Nutrition and Breastfeeding Articles

​Transitioning from breastfeeding or formula to family foods is a natural progression for a baby. A breastfed baby may continue to breastfeed beyond the first 12 months of life, whilst including dairy and family foods.
 
If your child is 12 months or older, it is safe to give your child whole cow’s milk (or fortified dairy milk alternatives) as a drink. Do not give cow’s milk as a drink 12 months of age, continue to breast or bottle feed. Beyond 12 months, formula is no longer required, this includes toddler formula, which is ultra-processed and creates a preference for sweet foods & takes up tummy space for core food groups, making fussy eating more likely.
 
Beyond 12 months:
 
By 12 months, a breastfed baby may include dairy in cereal, yoghurt and cheese as a snack. Continue breastfeeding as you wish, as breastmilk continues to provide ongoing benefits for health and immunity, and is a source of calcium and other nutrients.
 
A bottle fed baby may only be including a morning and night bottle of formula by 12 months. The morning feed can be replaced with a larger breakfast; add milk into cereal such as oats or Weet-bix, or try yoghurt and fruit or cottage cheese on toast. Incorporate dairy into snacks, e.g. small bowl of natural yoghurt with fruit, cheese and crackers or ½ cup of full cream milk, either after some meals or offered as a snack. . Offer dairy 3 times a day to ensure adequate calcium for growing bones.
 
What about the night time bottle?
 
Many parents report that their toddlers drink milk before bedtime and worry that stopping it will upset the bedtime routine. Parents are often concerned that their child isn’t eating enough during the day, especially if dealing with a fussy or selective eater.

There are many good reasons to change the evening milk routine. The evening bottle of milk may fill your child up and affect their appetites, which may contribute to fussy eating. Drinking milk out of a bottle or after teeth brushing can contribute to dental caries. Dairy contains 10 essential nutrients, including protein for growth, zinc for immunity and vitamin B12; essential to nerve cell function. However, it does not contain iron, so children who drink large quantities of milk are at risk of iron deficiency, as milk may replace other foods in their diet. Also other nutrients in milk can interfere with the absorption of iron, when consumed in excessive quantities.
 
Whilst your child adapts to the change, it may be a good time to alter the evening routine. Offer a small amount of milk at the end of the evening meal in a cup if concerned that dairy needs have not been met during the day. Perhaps a feeding chair can become the story chair, or moved out of the room if no longer needed.
 
Is toddler formula necessary?
Toddler formula is not required for healthy children. Formula may make your toddler too full to accept a variety of other solid foods. It is ultra-processed and creates a preference for sweet tasting foods. As it takes up tummy space for core food groups, fussy eating is more likely. Toddlers do not grow as much in their second year of life and will have variable appetites, which means some days they may eat more than others. Continue to offer a variety of foods across the core food groups to your toddler and trust their appetite, to meet individual growth needs. If you are feeling worried about your toddler’s intake, see a paediatric dietitian for support.
 
 

References:

1. Nicholas K. How to transition from formula to milk: 5 tips. Peanut app. 2022. Available at: https://www.peanut-app.io/blog/how-to-transition-from-formula-to-milk
2. Centers for disease control and prevention. Weaning. Nutrition. 2021. Available at: https://www.cdc.gov/nutrition/infantandtoddlernutrition/breastfeeding/weaning.html
3. Nicole Bando. Dairy & toddlers. Nicole Bando Paediatric & Family,  Dietitian & Lactation consultant. 2019. Available at: https://www.nicolebando.com/articles/previous/3

 
​By Emma McShane & Nicole Bando, November 2022
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Eczema is a disorder of the immune system caused by an abnormal skin barrier, dryness and inflammation.
30% of people with atopic dermatitis (eczema) also have an allergy.  A food allergy may trigger eczema, but it is not the cause of the eczema. Some foods such as dairy may exacerbate eczema.
 
Eczema can be normally well managed by maintaining, protecting and treating the skin by:
-         Applying moisturiser (at least twice/day)
-        Use non-soap based wash or oil in the bath or shower
-        Avoiding soap and washes that produce bubbles or foam (as these may cause the skin to dry out)
-        Using anti-inflammatory creams and ointments, such as topical steroids
-        Treating bacterial skin infections with antibiotics
-        Use immune modulating treatments if prescribed by your doctor or dermatologist.
 
Food exclusion diets are only recommended to be tried in children with eczema when the above treatments don’t work. Food exclusion diets should be guided by a clinical immunologist or allergy specialist and dietitian. Only short term food exclusion is needed to determine if the food allergy is causing the eczema.
 
Dairy is often a common trigger for eczema, even if they are not allergic to dairy but to something else. Research has shown that more often than not food exclusion diets can be short-term. This is because eczema is an immune response, and in children, their immune system is not fully developed. It is predicted that as a child’s immune system develops, they are likely less sensitive to dairy causing eczema and can slowly introduce these foods back into their diet. It is important that this is done under close guidance of a paediatric dietitian.

References:

1. Eczema and food allergy. Fast facts. ASCIA. 2020. Available at: https://www.allergy.org.au/patients/fast-facts/eczema-and-food-allergy

 

1. National eczema association. Everything you need to know about eczema and food allergies. 2018. Available at: https://nationaleczema.org/blog/eczema-food-allergies/

 

1. Nikolovski A, Rallis S (2020) The Impact of Dairy Elimination on Pediatric Atopic Dermatitis. J Nutri Med Diet Care 6:044. doi.org/10.23937/2572-3278.1510044

 
 

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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