Daily Dose Ep51: How To Feed Problem Babies (Colic, Reflux, Constipation, Allergy)

The Health Tune Up

In Australia and New Zealand we have the Food Standards dictating what’s allowed in your baby’s formula powder.

Fortunately most brands have to hit minimums for protein, carbs, and fats.

Unfortunately the optional extras are exactly that, optional! I have to also add a disclaimer: breast milk is KING. Formula comes nowhere close.

Breast milk is like the elixir of life: one moment it’s got lots of sugar to quench your baby’s thirst (the first portion of milk), the next it's filled with nutritious fats (hind milk) which nourishes your baby’s growth. It doesn’t end there, the human oligosaccharides (HMOs) are immune boosting prebiotics and scientists have not quite mastered how to replicate this. However synthetic versions aren’t too bad either and include: non-digestible carbohydrates (NDCs) such as galacto-oligosaccharides (GOS) and fructo-oligosaccharides (FOS). It gets even better! Even if mother isn’t quite up on her nutrition game, her breast milk composition always manages to come together just right. A miracle of the human body!

Enough about breast. Lets talk formula.

Colic babies, no one really knows why this occurs but if your baby is crying for no apparent reason, it could be something internal. Research on gut bacteria (the microbiome) reveals that if mum was given antibiotics during labour, then her ability to transfer good bacteria to the baby via milk is compromised. It leads to breast milk that is too high in HMO’s which remain undigested and upsets baby’s tummy. Probiotic supplementation has been found to improve this situation and it can be given either to mum and/or to baby. Having said that, which formula should you use? Find ones that say Colic on the front! They’re usually partially hydrolysed meaning the proteins are smaller and more easily digested by baby.

Constipation babies, this is a subjective matter because some babies poo daily and others every other day. Generally if a baby hasn’t pooped in three days, we can consider using gentle laxatives like glycerol suppositories. Now in terms of formula, choose those that state Constipation on the front. I haven’t looked closely into what the exact ingredients are that make these suitable but I’d say there’d be more fibre.

Reflux babies, now I’ve had the opportunity to work in a compounding pharmacy where I see the most extreme cases ie. projectile reflux, silent reflux, regurgitation. These babies have had to be prescribed a proton pump inhibitor (PPI) like Losec. Again noone really knows why babies do this but it seems to start around month 3 and ease off by month 10-12. Baby formula marketed for colic will generally be thickened with starches so that the stomach contents are less likely to backflow.

Finally allergy babies are those with intolerance to cow’s milk protein and/or lactose (a sugar or carbohydrate). It’s a big difference between the two so be careful selecting the right formula. Most lactose free formula are still based off cow’s milk therefore containing cow milk protein. DANGER! Life-threatening anaphylaxis can occur requiring adrenaline. Ensure your child has an ASCIA Action Plan. Allergy to cow milk protein also means likely allergy to other animal milk too e.g. goat, sheep, horse. Partially hydrolysed formula are NOT suitable e.g. NAN Supreme, formerly known as NAN HA. Your pediatrician may proceed in a stepwise manner as follows: Soy-based formula. Only for 6months+. Extensively hydrolysed formula (EHF) which has most of the cow protein broken down - not suitable if the baby is anaphylactic to cow milk protein Rice-based. Not suitable if food protein induced enterocolitis syndrome (FPIES) Amino-acid-based formula, 1 in 10 babies will need this. Available on prescription. Most tolerable. A great resource for allergy babies is: https://www.allergy.org.au/patients/food-allergy/cows-milk-dairy-allergy

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