Almost from the time Dawn Cirafesi's son, Ethan, was born, he was covered by an itchy red rash. He scratched his skin so much that it bled. When his mom fed him formula for the first time at 3 months, Ethan began vomiting violently and had difficulty breathing. It turned out that the baby was allergic to cow's milk -- which can show up in small amounts in breast milk and is the main ingredient in most infant formula. After Ethan's doctor put him on a special hypoallergenic formula, his symptoms gradually started to disappear. Though Ethan's case was severe, it's not uncommon for babies to react badly to something they ate (or you ate, if you're nursing). In fact, gastrointestinal issues are among the top concerns that new parents bring up, says pediatrician Gwenn Schurgin O'Keeffe, M.D., founder and editor-in-chief of pediatricsnow.com.
The Most Common Culprit
If your baby has frequent stomach problems after eating a particular food (gas, bloating, diarrhea, cramping, or vomiting), he may have a food intolerance. "All that means is that his digestive system isn't able to comfortably handle it," says pediatrician Gwenn Schurgin O'Keeffe. As many as 15 percent of babies under 12 months have some sort of intolerance, but the severity of it can vary enormously. For some kids it takes a lot of the problem food to provoke a response, while for others a tiny amount can cause a reaction. Sometimes an intolerance lasts just a few days; other times the trouble persists.
When to Worry: Food Allergies
Cow's milk is the most likely problem food. Up to 7 percent of infants have trouble digesting milk proteins. Many parents confuse this with lactose intolerance, an inability to digest the milk protein lactose that is common in older kids and adults. But this condition is rare in infants -- it sometimes shows up temporarily after a stomach virus but quickly goes away.
If your baby has stomach problems or is fussy after meals, talk to your pediatrician. She'll determine whether your baby has an intolerance or if something else is going on. "I consider many issues," says pediatrician Gwenn Schurgin O'Keeffe. "When babies don't take well to formula, incorrectly mixing the powder (not striking the right balance of water to formula) is a common cause. In a nursing infant, we look at the mom's diet to see if what she's eating could be producing extra gas. Overfeeding can cause similar symptoms."
Once your baby starts solids, other intolerances may emerge. Some babies have difficulty digesting gluten, the protein in wheat, rye, and barley. "You won't detect this until your child is around 6 to 9 months old and eating more grains," says Carla Davis, M.D., a pediatric allergist and immunologist at Texas Children's Hospital, in Houston. (Celiac disease, a serious form of gluten hypersensitivity, usually doesn't show up until later.) It's rare, but some babies have intolerances to fructose (fruit sugar) and sucrose (table sugar).
How to Pin Down the Problem
Your doctor may suggest eliminating one food at a time to pin down the culprit. Even if a baby is intolerant of a food, that doesn't mean she'll never be able to eat it. "If a parent says her baby has gas and fussiness after eating squash, for example, I'll tell her to try it again in eight weeks," says pediatric gastroenterologist Bryan Vartabedian, M.D., author of Colic Solved. "The problem often goes away."
The More Serious Issue
About 6 percent of babies have full- fledged food allergies. This means that when an infant is exposed to a particular food, her immune system overreacts, producing allergy antibodies that recognize the food. When she eats it again, she'll quickly experience symptoms like itching, rashes, vomiting, diarrhea, and/or difficulty breathing. Foods that most often cause an allergic response in babies include cow's milk, eggs, nuts, peanuts, wheat, soy, fish, and shellfish. And it doesn't matter if your 2-month-old has never tasted peanuts: If you had a peanut butter sandwich for lunch, she can be exposed to it through your breast milk or your skin, explains Dan Atkins, M.D., a pediatric allergist at Denver Children's Hospital and National Jewish Health.
Signs of an Allergy
One of the first signs of a food allergy may be eczema, the itchy red rash. In fact, up to 40 percent of babies with moderate to severe eczema also have food allergies, according to research by Parents advisor Hugh Sampson, M.D., director of the Jaffe Food Allergy Institute at Mount Sinai Hospital, in New York City. Other symptoms: vomiting, a chronic runny nose, fussiness and crying after feedings, diarrhea, and trouble gaining weight. Red blood in the diaper can be a sign of allergic colitis, a type of milk allergy that irritates the colon. The most serious allergic response is anaphylaxis, a potentially fatal reaction that produces a form of shock. "If your baby has trouble breathing, a swollen tongue, and becomes flushed and wheezy, don't drive to the hospital -- call an ambulance immediately," warns pediatrician Gwenn Schurgin O'Keeffe.
Avoiding and Outgrowing the Allergy
Doctors have two main strategies for pinning down allergies. Your pediatrician may have you eliminate items one by one from your baby's diet -- or from your own, if you're breastfeeding -- to figure out the problem food. Some doctors also recommend a skin test, in which an allergist pricks food-protein extracts into your baby's skin to see which ones cause a red, itchy bump.
If your breastfed baby is diagnosed with an allergy, you'll have to steer clear of her trigger foods. Doctors usually put formula fed babies on a hypoallergenic formula. It's pricey, but your insurance may pay for it. Just remember, while food allergies can be frustrating and even scary, they don't necessarily last forever, says Parents advisor Hugh Sampson, M.D., director of the Jaffe Food Allergy Institute at Mount Sinai Hospital, in New York City. Many kids grow out of them by age 5.
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In the Family
Doctors don't fully understand why some children develop food allergies and others don't. However, they do know that a baby is at higher risk if his parents or siblings have allergies -- to food or even to dust, animals, or pollen. (Kids usually don't get environmental allergies until age 2 or 3.) Experts used to think that babies with a family history of allergies might be able to avoid them if their moms stayed away from common problem foods while breastfeeding and if they waited to introduce those foods until their child was 2 or 3. Now, the American Academy of Pediatrics says there isn't enough evidence to support this practice, and some new studies are under way to determine whether early exposure to common allergenic foods may actually keep babies from developing an allergy.
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