Basics of Feeding an MSPI Infant
Breastfeeding Babies With MSPI
Proteins that are ingested by a nursing mother do pass into the motherís breast milk, so if you are nursing and your baby is having several of the symptoms, he/she is most likely reacting to the dairy proteins that you are ingesting. You will need to eliminate all dairy from your diet. Dairy proteins linger in the system for about 2 weeks, so if you are nursing, it takes about 4-5 weeks after you start eliminating dairy to see a major difference in your baby (2-3 weeks for all the proteins to leave your system and another 2 to leave your babyís system). About 50% of all babies who are either allergic to or intolerant to dairy proteins are also allergic to or intolerant to soy proteins. If you are nursing, it may therefore be necessary to eliminate all dairy and soy from your diet. The soy proteins only take about a week to clear from the system, so if soy is an issue, you will usually see improvement with your baby in about 2 weeks. Generally it is best to just eliminate both and then reintroduce soy to your diet once your babies symptoms are gone to determine if the problem was dairy and soy or just dairy.
Breastfeeding vs. Hypoallergenic Formula
If you are breastfeeding, your baby has some of the symptoms described and your babyís pediatrician recommends you to give him/her formula, please be aware that all formulas are either dairy or soy based. Even the formulas that are hypoallergenic (Nutramigen by Enfamil and Alimentum by Similac) do contain dairy proteins. In the hypoallergenic formulas, the dairy proteins are partially broken down, but there are still intact proteins remaining. If a baby is so sensitive to dairy proteins that they react to the very miniscule amount of dairy proteins in breast milk, it is very likely that they will also react to any dairy-based formula. The only formulas available that have all dairy and soy proteins completely broken down into their component amino acids (and therefore no chance for reactions) are call elemental formulas. The three formulas in this category are Neocate, Elecare, and Nutramigen AA. These formulas cost about $35 to $40 per 14 oz can (which generally lasts about 2-3 days). For these reasons, itís generally best to try eliminating dairy and soy from your diet for at least 6 weeks before deciding to try formula. Many momís will also opt to eliminate the top 8 food allergen from their diets (dairy, soy, eggs, wheat, peanuts, tree nuts, fish and shellfish) and/or try a total elimination diet (TED) before going to formula. There are very rare babies who cannot break down even the proteins in breast milk and have to be on elemental formulas in order to thrive, but these are always the exceptions.
Total Elimination Diet (TED)
The basics of a Total Elimination Diet: Select one of the least allergenic foods from each of the food groups (grains, vegetables, fruits, meats, and starch). Eat only these foods for 2 full weeks. For example: you may select rice, squash, apples, chicken or turkey and sweet potatoes. Eat only those foods with salt and pepper only for seasoning for 2 full weeks or until your babyís symptoms are gone (if sooner). Once your baby is doing well, then you can slowly add one food at a time to your diet. Only introduce one new food every 5 days. This diet is very restrictive and needs to be a last resort for a mom who is trying to make breastfeeding work. Itís also very important to make sure that you are continuing to take in enough calories so that your milk production doesnít suffer. If you are going to do a TED itís always a good idea to work with a lactation consultant and nutritionist to make sure you are getting adequate nutrition.
Formula Feeding MSPI Babies - The best formula options
If you are formula feeding your baby and he/she has the symptoms of MSPI or allergy, you will need to switch to one of the hypoallergenic formulas (either Nutramigen or Alimentum). The baby is reacting to the proteins in the dairy, NOT the lactose, so switching to a lactose-free formula will not help.
Soy formula information
Since about half of babies with dairy intolerances are also soy intolerant, soy formula is not a good option for babies who have the symptoms above. Not only are they likely to react to the soy, but there are also some concerns about giving soy formula to babies because of certain chemical compounds in soy (called isoflavones) which mimic estrogen in the body. Some studies indicate that giving soy formula to infants raises hormone levels equivalent to giving a baby several birth control pills a day. No studies have been done to determine what the long term effects of this are.
Some babies still react to the hypoallergenic formula
If your babies symptoms do not get better after a couple of weeks on the hypoallergenic formula, then your baby is most likely still reacting to the remaining proteins in the formula. If this happens, it will be necessary to try one of the elemental formulas (Neocate, Elecare, or Nutramigen AA) where all the dairy proteins are completely broken down.
Solids Introduction - How to introduce solids for babies with MSPI
Babies with MSPI react to the proteins in dairy and soy and are therefore at a little higher risk for reacting to proteins in other foods (particularly those closely related to dairy or soy proteins). For those reasons, introducing solids needs to be done carefully and in a very controlled way. Itís usually best to keep a detailed record of each food introduced and any reactions observed. You should space new food introductions by 4 or 5 days to make sure that the baby is not going to react before trialing a new food. Hereís a general guide for the order for introducing solids, realizing of course that all babies are different and may need to go at a faster or slower pace.
Birth to 6 months
Breast milk or hypoallergenic/hydrolyzed formula ONLY (Alimentum or Nutramigen or in severe cases, Neocate or Elecare). Because the babies gut doesnít mature or close until 6 months, proteins from solid foods can pass straight through the small intestines into the blood stream (called a leaky gut). Babies with MSPI are at greater risk for their bodies to recognize those proteins as foreign substances and react against them. This can lead to allergies other than to milk and soy. So if possible itís best to wait until 6 months to start introducing solids.
For babies without MSPI, it is often recommended to start with cereal such as rice cereal. With MSPI babies, thereís generally a greater chance of reacting to the more complex grains and proteins found in the grains than in fruits and vegetables. If you do start with a cereal be aware of: Make sure it is a single grain only (rice, oatmeal, or barley) Check ingredients. Most Gerber cereals are contaminated with dairy and/or soy. Safe brands of rice cereal include: Beechnut, Earthís Best, and Healthy Times. The only brand of baby oatmeal that is not contaminated with wheat (a more complex grain that is usually much more difficult to digest and high on the list of most common food allergens) is Healthy Times.
Vegetables: Winter squash (butternut and acorn), sweet potatoes, yams, carrot, beets, broccoli
Fruits: Apples, pears, apricots, plums (prunes), peaches, grapes, avocados
Safe oils to use (if oil is needed to add calories and healthy fats): Safflower oil, sunflower oil, olive oil
If you are buying jarred fruits and vegetables make sure you carefully check ingredients. Many jarred fruits and vegetables contain dairy or soy products, particularly past stage 1 fruits and vegetables.
Best to worst brands: Healthy Times, Earthís Best, Beechnut, Gerber
If tolerating all the above fruits and vegetables well, you can introduce the following fruits and vegetables and start introducing meats and grains. Also, at this age, many babies are ready for finger foods.
Vegetables: asparagus, cauliflower, Brussels sprouts, cucumbers, summer squash, white potatoes, lettuce
Fruits: banana, blueberry, nectarine, mango, papayas, raisins, cranberries, dates, figs
Meats: Turkey, Chicken, Lamb, veal
Grains: rice, oatmeal, barley, arrowro-ot or amaranth
This is the age when many LOís who are MSPI may start to outgrow this diagnosis. You can begin to test by introducing some of the vegetables that are in the same family as soy (such as green beans and peas) to see how they react.
Vegetables: Green beans, peas, spinach, tomatoes, celery, other beans, corn
Fruits: citrus (oranges, grapefruits, lemon, lime), strawberries, raspberries, pineapple
Meat: ham, pork, beef, fish,eggs
Grains: wheat and others
If all the above are well tolerated this is a good point to try introducing soy and dairy (one at a time - generally soy first then dairy).
Soy: In the following order waiting 5 days between: soy oil and soy lecithin, baked goods with soy ingredients, soy milk and tofu
Dairy: In the following order, waiting a full 5 days between to test for reaction: Hard cheese (such as cheddar), yogurt, butter, soft cheese/cottage cheese, whole cowís milk, and ice cream