Nutrition and Breastfeeding Articles

Dairy is a common allergy in babies. In Australia and New Zealand, more than 2% of infants are allergic to cow’s milk protein. Mild or moderate signs of a dairy allergy include:
-        Swelling of lips, face, eyes
-        Hives or welts on the skin
-        Stomach pain
-        Vomiting
-        Diarrhoea
 
Severe rapid onset allergic reaction (anaphylaxis): This reaction is life threatening, and immediate medical attention should be sought by calling 000.
-        Noisy breathing
-        Wheezing
-        Swelling or tightness in throat
-        Young children may be pale and floppy
 
Delayed reactions to cow’s milk and other dairy foods can occur, and reactions usually occur hours or days after consuming dairy.
Symptoms may include:
-        Eczema
-        Delayed vomiting
-        Diarrhoea
-        Blood in the stool
 
Lactose intolerance is caused by the lack of the enzyme, lactase, which helps to digest the milk sugar, lactose. It commonly occurs after the age of 5 years.
Symptoms of a lactose intolerance include:
-        Vomiting
-        Diarrhoea
-        Stomach pain
-        Gas (wind or bloating)
These symptoms are uncomfortable but are not life threatening. Lactose-free dairy is the best alternative. Very rare lactase insufficiency in babies can present as very poor growth, severe diarrhoea and is a medical emergency.
 
Secondary lactose intolerance: may occur due to conditions such as gastroenteritis, which damages the gut lining and will resolve once the virus passes. Lactose intolerance can also present with a new diagnosis of coeliac disease; once treated, it will resolve.
 
Functional lactose overload: may occur in breastfed babies who are receiving large amounts of lactose-rich milk, often in a case of over-supply. This can be managed with the right breastfeeding support, there no need to stop breastfeeding or switch to a lactose-free formula.
 
If you notice any of the above symptoms in your child, it is important to speak to your doctor, dietitian or lactation consultant, so the appropriate action may be taken.
 
For up-to-date, evidenced based information on allergies, check out the Australasian Society of Clinical Immunology and Allergy (ASCIA) website: https://www.allergy.org.au/ 

By Emma McShane, Dietitian, edited by Nicole Bando (APD, IBCLC), November 2022

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​Dairy products contain 10 essential nutrients; calcium, potassium, phosphorus, magnesium, carbohydrate, protein, vitamin A, riboflavin, vitamin B12 and zinc, important for healthy immune and blood systems, eyesight, muscle and nerve function, healthy bones, skin, energy, growth and repair of your body. If your child cannot have dairy, whether it be due to an allergy, intolerance or dislike, it is important to find alternatives that provide these nutrients.
 
Soy milk has the most similar nutritional profile to cow’s milk and is considered the best choice if your child cannot have dairy, unless they have a soy allergy. Soy milk is also high in protein. Look for soy milks with added calcium, Vitamin A, B1, B2, and B12. When opting for a milk alternative, always look for brands that contain 120mg/100mL of calcium.
 
If your child cannot have dairy and soy, other options are:
-        Oat; contains protein, fibre and is high in carbohydrates. Choose those fortified with calcium.
-        Almond milk; low in protein and carbohydrates. Again choose unsweetened brands with added calcium.
-        Coconut: High in saturated fat, and low in most nutrients e.g. protein, carbohydrates, vitamins and minerals.
-        Check out our article comparing plant vs dairy milks: https://www.nicolebando.com/articles/which-milk-a-review-of-plant-vs-dairy-milks
 
For dairy-free brands, see our article; https://www.nicolebando.com/articles/dairy-free-andor-soy-free-foods-supermarket-brands-to-look-for.
See here for information on how much dairy kids need.
 
Full cream or low fat milk?
The latest evidence suggests that full cream milk is recommended from the age of 12 months onwards, even into your adult years, unless you have high cholesterol, and then reduced fat is recommended.
 
Infants (0-12 months of age) should only be given breastmilk or infant formula. Cow’s milk as a drink is not suitable for infants under 12 months of age. Cow’s milk may be consumed as part of a meal, e.g. in cereal. 

By Emma McShane, Dietitian, November 2022 (Edited by Nicole Bando, APD, IBCLC)

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Children attend multiple parties every year. If each party provides lolly bags (alongside party food), our kids are likely to consume excessive amounts of sugar, with minimal nutrients. These foods take the place of healthier options and can impact healthy growth, mood & concentration, not to mention the copious plastic packaging that ends up in landfill. We can have a positive impact on our children and planet by choosing healthier party food options & lolly bag alternatives. Why not give these ideas a try for your next children's party?
 
-          Craft to-do sets e.g. scrapbooking materials
-          Colouring in books
-          Play-Doh kits
-          Pencils and notebooks
-          Books
-          Seedlings to grow a garden
-          Frisbee or sporting equipment such as a ball
-          Recipe cards to healthy recipes to make at home
 
Try providing these in paper bags instead of plastic bags to make your party more environmentally friendly. 

​By Emma McShane, Dietitian. Edited by Nicole Bando, Dietitian & LC

By Emma McShane, Dietitian. Edited by Nicole Bando, Dietitian & IBCLC, August 2022

At a party, a small amount of sugary food is okay, though it is important to ensure the majority of the food includes healthy options for children to ensure they are being nourished for growth & their best health. Children may have many parties over a weekend, which means their opportunity to eat high sugar, processed foods is beyond their needs for growth.
 
For quick, easy packaged food options to include in your next kids’ party, check out this link:
https://www.nicolebando.com/blog/simple-packaged-snack-swaps
 
These colourful ideas also promote growth, mood, play & concentration:
 
-          Vegetable sausage rolls made with filo pastry
-          Assorted sandwiches using multigrain bread
-          Fruit skewers
-          Fruit and yoghurt cups
-          Wholemeal pita bread pizzas loaded with vegetables such as spinach, capsicum, tomato, mushrooms etc.
-          Healthy bliss balls
-          Popcorn for children over 3 years of age
-          Cheese and crackers
-          Rice crackers & dips
-          See our allergy friendly party food list 

Lolly bags have an excessive amount of sugar and minimal nutrients, and are generally not recommended. Try swapping out lollies for something else, such as colouring books and utensils, craft ideas or recipe cards for healthy foods to make at home. Or offer 1 small treat instead of a bag.

By Emma McShane & Nicole Bando, March 2022
 
Some people need to remove dairy and soy products from their diet due to a food allergy or intolerance. As these foods contain vital nutrients, including protein and calcium; important for the health of our bones and muscles, dairy and soy should be replaced with nutritious substitutes. This easy to follow guide provides simple swaps to help you enjoy the foods you love and get the nutrients you need.
 
*Please note that this resource is a guide only. Always check the ingredient labels of foods, medications and supplements for allergens, as ingredients may change.  This resource displays food products labelled as dairy-free (DF*) or soy-free (SF*) or both. Products ‘may contain traces’ of either soy or dairy, please consult with your allergist or dietitian for guidance. Please note that plant based milks may not meet the growth needs of young children, seek advice from a dietitian. Daily calcium requirements vary according to age and gender.

Are you breastfeeding and avoiding soy/dairy? See this article for more about how to meet your dietary needs.
See here for more about breastfeeding & nutrition.

For further label reading advice, see: https://www.allergy.org.au/images/pcc/ASCIA_PCC_Dietary_avoidance_cows_milk_soy_2015.pdf
This does not substitute individual dietary and medical advice. 

When a mother is breastfeeding a baby with an allergy or intolerance to dairy and/or soy proteins, these foods may need to be eliminated from the mother’s diet for 2-4 weeks, before possible reintroduction (under guidance of a health professional). These conditions include Cow’s Milk Allergy, Food Protein Induced Allergic Proctocolitis (FPIAP) and Food Protein-Induced Enteropathy (FPIES).
 

• Both dairy and soy are common food sources of calcium, and many other important nutrients including Vitamin A, Vitamin B12, protein, zinc & magnesium.
• Calcium is vital to ensure strong bones and teeth and reduce the risk of osteoporosis, therefore it is important to find other sources of this mineral within your diet.
• A mother who cuts dairy and/or soy out of her diet may be at risk of developing weak bones and osteoporosis if she doesn’t replace these foods with alternatives
• Calcium in the breastmilk is constant and comes from the mother’s skeleton. A women’s dietary intake of calcium, or supplements does not affect the amount in breastmilk.
• The calcium taken from the mother’s bones is restored within a few months of stopping breastfeeding. Studies show that women who breastfeeds are not at higher risk of osteoporosis than a woman who does not breastfeed. 

​Below is a table of dairy-free (DF) and/or soy-free (SF) food sources of calcium. Check food labels every time you buy a food, medication or supplement, as ingredients may change. Use this guide for label reading: https://www.allergy.org.au/images/pcc/ASCIA_PCC_Dietary_avoidance_cows_milk_soy_2015.pdf

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This sample meal plan provides 1319mg of calcium across the day, and meets nutritional requirements from the five core food groups, in line with the Australian Guide to Healthy Eating (AGTHE), for a breastfeeding woman. It is a guide only. 

​Sometimes a calcium supplement is needed to ensure that you are getting the amount of calcium you need every day. Your dietitian or GP will help you decide if a supplement is necessary. 

References:
1.UCSF Health (2021). Calcium content of foods. University of California. Accessed June 10th 2021. Available from: https://www.ucsfhealth.org/education/calcium-content-of-foods
2.Nutrient Reference Values (2014). Calcium. NHMRC. Accessed June 10th 2021. Available from: https://www.nrv.gov.au/nutrients/calcium
3.Fishbein L. (2004). Multiple source of dietary calcium – some aspects of its essentiality. Regulatory Toxicology and Pharmacology. 39(2);67-80. Accessed June 10th 2021. Available from: https://doi.org/10.1016/j.yrtph.2003.11.002.
4.Gueguen L., Pointillart A. (2013). The Bioavailability of Dietary Calclium. Journal of the American College of Nutrition. 19;sup2, 119-136. Accessed June 11th 2021. Available from: 10.1080/07315724.2000.10718083
5.Australasian Society of Clinical Immunology and Allergy. Cow’s Milk (Dairy) Allergy. ASCIA, 2019. (Available from https://www.allergy.org.au/images/pcc/ff/ASCIA_Introducing_Foods_Fast_Facts_2019.pdf, accessed  May 31st, 2021).
​6. Australian Guide to Healthy Eating Serve Sizes [Internet]. Eat for Health. Australia; 2015. Accessed June 23rd 2021. Available from: https://www.eatforhealth.gov.au/food-essentials/how-much-do-we-need-each-day/serve-sizes  

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INTRODUCTION TO SOLID FOODS,
By Emma McShane, Dietitian
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The World Health Organisation states ‘infants should be exclusively breastfed for six months and after this time continue breastfeeding with appropriate introduction to solids’ (2020).
When breastfeeding is not possible, bottle feeding is recommended.
How do you know if your baby is ready for solid foods?

• Your baby has good head and neck control and can sit upright when supported
• Your baby shows an interest in food e.g. looks at or reaches out for your food
• Your baby opens their mouth when offered food on a spoon
• Your baby has an increased appetite, is feeding more often, and wants more breast milk or formula at the end of their usual feed.

 
VARIETY OF FOODS:
It is important to include a variety of foods from the five core food groups in your baby’s diet.

CEREAL FOODS
Be sure to offer a variety of grains including wheat, rice, oats and corn.
Example of cereal foods: Bread, crackers, pasta, iron-fortified cereals e.g. Weet-bix, all bran

DAIRY FOODS
Yoghurt, cheese, and cow’s milk on cereal.
Cow’s milk should not be given as a drink (instead of breastmilk or formula), for babies under 12 months of age.

MEAT AND MEAT ALTERNATIVES
Beef, lamb, poultry, well-cooked egg, fish, other seafood, legumes (e.g. lentils and chickpeas)

VEGETABLES AND FRUITS
Can be grated, cooked, pureed or mashed.

Introducing Common allergy causing foods:

• Common allergy causing foods should be included in your baby’s diet before nine months of age, as research has shown that early introduction may reduce the chance of your baby developing a food allergy.
• These common allergy causing foods are: Eggs, Cow’s Milk, Wheat, Soy, Peanut, Tree nuts, Sesame     Fish, Shellfish
• It is important to introduce one new allergy causing food at a time, early in the day, and then wait a few days to try another new food, so that you can identify any foods that may cause an allergic reaction.
• An example of how to introduce an allergy causing food, is to mix a small amount (1/4 tsp) of an allergy causing food e.g. hard-boiled egg or smooth peanut butter into your baby’s usual food e.g. vegetable puree. If there are no signs of an allergic reaction (These signs include: hives, welts, swelling of the lips, vomiting, or change in behaviour), then gradually increase the amount next time (1/2 tsp). If your baby does show signs of an allergic reaction, stop offering the food and seek immediate medical attention.
• It is important that once you have introduced these foods, to include these foods in your baby’s meals at least twice a week.

The below is a guide of solids progression, showing texture, quantity and breast/bottle feeds; it may be highly variable for each baby. You may also choose a ‘Baby Led Weaning’ approach, this involves introducing solids through appropriately textured and sized finger foods and allows your baby to explore the food themselves. There is no set way to feed your baby, so do what feels best for your family.
The above is an approximate guide for food quantities and expected number of breast and bottle feeds, this is because there are no set guidelines, as each baby will progress differently. If you feel unsure about how to introduce solids to your baby, a Children's Dietitian (Paediatric Dietitian) can provide specialised feeding advice.
  
6 MONTHS

TEXTURES
Coarsely pureed/mashed

QUANTITIES
1-2 tablespoons, twice a day (start with 1 meal and progress to 2 over weeks).

EXPECTED NUMBER OF BREASTFEEDS
Breastmilk is the main nutrition source. Continue breastfeeding on demand.

EXPECTED NUMBER OF BOTTLE FEEDS
If your baby is not breastfed, continue with bottle feeds, as this is still the baby’s main nutrition source. Slight decreases may be seen in the amounts taken.

EXAMPLE OF FOODS
Start with iron-rich foods; as your baby’s iron stores gained during pregnancy start to run low. These foods include fortified baby cereals, eggs, beans, lentils and soft cooked and pureed meat. Introducing allergy causing foods e.g. yoghurt added to pureed fruit and vegetables, Semolina porridge made with breast milk or infant formula.

6-8 MONTHS

TEXTURES
Lumpy, finely chopped, progressing to finger foods

QUANTITIES
Progressing 1-4 tablespoons of food 1-3 times/day by 8 months (slow progression) – up to ½ cup of food

EXPECTED NUMBER OF BREASTFEEDS
On demand

EXPECTED NUMBER OF BOTTLE FEEDS
3-5 times per day at 6-8 months

EXAMPLE OF FOODS
Peanut butter added to mashed foods or porridge, hummus mixed into mashed vegetables, finely shredded, soft meat added to puree vegetables.

8-10 MONTHS

TEXTURES
Grated, diced, chopped finger foods, progressing to regular menu
You’ll find your baby starts to play with their spoon. 

QUANTITIES
Up to 1 cup of food at each meal
At 9 months: 3 meals
At around 10 months: Introduce mid-meals, roughly ½ to ¾ cup of food (e.g. ½ cup full fat yoghurt with cut up banana).

EXPECTED NUMBER OF BREASTFEEDS
On demand; By 9 months: 4-5 breastfeeds

EXPECTED NUMBER OF BOTTLE FEEDS
3-4 formula feeds at 9-12 months

EXAMPLE OF FOODS
Well-cooked spiral pasta as finger food, hard-boiled egg with mashed avocado, soft grated cheese as finger food, pikelets.

10-12 MONTHS

TEXTURES
Chopped finger foods, Begins spoon feeding

QUANTITIES
Small balanced meals 3x/day e.g. 1 scrambled egg, chopped soft fruit, 1 Weetbix with cow’s milk, plus mid-meal snacks 1-2x/day.

EXPECTED NUMBER OF BREASTFEEDS
On demand; 3-4 breastfeeds per day

EXPECTED NUMBER OF BOTTLE FEEDS
600mL Bottle feed/day

EXAMPLE OF FOODS
Omelettes, cottage cheese and fruit mixed together, bread offered as toast fingers or sandwiches, homemade fish fingers, pesto sauce with pasta.

1-5 YEARS

Family foods (avoid small, hard pieces of food).  Can offer cow’s milk as a drink after 12 months.
Example foods: Scrambled eggs, Crumbed fish, vegetables dipped in hummus, pastas, cereals with cow’s milk
 
References:

1. Australian Breastfeeding Association. Breastfeeding and family foods.  ABA, 2020. (Available from: https://www.breastfeeding.asn.au/, accessed May 31st, 2021).
2. Australasian Society of Clinical Immunology and Allergy. Introducing foods and allergy prevention fast facts. ASCIA, 2019. (Available from https://www.allergy.org.au/images/pcc/ff/ASCIA_Introducing_Foods_Fast_Facts_2019.pdf, accessed  May 31st, 2021).
3. NIP Allergies in the Bub. Introducing solid foods. Prevent Allergies, 2018. (Available from https://preventallergies.org.au/introducing-solid-foods/, accessed 31st May 2021).
4. NIP Allergies in the Bub. Around 6 months (not before 4 months). Prevent Allergies, 2018). (Available from https://preventallergies.org.au/wp-content/uploads/2020/10/Food-Ideas-for-Babies-around-6-Months.pdf, accessed May 31st 2021).
5. NIP Allergies in the Bub. Around 7 to 9 months. Prevent Allergies, 2018. (Available from: https://preventallergies.org.au/wp-content/uploads/2020/06/RECIPE-IDEAS-FOR-BABIES-7-9-MONTHS.pdf, accessed May 31, 2021).
6. NIP Allergies in the Bub. Around 10 to 12 months. Prevent Allergies, 2018. (Available from: https://preventallergies.org.au/wp-content/uploads/2020/06/RECIPE-IDEAS-FOR-BABIES-10-12-MONTHS.pdf, accessed May 31, 2021).
7. Castle J., Jacobson M.  (2013). Fearless Feeding. Jossey Bass. pp 40-54. Accessed May 31, 2021.
8. Surwald, D. (2017). Baby-led weaning & introduction of solids. Peninsula Health. Accessed June 10th 2021. Available from: https://www.peninsulahealth.org.au/2017/08/25/baby-led-weaning-introduction-of-solids/