant Dr. Google.
Newborns are complicated creatures. Some are calm and sweet (this is the kind of baby everyone else seems to get at least once, but apparently my and my husband’s genetics do not morph in a manner conducive to a docile temperament), others are generally chill except for a bout of colic between weeks 2-8, and others are fussy all.the.time. This last group is the one that we need to worry about. Typically, a calm, contented baby is a well-fed and happy one. This is not to say that food allergies will not strike later in life, once solids are introduced, but a newborn who is sensitive to something in formula will usually express discomfort in a pretty vocal way. Watch out for:
- Extreme fussiness. Colic is defined as crying for a period of 1-3 hours, at least 3 days a week, typically in the evening. A baby who is sensitive to formula will cry constantly, throughout the day. They can sometimes be comforted, but only by extreme measures like continuous movement (we had to bounce FC so vigorously that once, while shopping for a new car, a man came up to us in horror and told us we should stop shaking our baby; a friend’s dairy intolerant breastfed baby was only comfortable while being vibrated in his bouncer – all night long), specific holds (the Harvey Karp /Happiest Baby hold is magical for babies with tummy issues). The difference between a “normal” fussy baby and one with potential allergy or intolerance is that they have 2 settings: sleep and screaming. The fussiness is the default, rather than the exception.
- Trouble sleeping. While many young babies sleep erratically, they usually sleep a lot cumulatively. A newborn with a formula intolerance will often be too uncomfortable to sleep.
- Trouble eating. This one gets tricky, because other issues can cause trouble with feedings – sensory issues, reflux, dislike of the type of bottle or nipple you are using… but one common symptom in babies experiencing formula intolerance is fussiness around eating. They may pull away from the bottle and scream; or eat only small amounts at a time. Reflux can also be associated with formula intolerance, so spitting up an excessive amount after every feeding (especially if there is curdled formula or blood in the spit up) might signal a problem. Some babies might develop an aversion to eating, associating the formula with pain, and refuse the bottle altogether. Others may “comfort feed” and want to eat constantly (more on this later).
- Inability to connect or bond. Again, this can signal a far more serious issue, but it should be noted that babies who are in constant pain have a rough time chillaxing enough to focus on their parents or begin engaging in social interactions. I’ve had numerous parents tell me that they had secretly worried their baby “had no soul” or “wasn’t all there” prior to diagnosing and solving a severe allergy or intolerance. If your baby is screaming constantly or is noticeably stiff, writhing, or doesn’t seem to be comforted by touch, see your doctor.
The physical manifestations of a formula intolerance are more straightforward, but they also tend to suggest a more serious problem (i.e., clinical allergy versus sensitivity). In terms of getting a diagnosis, they do make life easier, but they can also be scary when first encountered. These include:
- Weight loss, or extreme weight gain, from comfort feeding. I’ve heard of more than a few cases where babies who are overeating are misdiagnosed with the excuse that “milk protein intolerance causes failure to thrive”. This is true; many kids will have aversions to formula or breastmilk caused by associations with pain, and refuse to eat; these conditions can also cause malabsorption, so the baby isn’t getting the necessary nutrients to grow. But some babies find the liquid comforting as it goes down (especially those who have reflux associated with the intolerance or allergy), or like the sucking action, and want to eat constantly. The offending food causes more distress, which then creates a need to comfort feed more… and suddenly you’ve got Jabba the Hut, Jr. on your hands. Their girth may cause doctors to dismiss discomfort and symptoms as “overeating”(which can certainly cause a whole list of problems, but my point is that sometimes, the overeating is a symptom, not a cause).
- Blood in the stool – this can appear looking like strawberry jelly (red) or like coffee grinds (black). If you see blood, drop everything and call your pediatrician.
- Mucous in the stool – this is a biggie, because often the blood will be invisible to the naked eye, but mucous is easy to spot. Mucous looks like stringy, gelatinous strands, usually white or clear in color.
- Rashes – these can appear in a variety of forms, and may be hard to differentiate from normal newborn skin issues like diaper rash or infant acne. Sometimes the rashes might look like hives, but they can be atypical. FC would get petechia-type red dots on his cheek, right next to his eye, and down his cheek. (This same reaction continued as he grew into toddlerhood, and was a great way for us to know we’d screwed up and allowed for accidental exposure). Other parents have told me that the rashes congregate near the joints, or as a red ring around the anus. All lovely and comforting things to see on your precious newborn, right?
- Vomiting up blood. Again, this merits a panicked call to the doctor. Stat.
Something you should also know is that milk protein allergies come in two forms: rapid onset (immediate reaction) or delayed onset (reaction within 7-10 days of ingesting milk). This may explain why some babies don’t start reacting to formula until a week or so after birth/switching over from breastfeeding. Rapid onset looks more like a “classic” food allergy – hives, wheezing, bloody diarrhea. The rapid onset form is far more dangerous, as allergies can worsen with every exposure, eventually leading to anaphylaxis, so if you see these sort of symptoms, do not pass go, do not collect $200, just dial your pediatrician.
Which brings me to….
There are a lot of fabulous pediatricians out there. There are also some really crappy ones. And in the middle, there are doctors who have seen thousands of neurotic new parents who freak out at the first sign of slight fussiness in their babies, and also a slew of legitimately concerned parents dealing with the untreatable hell that is infant colic. Considering that in the majority of cases the babies they see are either healthy and just waking up to the world (it’s normal for a baby to be impossibly easy and sweet for the first few weeks and then wake up one day with an attitude. Think of it as good practice for the teen years), or are unfortunate victims of colic and just have to wait it out (excuse my tangent for a moment but I cannot for the life of me understand why no one has figured out this colic thing. Seriously? We can clone sheep and we can’t figure out why some babies cry inconsolably for exactly 3 hours at the same time every night??!), it is understandable that some pediatricians have dismissive or patronizing attitudes towards those complaining about fussy babies.
I have seen parents who do overreact to sudden onset of mild spitting up, fussiness, or constipation- it’s hard not to, considering the lack of sleep, the hormones, and the lure of the Internet (Dr. Google is an alarmist). But for the most part, every parent who has emailed me with a laundry list of weird symptoms and a general, foreboding sense that something is “not right” with their newborn, has later followed up to confirm diagnosis of an allergy or intolerance. I’m a big believer in mommy/daddy “gut” when it comes to your baby’s gut.
So, here’s what I would suggest: before you go in for your child’s appointment, write down a list of every symptom you have observed. If you’ve been noticing mucous or blood, collect a stool sample, and show your doctor the craziness that is coming out of your kid’s tush. If your doctor starts talking about colic, explain to him/her that you are well aware of what colic is, and colic does not explain the other symptoms you are noticing (you might also want to mention if your child’s crying doesn’t follow a colic-like pattern – meaning that it is not sustained crying for a specific period of time, but rather constant fussiness throughout the day).
It is also well within your rights to request allergy testing, but here’s the thing: with this sort of testing, only a clinical allergy will show up. If your baby has an intolerance or sensitivity, the testing will probably come back as inconclusive or “normal”. Additionally, there is some controversy on whether allergy testing in young infants is even accurate.
Luckily, there is another, non-invasive way to see if the formula you are using is the problem, which is what I like to call…
I could write a Shakespearean sonnet for hypoallergenic formulas, and I’m sure the folks who like to think I’m paid off by formula companies will find fodder for this conspiracy theory in how often I hawk Alimentum on here. But I just love the stuff. And not just Alimentum. Nutramigen, and Neocate, and whatever comparable product is on the European/Asian markets. The stuff is stinky, expensive….and utterly lifesaving.
If you suspect that your baby has a milk protein sensitivity, and the symptoms are not severe enough to necessitate medical intervention, you might want to consider doing a 48-hour hypoallergenic challenge. This is a 4-step process:
1. Get thee to thy nearest drugstore/grocery store
2. Purchase a commercial hypoallergenic formula (please read my post on types of hypoallergenic formula to ensure that you are choosing a true hypoallergenic and not simply a “sensitive” brand)
3. Serve said formula to thy infant, and observe for the next day or two
4. Thou shalt be singing high praises to the heavens by yonder morning, otherwise the formula probably wasn’t the problem in the first place.
While milk and soy protein allergies are the most prevalent in young infants, there are some kids who are sensitive to corn or other ingredients in formula. And for children with severe milk protein allergy, a commercial hypoallergenic isn’t going to cut it – they will need an amino acid-based formula, which is available by prescription only. But for most babies suffering from mild to moderate sensitivities/intolerances, a hypoallergenic formula is truly a godsend. You should see a marked improvement within 2 days if the problem is food related and not due to some other underlying medical condition (cough*call doctor*cough) or- and I seriously hate to say this – if it’s just colic or fussiness, in which case you really do just need to give it time, and start drinking heavily to get through the next few months. Kidding. (Maybe…)
If you are dealing with colic or normal infant fussiness, the good news is that you can skip the following section, and not have to worry about a childhood without ice cream and birthday cake. But if the formula does make a dramatic difference, you may want to consider….
If the hypoallergenic works wonders, you can continue to use the formula and try re-introducing a normal or sensitive formula at about 6 months, once your baby’s system has developed a little more. If symptoms return, then you simply return to the hypoallergenic.
That said, hypos are quite costly, and if your child does have a true milk protein allergy, you might be able to get the formula covered by your insurance. You’ll need to see your pediatrician to get the right paperwork filled out in order to do this.
I’d also suggest that you do ask for a referral to an allergist and/or pediatric GI, just so you will have someone in your corner when you start solids. While most children outgrow a milk protein allergy or intolerance as they become toddlers, some take longer than others. It gets really difficult to figure out a delayed-reaction allergy once they start solids, because the exposure could have been anytime in the week or so prior to the reaction. Also, weaning off formula looks a bit different in a dairy intolerant/allergic child. Sometimes, pediatricians will want you to stay on formula a little longer since it’s harder for kids to get the nutrition they need when they can’t eat or drink dairy products. In other cases, using a milk substitute like soy (unless your child is sensitive to soy as well, which many milk protein intolerant kids are), rice, almond (as long as you’ve seen an allergist and been tested for nut allergies), oat. or hemp, can be a perfectly acceptable option. My kids have both thrived on unsweetened almond milk, which is fortified with so much stuff nowadays that the only thing milk trumps it on is protein content and fat (and we incorporate other foods into their diets that compensates for this).
You’ll get very good at reading labels, and creative with recipes, and become a master at surreptitiously pulling vegan cupcakes out of your diaper bag at birthday parties so your kid won’t feel left out. You’ll probably do “challenges” with your kid every so often to see if his or her body has decided to make friends (or at least frenemies) with dairy, and when that day comes, you may even get to see a face like this:
|Fearless Child’s first time eating cake & ice cream at a friend’s birthday. And yes, I cried.|