This is a 4-topic series focused on nutrition for babies and toddlers with eczema. I’m passionate about nutrition and believe that it’s of utmost importance to our health – after all, it’s one of the daily survival activities of breathe, drink, eat and sleep! I’m honored to have Judy Converse, founder of Nutrition Care for Children LLC, to help out in this series. Judy is a licensed nutritionist, a registered dietitian for more than 20 years and authored the first web-interface accredited learning module for health care providers on nutrition and autism.
More on Judy Converse, MPH RD LD – Judy has a master’s degree in public health nutrition and a bachelor’s degree in food science and human nutrition. She authored 3 books including Special Needs Kids Go Pharm-Free and Special Needs Kids Eat Right: Strategies to Help Kids on the Autism Spectrum Focus, Learn and Thrive. She has also testified for safer vaccines and consulted with industry partners on specialized formulas for infants and children with inflammatory conditions. Judy is available for nutrition consultation at http://www.NutritionCare.net
Newborn – Just Milk but Complicated
Last 2 weeks, Judy has helped parents to navigate nutrition information. This week, I’m seeking her advice on nutrition for new born. Seemingly a simple task, after all, weren’t we first-time moms just asked at the delivery hospital ‘Breastfeed or Bottle-feed?’ It’s in the weeks and months that follow which we then found out feeding our newborn can get complicated!
MarcieMom: Judy, thank you so much for helping us. My questions will be based on my (thankfully, past!) experience and what I know other moms of eczema children face. We know that the American Academy of Pediatrics recommend breastfeeding for 6 months, but in reality, it’s not always possible in every family. In my case, I just can’t generate sufficient milk supply even after consulting with lactation consultant, taking their recommended supplements and a harrowing ordeal with tricking my baby to latch despite my lack of milk (using the supplemental nursing system). So, for parents of eczema child who are choosing formula milk, would you recommend that they go for fully hydrolyzed or partially hydrolyzed formula from the onset? Or should they wait and see if the child is allergic to cow’s milk before switching to alternatives? Since allergy testing is not accurate for a new born, how can a parent know if it is cow milk allergy?
Judy: First we should understand “hydrolyzed”. That means the formula uses an in-tact, whole protein source – casein or whey or soy – which is treated with enzymes to partly break it up or hydrolyze it. The idea is that this will make it easier for the baby to absorb. It’s a reasonable place to start. If it works, it should work in a week or so, to settle eczema down. But many babies do just as poorly on this as they do on whole protein formulas (this was my son). Then what?
There are a couple of options. The baby may do better on any formula, if gut biome is replenished with probiotics. I work these into care plans for many infants and children. There are many different types and potencies. Some probiotics are not appropriate for babies. More experience and data are emerging to show that beneficial bacteria are critical to mitigating inflammation in a newborn’s gut. What grows in a newborn’s gut appears to be predictive of whether or not they have allergies or asthma years later. So, no matter what, if a baby is having signs of inflammation, I would be keen on getting a probiotic in the mix.
If trouble persists, the next step is elemental formula. These are different from hydrolyzed formulas because they are not made from naturally occurring protein. Instead, individual amino acids are blended in a specific ratio known to be essential for human newborns. These are ready to absorb. A healthy human gut will break protein down into these constituent amino acids during digestion. So this formula simply provides the protein in that form, ready to absorb, and it can’t trigger inflammation. What surprises me is how often this option is not offered to families whose infants are really uncomfortable with eczema and colic. Many pediatricians may not know about elemental formulas. Brand names are Elecare or Neocate. The caveat with using formulas is that they change the baby’s gut biome. That is, they change the profile of bacteria in the baby’s gut. Breast milk sets up the healthiest gut biome, which humans need to develop normal, healthy immune signaling and avoid allergy. Formulas, especially the
elemental ones, make it easier for nasty species like Clostridia difficile or fungal strains to grow.
To have a win win, use a probiotic for your baby. My book Special Needs Kids Go Pharm-Free guides parents on how to pick these, and what to do for colicky babies with eczema.
Second – how do you know it’s cow’s milk allergy? Easy. Do an elimination trial. Newborns eat one protein source (breast milk, or formula). Change it and observe. Note that soy protein is triggering often as well. My preference, if breast feeding is truly out, is to trial homemade goat milk formula (I provide recipe and steps to do this safely in my books) first. This often goes very nicely, and it may support a healthier biome than commercial formulas. If eczema is still persisting, then I suggest hydrolyzed casein or whey formulas, then elemental. If you must use soy protein, which I hesitate to do since it has other impacts as a phytogen and is usually genetically modified, then be sure you use an organic source.
MarcieMom: Thanks Judy, and yes you’re right, I haven’t heard of elemental formulas and indeed, it had never been offered as an alternative to me though I’ve seen the well-esteemed pediatric clinic group in Singapore!