When Breastfeeding Doesn’t Work Out
Good parenting is more than just breastfeeding. In this article, we are going to explore for these mothers – who are already frustrated enough at not being able to provide breast milk for their babies – the various milk alternatives and considerations on choosing the best formula for infants with eczema or allergies.
Alternative Milks for Infants (Up to 1 Year Old)
Cow’s Milk or Dairy-based Infant Formula
Cow’s milk-based infant formula is suitable for most healthy full-term babies and can be used from birth. This specific formula is prepared to mimic mother’s milk closely and are fortified with all the necessary nutrition that are important for the baby’s growth and development.
Fresh cow’s milk is not offered to infant until 12 months or older because they are high in protein and electrolytes and not easily digestible. The excessive protein load in cow’s milk can also overload a baby’s kidneys.
Dairy products and cow’s milk in most infant formula are said to contain more than 20 substances that are allergens and can potentially trigger a rise in IgE antibodies that sensitize babies. Many babies, especially those with eczema, still have problems with cow’s milk formula. Some reactions to cow’s milk involve the immune system (‘allergy’) and others are caused by difficulty digesting the milk (‘intolerance’).
If the negative reaction is manifested in eczema rashes, the baby (and even breastfeeding mothers) need to avoid cow’s milk formula and dairy products. If you see an improvement with the avoidance of cow’s milk, your baby will have to continue avoiding dairy intake, even with negative skin test.
Hydrolyzed Cow Milk Formula
When a baby has cow’s milk allergy and is not being breastfed, switching from a regular formula to hydrolyzed formula can potentially relieve the allergic symptoms. This type of formula is also recommended for prevention of allergies in high risk babies.
Hydrolyzed means that the milk proteins are broken down by enzymes, making it easier for baby to absorb and hence, less likely to trigger an allergic response. If it works, it should settle eczema in about a week.
Extensively hydrolyzed formula (EHF) is usually the formula of first choice. Partially hydrolyzed formula (HA) is also available, but this is unsuitable for baby with cow’s milk allergy because it still contains sufficient protein to trigger a reaction. Again, many babies do not also do well on hydrolyzed formula as they are not on whole protein formula.
Amino Acid Formula (AAF)
If your baby is still having persistent symptoms on hydrolyzed formula or if her allergy is so severe or is having multiple allergies, you can consider an elemental option.
Amino Acid (AA) formula is different from hydrolyzed formula because they are not made from naturally occurring protein. The proteins in AA formula are completely broken down into the smallest units known as the amino acids. This is believed to prevent any cow’s milk protein reaction in allergic or intolerant baby.
The amino acids are also engineered in specific ratios that are essential for newborns. If your pediatricians do not offer this option, do not be surprised because many do not know about elemental formula. Be mindful that this formula may change the baby’s gut microbiome, therefore probiotics are best used together in elemental formula. Available brand names of AA formula include Elecare or Neocate.
Some parents feed their babies goat’s milk formula because milk is as versatile as cow milk but less allergenic, easier to digest and rarely causes lactose intolerance. It still contains casein as does cow and human milk but in gentler configuration that is slightly different; which also explains why goat milk is often tolerable for babies who cannot take cow’s milk.
For some babies who are allergic to cow’s milk proteins, they may also be allergic goat’s milk because after all, its protein profiles are still similar to those in cow’s milk.
Many babies with cow’s milk allergy can tolerate soy-based formula. But this is not a suitable candidate if the infant is allergic to soy. Soy is another common food allergy for children, as such, it is not commonly used as the main food for babies under 6 months. For this reason, soy-based formula is only used when recommended by your doctor after establishing non-allergy to soy.
If you have to use soy milk, be sure to find an organic source, avoiding those sourced from genetically modified crops.
Rice milk or rice protein-based formula is generally not recommended for babies because it is devoid of protein and healthy fats that are essential for their growth and development. Similarly, the same applies for oat milk or almond milk.
New information about milk alternatives are evolving and new brands are coming up with so-called ‘better products’ that are healthier for the babies. It is important to gather all facts when studying differences or benefits across different brands.
Babies generally do better on any formula if their gut microbiome is replenished with probiotics (the ‘good’ bacteria). Beneficial bacteria are key when it comes to mitigating inflammation that arises from the baby’s gut dysbiosis. Even for nursing mother who plans to breastfeed, taking probiotics during pregnancy and nursing have been studied to reduce baby’s risk of developing eczema.
Starting Your Eczema Baby on Solids
Solids can be introduced to your baby once she is able to sit well, unassisted; and can hold her head up or swallow soft foods safely with little practice. Typically, this happens around 6 months. Some babies may want solids sooner than others. A lot of parents start their babies with iron-fortified rice or oatmeal cereals. Then, graduate them to vegetables and/or fruits.
- In a review of 52 studies, we know that early introduction of solids can increase the chance of food allergy .
- For high-risk babies, the optimal age to introduce selected foods should be 6 months; dairy products at 12 months; hen’s egg at 24 months; and peanut, tree nuts, fish and seafood at 36 months.
In eczema case, parents must only introduce one pure food, in small amount, at a time into their baby’s diet and monitor any reactions for the next 3 days. Keep a journal of all your observations in our Foods & Symptoms Journal. Your baby needs to continue eating the same food for 3 days and if no negative reactions are observed, then it is safe to move on the next pure food Day 4.
Remember to feed only pure food at each time. Avoid packaged food because it may contain a complex profile of many other ingredients that can also be potential triggers. Mixed foods containing various food allergens should also not be given unless tolerance to each and every ingredient has been assessed.
If you have read our article on Elimination Diet and Rotation Diet for Eczema: Simple Plans that Change your Life, you will realize that the procedures are the same as the food re-introduction phase. Do feel free to refer to this article for more details on re-introduction. On a positive note, if you have performed the food introduction to your eczema baby properly, you can easily figure out her eczema food triggers and allergens through oral challenge test when she is just starting out with basic food – the direct opposite of a more complicated diet and environmental exposure seen in an older child.
-  Fiocchi A et al. Food allergy and the introduction of solid foods to infants: a consensus document. Ann Allergy Asthma Immunol. 2006 Jul;97(1):10-20; quiz 21, 77. https://www.ncbi.nlm.nih.gov/pubmed/16892776