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.

It’s working!

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.

Other sources which may be helpful include fed up and friendly food.

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.

What next?

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.”).

I’ve noticed I have a pattern around a lot of debates like this. I do research, find out what the scientists and peak bodies think, read the arguments from the really crunchy hippies, and then pick what feels intuitively most nurturing but still matches the science.

That how I’ve ended up a big breastfeeding advocate. The World Health Organization agrees that breast is best and further that breastfeeding should continue (accompanied by safe solids) up until baby is two years of age and may continue beyond that for best health outcomes. It suggests exclusive breastfeeding until six months. The American Academy of Pediatrics issued a revised policy in 2005 that also called for exclusive breastfeeding until six months. It’s important to note the wording though: it says juice, water, solid food etc is “generally unnecessary” for children under six months.

This has meant that some people seem to say, “Baby is six months old today! Solid food for you!”. That doesn’t make a lot of sense to me. I want to know what it is that’s magically happening “around six months” that leads to this readiness for food.

The attachment parenting guru, Dr Sears, gives some reasons: baby’s ‘tongue thrust reflex’ (medically known as the extrusion reflex) is gone and the gut has started to go through ‘closure’. Gut closure refers to the lining of the gut which stops microscopic antigens entering the blood stream (my favourite quote on this was that it “is the process by which the epithelial surfaces of the intestine become impermeable to antigens”). A very quick search suggested that in most humans, gut closure starts before birth, because premature babies have more issue with macro antigens entering the blood stream whether they are breastfed or not. Fascinatingly, though, breastfeeding, and especially colostrum, that fabulous early milk, may actually trigger gut closure which is why breastfed babies may have fewer allergies. It’s chock full of secretory IgA hormone which helps stimulate the baby’s enzymes. Where does this four-to-eight month thing come in then? What’s this six month magic marker?

Interestingly, it seems possible that gut closure completion  is triggered by the introduction of solid food. I don’t have a link for this just yet, as the article that suggested it is behind locked walls and I haven’t had time to read the full reference, but that would suggest we’re looking for other physical signs, then we introduce the solid food, and then the gut realises what’s going on and does its thing. Certainly, in other animals, gut closure is triggered by weaning.

My darling daughter is now five-and-a-half months old. We have a lot of allergies in our family. Between my sisters, nieces and nephews, we have soy, dairy and wheat allergies and my partner is allergic to anything with fur or feathers (skin sensitivity), allergic to arrowroot (as a food and as a skin irritant) and lactose intolerant. She’s sitting up unaided, watching us eat with rivetted attention and most importantly, grabbing at food. Naturally, I’m hesitant to introduce solids if my darling is going to have allergic reactions. The “common knowledge” about this is that you shouldn’t introduce things like egg and peanuts until baby is at least a year old. Based on the latest research, though, the common knowledge is wrong. The Infant Feeding Advice from the Australasian Society of Clinical Immunology and Allergy says there is insufficient evidence that delaying allergenic foods helps prevent allergies and acknowledges that there is some suggestion recently that delaying such foods can increase allergies. (Who knows how, given the whole gut closure discussion…)

So, with yet another lots of conflicting advice whirling through poor mama’s head, where does that leave us? I think it leaves us as follows:

• Keep on breastfeeding, as it’s the best source of vitamins and minerals for her and the World Health Organization says it has all the nutrients she needs for survival.
• She’s showing all the signs that she’s ready to start eating, even though she doesn’t need food yet. Start giving her tiny pieces of low allergen foods (carrot, potato, rice, pumpkin) to trigger the completion of gut closure.
• Introduce each food as a food on its own, in the morning, as recommended by Dr Sears, and watch carefully for allergic reactions. If none are seen, that food goes onto the list of foods okay to combine with other foods.
• Continue with baby-led weaning. (Note that this is weaning onto solid foods and not off breastmilk.) She’s already licked a few foods — cucumber, carrot — but we’ll follow her lead with how much she wants.
• After she hits six months, but not necessarily on the day, offer her an actual meal of solid food, with selections of items she’s not allergic to, and see how she goes.
• Delay those allergenic foods to eight months, just to give that gut closure a chance to happen but not worry too much about delaying further, based on ASCIA’s recommendation.

Your baby will have her or his own individual signs that he or she is ready to eat. Pay attention to them. Some babies don’t sit up unaided until almost nine months. If yours is one of them, and he or she is NOT reaching for food, there may be no need to start him or her on it yet. And remember that information changes as research occurs. This information is current as of July 2009. If you’re reading this more than a year down the track and we haven’t updated it, check our sources for up-to-date information or hassle us to find out the latest.

For example, Bisphenol A (BPA) is an ingredient in plastics which are currently defined as food-grade. Minute amounts of BPA are believed to have a hormone-like effect on the body’s endocrine system, possibly causing chronic toxicity, and a bunch of other things (see this Wikipedia page for much more detail, including a list of studies).

BPA is in epoxy resin (the lining of all food cans) and polycarbonate, the strong, clear plastics used for water bottles and baby bottles. Internationally, the regulations on BPA vary wildly, from a complete ban through to statements saying that it’s safe. This is one area where we can’t just trust the regulators to protect us.

The release of BPA from polycarbonates is increased by putting the plastic under stress, such as detergents, microwaving, dishwasher, sunshine, physical stress, and high temperature. Many regulators have gone down the path of saying that BPA polycarbonates are ok when used in accordance with the manufacturer’s instructions. To me this seems inadequate, when the standard household dishwashing detergent is a harsh chemical. I don’t know anyone who uses “Velvet pure soap” (for example) as the only soap in their kitchen sink. And there is a recently slashdoted study of humans drinking from polycarbonate water bottles AT ROOM TEMPERATURE for two weeks, and coming up with measurable levels of BPA in their urine.

It is very difficult to avoid BPA completely. Even strawberries grown in polycarbonate greenhouses have been found to have BPA contamination. However, the highest average intake of PBA in humans is in infants and children, right when they are most vulnerable. There are a couple of key things you can do to reduce their exposure to BPA.

1) Don’t use a polycarbonate bottle, if you are bottle feeding. Yes, this will take some research. Don’t assume anything. Even brands that have introduced BPA-free models, like Avent, still have BPA-filled versions on the shelf too.

2) Check any other baby plastics you are using (spoons, sippy cups, ice-cube trays, etc) for their recycle symbol. Polycarbonates have the Recycle 7 symbol.

3) Check the Recycle symbol on pre-packaged foods, such as yoghurt, juice, water, etc. Avoid the No. 7 plastics, especially if they are the strong, clear plastics.

4) Offer fresh, non-wrapped foods as much as possible. ALL cans of food are lined with BPA epoxy resins.

5) When using commercial baby foods, go for the little glass jars and not the tins or plastics. Sadly, even the lids of baby food jars are lined in epoxy resin BPA plastics (so I don’t scrape the food off the lid any more) but this is better than being completely encased in it.

The more you look into it, the more you will find that it’s virtually impossible to completely avoid BPA. But don’t let that depress you. We deal with situations like this all the time at work. Use the 80-20 rule initially, and then go for continuous improvement as the resources (like adequate sleep) become available.