Feeding
The information provided on Crying Over Spilt Milk is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician.
Please seek assistance from your Doctor, Midwife, Well Child Provider, Health Professional or Dietician about feeding your baby.
Food and reflux pain
The foods that can make reflux pain worse for a baby/child are:
- Fruit and fruit juice, especially oranges, apples and bananas. Pears are the least acidic and an ideal first fruit for reflux babies.
- Tomatoes and tomato sauce
- Chocolate
- Tea and coffee
- Spicy Foods
- Fizzy drinks (especially coke)
- Fatty foods (i.e. fish and chips!!)
It is important to note however, that these foods will not worsen vomiting, and so it is not necessary to avoid them in a ‘happy chucker’.
Well tolerated first solids include baby rice (please check the ingredients as some brands of rice cereals, contain milk products), kumara and pumpkin.
Starting Solids from heathed.govt.nz is a feeding guide that can easily be adapted.
Breastfeeding and the mother’s diet
Citrus fruit, tomatoes, caffeine containing drinks (tea, coffee, coke) and chocolate may also need to be avoided by the breast-feeding mother of a reflux baby. Remember that all babies are different and different babies react to different foods – the list above is a guideline only.
Volume and variety
Some babies progress well onto solids, but are reluctant to take mixed (lumpy) textures. Aim to start your baby on mixed (lumpy) textured solids by seven to nine months of age. Delaying introduction of mixed textures until beyond nine months is associated with fussier feeding during pre-school years. Make eating a fun experience and allow your child opportunities to feed themselves and experience new textures in their own way. Be prepared for lots of mess! Research shows it is the frequency of tasting solids rather than the amount your child eats that helps them progress onto new tastes and textures. Therefore, try offering your seven to nine month baby very small amounts of mixed texture food at least twice daily until your child indicates he/she is keen to eat more.
Food allergy or intolerance
Studies have shown that about one third of infants with gastric reflux disease will have a cow’s milk protein allergy or intolerance. Skin prick or blood tests may not diagnose an allergy as gastrointestinal delayed reactions are often intolerances.
If you suspect that this is a problem for your baby and you are bottle-feeding, you may need to try an alternative to standard cow’s milk based formula. (Please discuss which formula to choose with your Health Professional (Doctor, Well Child Provider or Dietician) or contact the Nutricia Careline team for advice https://nutricia.co.nz/karicare/contact-us).) If you are breast-feeding, you can go on a “dairy-free” diet. This means avoiding all milk and foods that have dairy products in them (e.g. cheese, yoghurt, bread, biscuits, cakes etc.) for up to two or three weeks to see if there is any improvement in your baby. Any solids that your baby is eating will need to be dairy free also.
For information on preventing food allergy please speak to your health professional. You may also find useful information at http://www.allergy.org.nz/
GRSNNZ recommends that limited diets be supervised by a dietician, that a medically qualified health professional (paediatrician, allergist, immunologist etc.) be involved and if appropriate the foods be challenged after a suitable time lapse.
Cow’s milk protein allergy should not be confused with lactose intolerance. Breast milk always contains lactose even if the mother is on a strict dairy free, lactose free diet so a baby who responds to a change in their mother’s diet, does not have a lactose intolerance.
References:
[i] https://www.health.govt.nz/your-health/healthy-living/babies-and-toddlers/breastfeeding/getting-ready-breastfeed/what-avoid-while-breastfeeding/avoiding-alcohol-while-breastfeeding
[ii]Gastroesophageal reflux and cow’s milk allergy in infants: A prospective study.
[iii] Northstone, Emmett, Nethersole & The ALSPAC Study Team (2001). The effect of age of introduction to lumpy solids on foods eaten and reported feeding difficulties at 6 and 15 months. Journal of Human Nutrition & Dietetics, 14, 43-54.
Acknowledgements:
- Fiona Kenworthy, Speech-Language Therapist contributed to the volume and variety section of this article and provided some references.
- Gastric Reflux Association for the Support of Parents/babies (GRASP)
© Crying Over Spilt Milk Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust (GRSNNZ) February 2022. Updated by Roslyn Ballantyne (RN), Trustee.
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