Many breastfeeding mothers wonder if the foods they eat will affect their breast milk. The good news is that your milk will probably be just right for your baby regardless of what you eat. Your body knows exactly what nutrition your baby needs at every stage of development. However, in some cases, a baby may experience acid reflux, and a mother's diet can play a role. This article provides dietary tips for breastfeeding mothers to help manage acid reflux in their infants.
Understanding Infant Acid Reflux
Many babies bring milk back up through their food pipe at different times of the day or night. This is called reflux (short for Gastro-Oesophageal Reflux, or GOR). Simply put, the valve between the stomach and the food pipe (oesophagus) is not keeping the baby’s milk down and it comes back up the pipe the wrong way. Reflux usually begins before 8 weeks old, often declines after 6 months and disappears by itself by the time babies are a year old. Babies with reflux may also cry a lot or be uncomfortable or irritable. Even though reflux is often a normal part of infancy, it can be very hard for parents whose babies frequently bring up milk, as they may seem distressed or uncomfortable.
Reflux vs. Colic
Colic and reflux can both keep a baby on edge, but they have very different symptoms. To distinguish between the two, timing is key: Colic-related irritability is more likely to surface in the afternoon, and if your baby does get agitated, it will be easy to calm her down. Reflux is more likely to follow feedings, and can bring sharp cries of pain - distinct from colicky cries of frustration - at random times throughout the day. Babies with reflux won’t be as easily soothed as babies with colic.
Why Reflux Occurs
Reflux is pretty common for babies because they’re eating an all-liquid diet and lying down most of the time. The muscle between their esophagus and stomach (the lower esophageal sphincter) can be a bit immature and allow milk to flow back up. This is why reflux is especially common in premature babies. Another possible cause is a food intolerance or allergy, often to cow’s milk protein, so sadly, your nightly bowl of ice cream could be behind your baby’s reflux flares.
General Dietary Recommendations for Breastfeeding Mothers
Use the following tips to help plan your diet.
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- Include protein foods 2-3 times per day such as meat, poultry, fish, eggs, dairy, beans, nuts and seeds.
- Eat three servings of vegetables, including dark green and yellow vegetables per day.
- Eat two servings of fruit per day.
- Include whole grains such as whole wheat breads, pasta, cereal and oatmeal in your daily diet.
- Drink water to satisfy your thirst. Many women find they are thirsty while breastfeeding; however, forcing yourself to drink fluids does not increase your supply.
- Dietary restrictions from pregnancy do not apply to breastfeeding moms.
Calorie Intake
Breastfeeding requires extra calories. If you still have baby weight from your pregnancy, these extra calories will naturally be used for your milk. If you have lost all your baby weight, you may need to eat an extra 500-600 calories per day. After your baby starts eating other foods at 6 months, you will be making less milk and you can cut back on your calorie intake.
Alcohol and Caffeine
If you wish to drink alcohol, wait 2-3 hours after each serving (12 oz. beer, 6 oz. wine, 1.5 oz. liquor) before breastfeeding/pumping. Alcohol does not stay in your milk. It is removed as your blood alcohol levels go down. When you are sober, the alcohol is gone from your milk. If you are feeling the effects of alcohol and your breasts are full, you may need to “pump and dump."
Caffeine is passed into your milk but most babies are not bothered by it. If your baby isn’t sleeping well or is irritable, you may want to limit or avoid caffeine. Newborns may be more sensitive to caffeine than older babies.
Importance of DHA
DocasaHexanenoic Acid (DHA) is an important omega 3 fatty acid needed by babies for brain development. You can boost the DHA in your milk by eating fish 2-3 times per week. The best sources of DHA are: salmon, bluefish, bass, trout, flounder and tuna. Do not eat tile fish, swordfish, shark and king mackerel. They contain high levels of mercury.
Food Flavors
The colors of the foods you eat, including naturally occurring pigments in vegetables and herbal supplements or food dyes added to foods, may change the color of your milk. The varied flavors in your diet will appear in your milk. Your baby will even enjoy milk flavored with garlic!
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Dietary Adjustments for Reflux
Spicy and gas-producing foods are normally tolerated by most babies. If you find your baby is often gassy or colicky and has increased diarrhea after you eat a particular food, try avoiding that food for several weeks and see if the symptoms go away. Then try the food again to see if you still need to avoid it.
Identifying Potential Allergens
In rare cases a breastfeeding baby may develop a food allergy to foods the mother is eating. The most common symptoms are green, mucus-like and blood-specked stools. Colic and reflux are not usually caused by food allergies.
The most common foods that cause allergies are dairy products, soy products, wheat and eggs. Less common foods that cause allergies include fish, nuts, peanuts or corn. A baby could develop an allergy to any food you eat.
Keeping a food diary of symptoms along with what you eat might help you know which foods are causing the problem. As long as your baby is gaining weight and not anemic, the allergy is not going to cause any long-term problems. You do not need to stop breastfeeding.
Removing the suspected foods from your diet by carefully reading all food labels should solve the problem but it may take 4-6 weeks for the infant’s symptoms to resolve.
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Common Culprit: Cow's Milk Protein
Cow’s milk protein (not the lactose, but the protein in dairy products) is the most common issue, but if you’re not sure what the problem food is, start jotting down what you eat and when. Over time, you may be able to spot a pattern and draw a connection between the foods you eat and your baby’s reflux flare-ups. For babies who are sensitive to dairy, many also have problems with soy.
Elimination Diet
As your baby can be reacting to anything you eat, I suggest you do 3-5 days of your ‘normal’ diet, noting down the symptoms so you have a clear picture of where you’re starting from. Then, cut out all major allergen foods such as dairy (including any hidden dairy proteins and sugars such as beef, gelatin, and lacto-anything), soy, eggs, and nuts. In my practice, I see quicker improvements through a faster and greater elimination diet, so suggest restricting your diet for a few days (3-4 should do) and gradually reintroduce the foods according to your baby’s ease of digestion.
Other Strategies to Help with Infant Reflux
If you suspect your baby has reflux, you can do a few simple things to help prevent and relieve their symptoms.
- Position them upright for 20 to 30 minutes after feedings (here’s where you can put that new wrap or carrier to good use).
- You can also experiment with more upright nursing positions.
- Try smaller, more frequent feedings and stop often to burp baby.
Feeding Techniques
It often helps to feed your baby in a more upright position. You may need to try out different positions:
- Sit your baby facing your breast, their legs on either side of your leg.
- Or cuddle them against the side of a sofa, facing your breast.
- Instead of cradling your baby around your body, you can cradle baby down your body. To do this, you could feed twin-style or you could try feeding standing up.
- Lie back so that your baby lies on top of your body.
After a feed, keep your baby upright and still. Some babies do better with smaller, more frequent feeds. This causes less pressure on the sphincter muscle between the oesophagus and the stomach. Your baby may not want both breasts at each feed or may do better if you offer only one side, but more often. However, reflux episodes are worse in the first hour or so after feeds so your baby may prefer a larger feed less often. These babies may feed from both breasts at each feed and go longer between feeds.
Addressing Oversupply
Mother has an oversupply of milk that can result in baby taking too much too fast for the stomach to handle. Either can result in additional air swallowed with the large volumes of milk. Adults recognize this feeling as heartburn.
Positioning
Use positions for feeding that keep baby’s head higher than her tummy, such as a laid-back position or having baby diagonally across your chest in a cradle hold.
Safe Sleep
Safe sleep guidelines state that babies sleep on a flat surface. If your doctor recommends that you raise one end of their cot or crib, use a crib designed for this purpose in accordance with the manufacturer’s guidelines, rather than raising the mattress within the cot.
Breastmilk vs. Formula
People may suggest you change to formula. You might even wonder if giving your baby formula instead of breastmilk could be better for them. However, breastmilk is the normal food for all babies and is even more important for a baby with symptoms of reflux. It’s easy to digest and contains everything they need for normal development. If your baby breathes in their vomit, breastmilk is less harmful than formula. Breastmilk has immune factors that help to heal sore or damaged areas in your baby’s gut. Formulas that claim to help with reflux lack these factors. They only differ from standard formula because they have thickener added. Reflux is about as common in formula-fed babies as in breastfed babies. However, reflux episodes in formula-fed babies tend to happen more often and last longer. The smell of the vomit and poos of babies fed formula is much stronger than those of breastfed babies. Formula is harder for a baby to digest.
When to Seek Medical Advice
Moms are well-equipped to notice changes in their baby’s temperament, which can be the earliest indication of reflux. If you’ve tried making lifestyle and diet changes and something still feels off, talk to your pediatrician to get a more concrete diagnosis. You may have a “happy spitter” - a baby who’s not terribly upset by reflux - in which case, they may not recommend anything besides doing a lot of laundry. But in other cases, your pediatrician may refer you to a pediatric gastroenterologist (GI) or prescribe a medication like an H2 blocker (usually Zantac) or proton-pump inhibitor PPI (such as Prevacid).
A health professional may want to investigate further if your baby has other symptoms such as unexplained lack of weight-gain, severe distress, or very forceful and frequent regurgitation, spitting up green/yellow fluid or what looks like coffee grounds, blood in baby’s poo or baby repeatedly refusing feeds.
Gastro-Oesophageal Reflux Disease (GORD)
Gastro-oesophageal Reflux Disease may be diagnosed when several of the following are happening together: baby not gaining weight, frequent and forceful vomiting, distressed behaviour and/or recurring coughs, hoarseness or pneumonia.
The NICE guidelines state that a review of feeding history should first take place, and smaller more frequent feeds may be appropriate. A breastfeeding assessment should take place for breastfed babies - a trained breastfeeding counsellor or International Board Certified Lactation Consultant can offer this support.
If feeding advice does not reduce symptoms, then a trial of alginate therapy may be given. This should be stopped at intervals, to see if symptoms have reduced. The next step treatments for babies with reflux in addition to unexplained feeding difficulties, distressed behaviour or faltering growth may be a trial of proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs). If your baby may be allergic to cows’ milk protein, then an elimination trial of all cows’ milk from the mother’s diet may help to improve symptoms (under medical supervision).
Additional Factors to Consider
Latch Issues
Babies who are not latching effectively for breastfeeds may have reflux. This can be because they are taking in air when feeding or when crying. Sometimes, babies just need to be in a slightly different position to latch more deeply. Babies who have an allergy may have reflux as a symptom, or reflux may be a symptom of microbial dysbiosis - an imbalance of gut bacteria.
Wind and Gas
Wind in breastfed babies can come from several sources such as taking in too much air. This can be spotted if your little one clicks, gulps, feeds noisily, or spills milk whilst feeding. If your baby is doing any of these whilst being fed, you should visit a Tongue Tie Practitioner or a certified lactation consultant for latch support.
Teething
Occasionally, some older babies will start to spit up when they hadn’t typically been spitting up. Teething - the discomfort of the gums may cause baby to be less efficient with her sucking and take in more air. Teething can also result in increased saliva production and swallowing, adding to the volume of fluid and air in her tummy.