In breastfeeding allergy circles there is a theory, held by many, that if a baby has allergies it is best practice to do any trials directly.
That trialling through mums milk makes it “unclean” and that breastmilk cleanliness is why we use it for breastfed babies…
These theories can be really unhelpful, especially when treated as a golden standard. They can undermine the individuality of each of our children’s situations, and like many over generalised guidelines, don’t actively support parents to make informed decisions for their child’s health.
This blog, and our primary Facebook group, function on the basis babies can have acute or chronic reactions through breastmilk.
From the beginning of an extreme elimination diet nursing mothers routinely reintroduce solids into their diet, before baby is on solids, to expanded their diet and nutrition for diversity. This is really important, when possible, because we need nutrients to function optimally and heal, and a nursing mother needs them even more to support herself and her child.
Typically, if a child is prone to reactions through breastmilk and a food doesn’t cause a reaction indirectly, then it is a lot less likely to directly. There are exceptions to this rule, but they are not especially common, not even in our TED mamas community that is full of exceptional cases. Though depending on a mother’s gut health and intestinal permeability, some infants don’t react through milk at all but may still develop or display symptoms after non-breastmilk items like breastmilk substitutes or solids are introduced.
As reactions through breastmilk are generally less acute, it can be an especially useful tool for those with a history or tendency toward anaphylaxis, to trial through breastmilk. Anaphylaxis through breastmilk almost never happens. That doesn’t make it impossible. But for most that have anaphylactic reactions, trialling through breastmilk can be the difference between a few hives or an eczema flare and anaphylaxis.
Even without anaphylactic symptoms, many parents prefer indirect trials, because longer small reactions can be less risky and ultimately dangerous, than the more acute reactions direct trials can cause.
On the flip side, other parents can prefer direct trials. They can be more immediately conclusive, depending on the child. Which can help when it is harder to identify triggers. Some find the risk of a shorter reaction from direct exposure preferable to a more drawn out reaction. Though the jury is still out on the duration of inflammation that either type of reaction could cause.
Some professionals, fortunately not all, are very unfamiliar with the diversity of triggers that can cause reactions through breastmilk and consequently some treat direct trials as a golden standard. When if you understand and appreciate the role of breastmilk in exposure to potential allergens it can be a really useful tool, that parents can then use to their own discretion.
If a mother has began the voyage into an elimination diet for their child, they generally have seen with their own eyes that their child reacts to foods through their milk. So nursing can be a known pathway that we can utilise to minimise the risk for our children. To our own discretion.
As for the cleanliness of our milk…
Allergens from trials pass through breastmilk very quickly, especially compared to the initial removal period at the beginning of an elimination diet. Which is the difference between ongoing exposure from days/weeks etc with the much smaller isolated exposure in a trial. Nursing through reactions even with allergens present in breastmilk is more ideal for mum and baby almost always; due to the anti inflammatory and immune boosting support breastmilk brings amongst other benefits.
Food from trials also passed through a mother’s milk substantially quicker than an initial elimination, some reactions can also last a whole week from a singular direct exposure. So avoiding nursing for the duration of a reaction can be excessive as the allergen exposure, which is typically much shorter than the reaction itself. Nursing through reactions continues to nurture our child’s needs for nutrition and comfort, while supporting our milk supply.
Many mothers struggle to express and store a supply of trigger free milk for emergencies so avoiding using it for reactions can help save what they can express. Other mothers are advised to give formula, hydrolysed/amino acid or otherwise, while cutting out triggers which can be unhelpful as it doesn’t let us know when the allergens are removed from our milk; many TED families also find their little ones react to hypoallergenic formulas as there isn’t one on the market truly free of traces of all common allergens, corn and coconut, which are all fairly common sensitivities in TED infants. That isn’t even considering the virgin gut theory which suggests any exposure to any food/medications other than breastmilk before an infants gut becomes less permeate around the middle of the first year puts them at a higher risk of allergies. Many of us with allergy children may think “they already have allergies, so whats the point” but breastfeeding allergic infants is proven to reduce their number and duration of allergies.
Though we may not know their “true tolerance” through breastmilk; a food that has been trialed indirectly it is substantially more likely to pass directly if it has already passes through breastmilk, if the child is known to react to other foods through breastmilk.
Many consider indirect trials as a pre-ladder, for common allergen introductions. For example, when a mother is eating all dairy many suggest it to be the equivalent of up to the first stage on the dairy ladder. So if an infant shows signs of a reaction through breastmilk it can save us from the increased risk of a direct trial. It can also reassure us that a direct reaction is less likely, or would be less acute acute if it does happen.
So, if we have the ability to incrementally trial foods at a substantially lower safer quantity. It’s something we can all choose individually if we believe it is the best thing for our child and situation or not.
I do not believe this is something someone else should tell us what we can or should do. As parents we need to assess the risks for ourselves and make the decision we believe is best for our child, regardless of others biases or opinions.
A little more info on the virgin gut theory: https://www.thealphaparent.com/virgin-gut-note-for-parents/