Your baby doesn’t seem to be nursing as happily any more. You have your suspicions that it could be an infant food intolerance. Your doctor’s appointment is booked for next week. What now? Baby’s gotta eat! It’s time to do a quick home-spun low-allergen diet, and see what happens.
An allergen is anything the body is allergic to.
Allergens are not (necessarily) bad/junky or contaminated foods. Even the very best good healthy foods are an allergen for someone. While allergens can come to the baby through breastmilk, in general, the mother’s body acts as a filter, turning all sorts of rubbish (from junk food to contaminated water) into healthy, nutritious baby milk. In fact, even if mum has food poisoning, breastfeeding should continue.
How do you do the test?
It’s easy, actually:
Breastfeeding Mother: eat nothing but plain rice and peeled pears, and drink nothing but plain water for a couple of days.
Breastfed Infant: should nurse, but can also be offered cooled pre-boiled water and peeled pears without compromising the test.
Do not offer previously expressed breastmilk, if you can help it, as you won’t know what you ate the day it was expressed.
Artificial colours, flavours and other ingredients in baby paracetamol (and other products you may be using to ease baby’s distress) are also possible allergens. Paracetamol is no longer being used as routinely for children as it once was. I’d consider giving the paracetamol a break during the test. But please continue any prescription medications as directed.
If your hunch about an infant food sensitivity is correct, you will often observe an improvement in nursing behaviour in just a couple of days. Food allergens can take minutes, hours or days to cause a reaction. Also, depending on type, it can take hours, days or weeks after you cease consuming a particularly allergen for your system to be clear of it.
Two days is not a definitive time period. But a hungry, thirsty, miserable baby will be willing to give the boobie a damn good go, if you can noticeably reduce the badness for them. Two days without topping up on the allergens is often enough for this. Two days is also an achievable period of time to be on an extremely restrictive diet before you go CRAZY!!
Is rice and peeled pears a hard and fast rule?
No. There’s nothing magical about rice and pears. Those foods are typically used to kick off an elimination diet as they are about the least allergenic foods we know, but it’s possible (though extremely unlikely) to be allergic to them.
It’s technically possible to spend two days fasting on nothing but water. The production of breastmilk has minimum hydration and rest requirements, but no minimum maternal nutrition requirements. But I would certainly not recommend you try it.
If you need help making it through the two days, you can add foods to the test, but each ingredient you add decreases the likelihood of a clear and immediate result. When I did it, I added butter to my rice. Many people with a dairy allergy can (for whatever reason) tolerate butter.
Interpreting results from the test
You are primarily looking for an improvement in nursing behaviour. Are nursing sessions longer, more relaxed, with less screaming, biting and back arching? Is there an improvement in overall behaviour and a reduction in your baby’s distress?
Yes, these observations are very subjective, and not the stuff of scientific experiment. But it’s your child, you love them, and you need them to be happy — so your instincts on these things are often right.
Beyond nursing-related behaviours, I wouldn’t agonize trying to look for a lot of other evidence of change in just two days. It’s too soon to expect to see visible skin signs clear up, and baby’s fear of the pain will continue to affect their behaviour. Hunger will motivate them to nurse, however miserable they may feel. These other symptoms all add to the picture if/when you get to keeping a food diary.
What to do after a positive result
If your fasting (and restricting baby’s solids) is giving your precious child some relief, then naturally, you are not just going to revert back after two days. But you can’t continue to eat only rice and peeled pears either.
In my case, I took a punt and tried adding back all low salicylate foods. Salicylates are one of the food patterns which can assist in elimination diet testing. By testing for salicylates first, I was able to add back several foods at once.
Luckily for us, salicylates have proven to be the key to our problem. When I mistakenly eat something which is high in salicylates, my baby visibly suffers from it and his temperature rises as his immune response kicks in. I had a tense few days testing whether the “medium salicylate” fruit and vegetables were going to be a problem for us, and I’m glad to say that they are not.
The negative result
If there is no change in baby’s nursing behaviour, the result is slightly less informative. How pure were you about only having rice, peeled pear and water? Did you use preserved pears with a food additive? Were you taking any other supplements or medications? Did baby have anything other than breastmilk, water and peeled pear? Was two days simply not enough for baby’s particular type of allergen to be flushed out sufficiently for their constitution to notice an improvement? Is baby allergic to the pears?
Again, trust your instincts. If you feel that you gave it a good go, then it might simply be something else.
However you choose to proceed, you might find it helpful to keep a food and wellness diary to keep track of your success. No matter what happened with the test, at least you have one more piece of information for your doctor (eg. “I experimented with eating only rice and pears for two days, and it didn’t seem to make any difference.”).