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Breastfeeding

WARNING: Before starting any diet contact your health care physician first. The following information has been compiled from personal experiences. WE are NOT doctors nor nutritionists.

Here are some of the links and pointers that our moms have put together regarding breastfeeding and elimination diets. Please check back often as we update this information.

Total Elimination Diet (TED) Basics: http://www.infantreflux.org/forum/forum_topics.asp?FID=43
Total Elimination Diet (TED) Recipes: http://www.infantreflux.org/forum/forum_topics.asp?FID=44
Dr. Sears TED: http://askdrsears.com/html/4/T041200.asp

And here are a few tips from moms:
  1. One of the greatest tools for successful breastfeeding is the food diary. It is absolutely essential in correlating symptoms with Mom's diet. I'm attaching the one that I used as an example. There's a column for calories to help Mom determine if she's eating enough. For "Feeding" I would record the time of day. For "Sleeping" I would record length of naps and length of night-time sleep. For poops I would give a description of each poop.
  2. Don't start solids until you feel like babies symptoms are stabilized on Mom's diet. Then hold Mom's diet as steady as possible as you introduce new solids so that you can properly determine if the solid is being tolerated.
  3. The same is true if trying to expand Mom's diet, hold babies diet as steady as possible while adding new foods to Mom's diet.
  4. Don't forget the importance of sleep, water intake, quality food intake. In order to make breastfeeding successful Mom needs to be healthy and providing healthy milk for the child. Even on an extremely restricted diet it is still possible to eat very balanced. Be sure to add plenty of "healthy" fats to Mom's diet, and be sure that Mom is getting the proper amount of essential fatty acids as these are crucial for baby brain development.
  5. For emergencies or special occasions be sure to have some EBM stored in the freezer. Mark this milk with the date so you can go back to food diary if needed to see what Mom's diet contained at the time.
  6. When switching from breastmilk to something else, such as formula, alternative milk, or milk (if intolerance is outgrown), please be sure to maintain your milk supply for a period of time to be absolutely sure your baby is tolerating the new feedings. I would recommend 3-4 weeks just to be sure that a honeymoon period isn't occurring where baby initially does well then symptoms start appearing a few weeks into the change.



Formula Feeding

WARNING: The information posted on this page is not a substitute for professional medical advice. Before starting a formula, or changing formulas, you must have your child seen by a doctor.

Visit this link for more information on the different types of formulas and how they are tested and used for intolerant/allergic babies.
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;106/2/346

Although breastfeeding is the best option for babies, many parents have made the decision to use formulas to feed their babies. However, be aware that for the MSPI/MFPI/FPIES child, finding the right formula can be extremely difficult and frustrating. Many doctors will start a baby on a hydrolyzed, or broken down, hypoallergenic formula. Usually the baby is given time to see if a reaction will occur. Sometimes a child may go through 5 or more formulas before finding one that works well. However, switching formulas quickly and often is not recommended. Unfortunately, it is trial and error to find one that can be tolerated by the child. There may be a time where it looks like the formula is going to be successful, but then the child may start reacting to it later on. That is called the "honeymoon period", because you get a better acting baby, then the pain and discomfort starts all over again. The theory behind the honeymoon period is it takes time for the body to build up a defense against the offending proteins in the formula. The average honeymoon period is two weeks, but it can start as fast as an hour after consuming the formula, or it may take as long as 3 months before a reaction occurs.

Some babies may have an increase in reflux symptoms or increased spitting up when started on formula. Elemental (amino acid) formulas are thinner than other formulas, so the spitting may increase. Many moms report their doctors tell them that if the baby is happy, gaining weight and not having GI problems, then they may be a happy spitter and not worry about it. Some moms state they go through many bibs and burp rags, but the payoff is worth it. Stools may become thicker, and some babies may have problems with constipation. Speak with your doctor if constipation becomes an issue. The elemental formulas are digested high in the digestive tract due to their broken down state. Stools may appear green or black. This is bile that is present in the stool and is very common due to the fact that it is digested high in the intestinal tract.

Below is a list of commonly trialed hypoallergenic formulas. Some are still milk-based, but do contain broken down milk proteins. The powder formulas have corn solids in them, therefore, if you know your child has intolerance to corn, the ready-to-feed formulas are a better option. This list is not all-inclusive, but it gives a good idea of the different formulas and the possible ingredients that MAY trigger reactions. This is not intended to take place of a doctor's recommendations. You need to have a doctor's advice before starting your baby on any of the formulas listed. For the amino acid formulas, you may be required to get a prescription, depending on your insurance plan. Many insurances do not cover formulas, however, many parents have been successful using other resources to find affordable formula. Some doctors may start the baby out on soy based formulas, but many parents have expressed interest in by-passing the soy formula due to the diagnosis of Milk/Soy Protein Intolerance.

Enfamil Nutramigen LIPIL
Enfamil Nutramigen LIPIL is a hypoallergenic formula for babies who cry excessively or develop other colic symptoms or rash due to milk protein allergy. It's easy-to-digest, balanced nutrition for baby's first 12 months.

Ingredients: Corn Syrup Solids (46%), Vegetable Oil (Palm Olein, Soy, Coconut), and High Oleic Sunflower Oils (25%), Casein Hydrolysate (17%), Modified Corn Starch (7%), Less Than 2%:, Mortierella Alpina Oil (source of Arachidonic Acid (ARA)), Crypthecodinium Cohni Oil (source of Docosahexaenioic Acid (DHA)), Vitamin A Palmitate, Vitamin D 3, Vitamin E Acetate, Vitamin K1, Thiamin Hydrochloride, Riboflavin, Vitamin B 6 Hydrochloride, Vitamin B 12, Niacinamide, Folic Acid, Calcium Pantothenate, Biotin, Ascorbic Acid, Choline Chloride, Inositol, Calcium Citrate, Calcium Hydroxide, Calcium Phosphate, Magnesium Oxide, Ferrous Sulfate, Zinc Sulfate, Manganese Sulfate, Cupric Sulfate, Sodium Iodide, Sodium Selenite, Sodium Citrate, Potassium Citrate, Potassium Chloride, L Cystine, L-Tyrosine, L Tryptophan, Taurine, L Carnitine

Enfamil Pregestimil
Enfamil Pregestimil® was specially designed for babies with fat malabsorption problems. It is a hypoallergenic infant formula. Pregestimil does not look or taste like milk or soy formulas. It may separate in the refrigerator. Shake well before feeding.

Ingredients: Corn Syrup Solids (32%), Casein Hydrolysate (17%), Medium Chain Triglycerides (Mct Oil [16%]), Dextrose (10%), Modified Corn Starch (8%), Soy Oil (7%), Corn Oil (3%), High Oleic Oil (Safflower or Sunflower [3%]), Less Than 2%:, Vitamin A Palmitate, Vitamin D 3, Vitamin E Acetate, Vitamin K1, Thiamin Hydrochloride, Riboflavin, Vitamin B 6 Hydrochloride, Vitamin B 12, Niacinamide, Folic Acid, Calcium Pantothenate, Biotin, Ascorbic Acid, Choline Chloride, Inositol, Calcium Citrate, Calcium Phosphate, Magnesium Oxide, Ferrous Sulfate, Zinc Sulfate, Manganese Sulfate, Cupric Sulfate, Sodium Iodide, Sodium Citrate, Potassium Citrate, Potassium Chloride, Sodium Selenite, Acetylated Monoglycerides, L Cystine, L-Tyrosine, L Tryptophan, Taurine, L Carnitine

Similac Alimentum
Use Similac Alimentum to give your baby a strong start in life. It's hypoallergenic and contains a milk protein that is broken down into tiny pieces to virtually eliminate allergic reactions in most babies who are allergic to cow's milk protein. It's designed for babies with colicky symptoms such as excessive crying and fussiness due to cow's milk protein sensitivity.

Ingredients: Corn Maltodextrin 35.5%; Casein Hydrolysate (Derived From Milk) 17.5%; Sugar (Sucrose) 14.5%; High Oleic Safflower Oil 9.7%; Medium-Chain Triglycerides 9.5%; Soy Oil 8.0%; Less Than 2% of: C. Cohnii Oil*; M. Alpina Oil**; Calcium Phosphate; Datem; Potassium Citrate; Xanthan Gum; Magnesium Chloride; Monoglycerides; Sodium Chloride; Ascorbic Acid; L-Cystine Dihydrochloride; Calcium Carbonate; L-Tyrosine; Potassium Chloride; Choline Chloride; Ferrous Sulfate; L-Tryptophan; Taurine; m-Inositol; Ascorbyl Palmitate; dl-Alpha-Tocopheryl Acetate; Zinc Sulfate; L-Carnitine; Niacinamide; Mixed Tocopherols; Calcium Pantothenate; Cupric Sulfate; Vitamin A Palmitate; Thiamine Chloride Hydrochloride; Pyridoxine Hydrochloride; Potassium Iodide; Phylloquinone; Sodium Selenate; Vitamin D3; Cyanocobalamin; *A Source of Docosahexaenoic Acid (DHA); **A Source of Arachidonic Acid (ARA)"

Neocate Infant Powder
Hypoallergenic, Nutritionally complete, 100% free amino acids, Amino acid profile similar to breast milk, Over 45 extensive clinical validations. Indications for use include cow and soy milk allergy, multiple food protein intolerance, short bowel syndrome, eosinophilic esophagitis, gastroentestinal reflux and the transition from parenteral to enteral nutrition or other medical conditions for which an amino acid based diet is required.

Ingredients: Corn Syrup Solids, High Oleic Safflower Oil, Refined Vegetable Oil (Coconut, Soy), Calcium Phosphate Dibasic, L-Arginine, L-Aspartate, Tripotassium Citrate, L-Leucine, L-Lysine Acetate, L-Glutamine, L-Proline, L-Valine, L-Isoleucine, Glycine, CAEM (An Emulsifier), L-Threonine, L-Tyrosine, L-Phenylalanine, L-Serine, L-Histidine, L-Alanine, Sodium Chloride, L-Cystine, L-Tryptophan, L-Methionine, Magnesium Acetate, Magnesium L-Aspartate, Potassium Chloride, Choline Bitartrate, M-Inositol, L-Ascorbic Acid, Ferrous Sulfate, Zinc Sulfate, Taurine, L-Carnitine, Niacinamide, DL-Alpha Tocopheryl Acetate, Calcium D-Pantothenate, Cupric Sulfate, Manganese Sulfate, Pyridoxine Hydrochloride, Riboflavin, Vitamin A Acetate, Thiamine Chloride Hydrochloride, Potassium Iodide, Chromium Sulfate , Phylloquinone, Sodium Molybdate, Folic Acid, Sodium Hydrogen Selenite, D-Biotin, Vitamin D3, Cyanocobalamin.

Elecare
ELECARE is a nutritionally complete elemental formula specifically indicated for infants and children who need an amino acid-based medical food or who cannot tolerate intact or hydrolyzed protein. ELECARE is indicated for the dietary management of protein maldigestion, malabsorption, severe food allergies, short-bowel syndrome, eosinophilic GI disorders, GI-tract impairment, or other conditions in which an amino acid-based diet is required. ELECARE Unflavored product is for both infants and children· ELECARE Vanilla product is for children age 1 year and older. For oral or tube feeding.

Clinically documented to be hypoallergenic1 , virtually eliminating the potential for an allergic reaction· Clinically shown to support growth when used as a primary source of nutrition2· 100% free amino acids as nitrogen source· One-third of fat as medium-chain triglycerides, an easily digested and well-absorbed fat source· Stringent manufacturing standards to reduce risk of whole-protein contamination· Does not contain milk protein, soy protein, fructose, galactose, lactose, or gluten.

Ingredients (Unflavored): 55.9% Corn Syrup Solids, 9.0% High Oleic Safflower Oil, 7.6% Medium Chain Triglycerides, 6.5% Soy Oil. L-Glutamine. Less than 2% of the following: L-Asparagine, L-Leucine, DATEM (an emulsifier), L-Lysine Acetate, Calcium Phosphate, L-Valine, Potassium Phosphate, L-Isoleucine, L-Arginine, L-Phenylalanine, L-Tyrosine, Sodium Citrate, L-Threonine, Potassium Citrate, L-Proline, L-Serine, L-Alanine, Glycine, L-Histidine, L-Methionine, Ascorbic Acid, Magnesium Chloride, L-Cystine Dihydrochloride, L-Tryptophan, Calcium Carbonate, Choline Chloride, m-Inositol, Salt (Sodium Chloride), Ferrous Sulfate, Taurine, Ascorbyl Palmitate, Zinc Sulfate, Niacinamide, dl-Alpha-Tocopheryl Acetate, L-Carnitine, Calcium Pantothenate, Thiamine Chloride Hydrochloride, Cupric Sulfate, Vitamin A Palmitate, Manganese Sulfate, Riboflavin, Pyridoxine Hydrochloride, Beta-Carotene, Folic Acid, Biotin, Phylloquinone, Chromium Chloride, Potassium Iodide, Sodium Selenate, Sodium Molybdate, Vitamin D3, and Cyanocobalamin. (FAN 8230-03)

Ingredients (Vanilla): 55.3% Corn Syrup Solids, 8.9% High Oleic Safflower Oil, 7.5% Medium Chain Triglycerides, 6.4% Soy Oil. Less than 2% of the following: L-Glutamine, L-Asparagine, L-Leucine, DATEM (an emulsifier), L-Lysine Acetate, Calcium Phosphate, L-Valine, Potassium Phosphate, Artificial Flavor, L-Isoleucine, L-Arginine, L-Phenylalanine, L-Tyrosine, Sodium Citrate, L-Threonine, Potassium Citrate, L-Proline, L-Serine, L-Alanine, Glycine, L-Histidine, L-Methionine, Ascorbic Acid, Magnesium Chloride, L-Cystine Dihydrochloride, L-Tryptophan, Calcium Carbonate, Choline Chloride, m-Inositol, Salt (Sodium Chloride), Acesulfame K, Ferrous Sulfate, Taurine, Ascorbyl Palmitate, Sucralose, Zinc Sulfate, Niacinamide, dl-Alpha-Tocopheryl Acetate, L-Carnitine, Calcium Pantothenate, Thiamine Chloride Hydrochloride, Cupric Sulfate, Vitamin A Palmitate, Manganese Sulfate, Riboflavin, Pyridoxine Hydrochloride, Beta-Carotene, Folic Acid, Biotin, Phylloquinone, Chromium Chloride, Potassium Iodide, Sodium Selenate, Sodium Molybdate, Vitamin D3, and Cyanocobalamin. (FAN 8230-02) The PIC Foundation