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Breast Feeding

Milk protein intolerance in breastfed baby

05/16/2002

Question:

I`m trying to learn more about milk protein intolerance in breast milk. My infant son and I had six great weeks of breastfeeding. We had no typical problems that often occur in the beginning. Everything seemed to be on track and he had even bypassed his original birth weight at his two-week check up. He also did fine with taking an occassional bottle of breast milk. After six weeks though, he gradually began getting sick. He would often scream sometime during or after the breastfeeding session, throw up (not spit up) numerous times after feedings, and had profuse diarrhea. His pediatrician diagnosed him, based on his symptoms - no tests, with reflux. We started him on Bethanechol and Xantac to no avail. He continued to worsen. The ped and I also suspected food allergies might be a factor, since he had passed two very small reddish blobs and I had displayed food allergies/intolerances (hives, diarrhea, headaches) off and on as a child. I eliminated all obvious forms of dairy from my diet a week after my son began showing symptoms. A couple weeks later after reading up on dairy, I eliminated all foods with whey, casein etc. The reflux medicine and the dairy elimination did not help. Working with the La Leche League and a nutritionist, I went on a strict elimination diet in an effort to determine the culprit(s). None of the dietary changes helped. He continued to worsen and was screaming uncontrollably throughout the day, throwing up constantly and had profuse diarrhea. The pediatrician sent him to a GI specialist, who based on my son`s symptoms, also diagnosed with milk protein intolerance in addition to reflux. The GI tested his stool sample and it showed he was passing blood (not visible to the naked eye). My son was also losing weight at this point. The GI prescribed Neocate, a medically supervised formula that breaks down all the proteins, and switched his one reflux medicine from Xantac to Prisolec and kept him on Bethanechol. With Neocate, Prisolec and Bethanechol, my son began to show dramatic improvement within a week. The GI specialist said it was very rare for a three-month old breastfed baby to be so sensitive to the proteins in breast milk, but it can happen and that he may outgrow it. I used a hospital grade pump to keep up a full supply while he was on Neocate and limited breastfeeding to only once a day. (These were not usually followed by a screaming session.) After about two weeks though, he weaned himself.

I`ve searched the literature, but can`t find anything that discusses this situation in a breastfed baby. I`d like to understand what caused this, if possible. I`d also like to avoid this happening again if I would have a second child. Some articles suggest avoiding dairy if a pregnant mother has allergies. I ate plenty of dairy when I was pregnant and craved ice cream, but at that time, I didn`t display typical allergic signs (i.e. hives, headaches) as I had as a child. Other possible allergic signs such as bouts of gastrointestinal problems were simply attributed to normal pregnancy conditions. I also developed PUPP (an intense skin rash) in the 37th week that caused serious sleep deprivation. Skin conditions are sometimes associated with allergies and I`ve wondered if there was a connection.

Finally, to see if my son had outgrown this intolerance, the doctor had us recently introduce a formula that only breaks down most of the proteins, but our son soon started showing symptoms: intense screaming sessions, diarrhea, a distint pink ring around the anus, and irritated skin in the groin area that did not respond to ointment. He was also still on the reflux medicines during this test.

I know this is long, but I wanted to give the pertinent facts. Thank you for your help.

Answer:

WOW!! You have really had unusual experience with breast feeding. I have had some difficulty in finding information on your problem, but I can tell you that it is extremely rare from what I can find.

In principle no human infant feeding is thought to be more hypoallergenic than human breastmilk, because the proteins are human proteins and are usually non-allergic to human infants. However, human breastmilk does contain small amounts of food allergens from the mothers diet, and these may play a factor in the infant`s sensitization of proteins. If you are not able to control the symptoms your son displays you may need to discontinue breast feeding.

Prior to your next pregnancy you may want to consult with an allergist to see if you should eliminate milk and milk products during your pregnancy. It is also important to remember that even though you son has had difficulties with breast feeding, you next child may not, or just think how severe problems would have been if you had never breast fed.

Good luck, remember that you have given your son a golden start in life.

REFERENCE: Elx, BM and Fritsche,R (2001) "Cow`s milk protein allergy and possible means for its prevention" Nutrition, 17:642-651.

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Response by:

Tina   Weitkamp, RNC, MSN Tina Weitkamp, RNC, MSN
Associate Professor of Clinical Nursing
College of Nursing
University of Cincinnati