Judy Converse, MPH RD LDN is the founder of Nutrition Care, a licensed nutritionist, a registered dietitian who has a master’s degree in public health nutrition and a bachelor’s degree in food science and human nutrition. She has also testified for safer vaccines and consulted with industry partners on specialized formulas for infants and children with inflammatory conditions. Her books include:
This is a 4-topic series focused on nutrition for babies and toddlers with eczema. It was originally spanning 7 posts, and combined to 3 longer informative posts.
- What’s Reliable Nutrition Information
- Newborn Nutrition – Just Milk, but Complicated
- Breastfeeding – Impact on Eczema Babies & Infant Reflux
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).
Selection of Milk Formula for Eczema Babies
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?
But many babies do just as poorly on this as they do on whole protein formulas (this was my son)
Probiotics in Formula Mix
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.
Elemental Formula for Babies
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.
Breast milk sets up the healthiest gut biome, which humans need to develop normal, healthy immune signaling and avoid allergy.
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.
Is it Cow’s Milk Allergy for your Eczema Baby?
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.
Which Cow’s Milk Formula to Choose?
MarcieMom: Let’s talk about the scenario where the child has no cow’s milk allergy and parents can decide among the many brands of formula cow milk. I’ve read about the toxins in formula milk – the antibiotics given to the cows and the cows eating a diet of genetically modified corn. I’ve also seen babies who drank lots of formula milk growing very big, exceeding far more than 100% on the growth chart.
Is there (i) any conclusive study done on formula milk and its impact on the child’s health, (ii) does formula milk contain toxins and is it inflammatory? (if yes, which ingredient makes it so?) and (iii) how soon should parents attempt to replace formula milk with solid food that are rich in protein, calcium, vitamins and other minerals?
Quality of Breast Milk
Judy: Breast milk is best, hands down. We’ve all heard that, and it is still true. There are so many immune modulating components in human milk that formula will never be able to emulate. It is so powerful in this regard, that it may outperform vaccinations in protecting the baby. Its impact on gut biome and long term immune function is just emerging in the literature. Unfortunately there are toxins in breast milk too, simply because we now live in a toxin filled world. These concentrate in breast milk. Rather than not breast feed, I would like to see women become conscious prior to pregnancy about eliminating toxins from their diets. Begin early to eat very healthfully, avoid pesticides, poor air quality, heavy metals, and other toxins. Consider working with providers who can help you detoxify prior to conception.
Quality of Commercial Milk Formula – Corn Syrup & GMO
Meanwhile, yes, it is often easier for babies to gain and grow on commercial formula, as long as they are not allergic/sensitive to it. Bottle-feeding can offer faster delivery, so more is taken per feeding. But “more and faster” is not necessarily better. The carbohydrate source is often corn syrup, which is troubling for weight gain in older children. And yes all these ingredients – unless you have an organic formula – may come from genetically modified sources. I think there are enough data implying that GMO foods may be more allergenic to consider avoiding these entirely for a newborn, or during pregnancy. This is a big debate. For more info, parents can visit ResponsibleTechnology.org. Click on the link for health professionals, then on the “state of the science” link.
Solids for Your Baby
Solids can be introduced once your baby is able to sit well unassisted, can hold his head up, and is able to move soft foods to back of tongue and swallow them safely with a little practice.This can be around six months, but later is okay too. This might also depend on your baby’s growth pattern. Some will want solids sooner than others.
Cow’s Milk Alternative
MarcieMom: Let’s talk about the scenario where the child has cow’s milk allergy. What would be the cow’s milk alternative? Fully hydrolyzed formula or goat’s milk (which I understand to be similar to cow’s protein, so may not help cow milk allergy?) or soy milk or rice milk?
Judy: We covered that in the previous section, except for rice milk. Rice milk should not be used for infant formula, period. It is devoid of protein and healthy fats that are essential for brain development. Please do not use rice milk! Same goes for oat milk, hemp milk, or almond milk. None of these are safe or appropriate for babies as a substitute for breast milk or formula.
Rice milk should not be used for infant formula, period.
Goat milk has casein, as does cow or human milk. But it is in a gentler configuration, slightly different than the cow casein, and is often quite tolerable for babies who can’t take cow’s milk. Again think in terms of two parts to this puzzle – the protein source, and the baby’s gut biome. Both may need changing to successfully arrest inflammation.
Advice for New Moms – Choosing Cow’s Milk Formula Alternative & Reading Product Label
MarcieMom: I remembered the first six months when my baby was too young to take allergy test, we were advised to switch to partially hydrolyzed milk (our girl turned out not to have any allergy). When her rashes didn’t go away with the partially hydrolyzed milk, we switched to goat’s milk then soy milk (her rashes were still there all the time). It was a stressful experience copying all the ingredients across formula brands and different types of milk, and comparing which brand had higher carbohydrates, protein, calcium, DHA and more than 20 nutrition elements listed. What would be your advice when choosing formula milk – I assume first decide on the type of milk and once that’s decided, how to see which brand is better formulated?
Judy: This is too much stress for a new mom! I went through that and then some myself. This is how I became so interested in this niche of practice. I could not fathom that my pediatricians didn’t have good answers for me, or why it was so hard. I would have added an elemental option to those you were told to try, plus probiotics. As I mentioned earlier, this is commonly overlooked.
Worth Looking Into – Why a Baby’s Gut Could be Inflamed
I would also want to know what set your daughter’s gut up to be inflamed. Did she need antibiotics, C-section delivery (another early antibiotic exposure), time in NICU? All these things disrupt optimal colonization of the newborn gut with healthy bacteria. If this is found to have been the case, sometimes babies need herbs or medications to treat fungal species dominating the gut biome. I give this topic a lot of ink in both my books.
Milk Protein Sensitivity
Your daughter may have had a milk protein sensitivity and a soy protein sensitivity, without allergic to either. These are mediated by different classes of immunoglobulins, one is IgE (allergy) and the other is IgG (sensitivity). Both can cause skin changes, feeding problems, and eczema.
A negative IgE test does not mean that a food protein is safe. Most allergists do not test for IgG reactions, because they think the testing is unreliable. This is not my experience in practice. The tests are not perfect, but they are useful, when interpreted in the context of food intake, signs, and symptoms.
MarcieMom: Thanks so much Judy, honestly, I feel like bursting into tears now, just thinking how difficult the first 9 months are, sorting through the milk formula, breast feeding, solid feeding – if only I’ve known you earlier! I’m sure many parents reading this will feel the same, and start to ask their docs of other alternatives.