Your client is exhausted and at the end of her rope. Her new baby seems to get fussier every day, and it feels like he never sleeps! The pediatrician says it is just colic, and to wait for him to grow out of it, but the discomfort looks so real. The baby seems gassy, and his poops look strange: odd colors, with blobs of what looks like mucus. Lately there is the occasional small bright-red spot. Mom is breastfeeding and she wants to know if her milk could be the problem. Or could it be something she is eating?

Allergic Proctocolitis (AP) in the breastfed infant is an adverse reaction to dietary proteins excreted in human milk. The most common symptoms are mucus and blood in the stools, often accompanied by fussiness and poor sleep. As with other food allergies, the treatment for AP is to avoid the protein or proteins that are causing the problem. While an allergic reaction can occur to any protein, cow’s milk protein is the most common cause of AP. For breastfeeding mothers, this means avoiding all dairy products, as well as “hidden dairy” (milk proteins added to many processed/manufactured foods.) Since dairy and soy are often cross-reactive in these cases, many of these mothers will need to avoid both dairy and soy proteins. These are the most common culprits, but allergies can occur to other food proteins as well.

It is important that a physician rule out other, possibly more serious, causes for the baby’s distress. If the physician suspects AP, an elimination diet is generally undertaken to confirm the diagnosis. If symptoms improve after the removal of a suspected protein from the mother’s diet, a diagnosis of AP is confirmed. The elimination diet must then be maintained by the mother and child until the baby outgrows the allergy (usually by 1 year of age).

Mothers who undertake a strict elimination diet without nutritional counseling are at risk for malnutrition. Additionally, without proper guidance, mothers may choose to wean their infants onto an extensively hydrolyzed or amino acid formula. Registered Dietitians and Lactation Consultants are both in excellent positions not only to spot this often-misdiagnosed condition, but also to guide mothers through this often-overwhelming process.

If you are a Lactation Consultant working with a mother on an elimination diet, a Registered Dietitian can not only help to insure proper nutrition for mother and child, but also teach the family how to cope with the new shopping, meal planning, and food preparation techniques the diet demands. Click here to find a Registered Dietitian in your area.

If you are a Registered Dietitian working with a breastfeeding mother, a Lactation Consultant can be an important ally. According to the position statement of the Academy of Nutrition and Dietetics, “dietetics professional have a responsibility to support breastfeeding” and to work to eliminate barriers. Dietetics professionals can support this mission by becoming knowledgeable about the diagnosis and treatment of Allergic Proctocolitis, and working to educate other members of the healthcare team about this condition. You can find one through the International Lactation Consultant Association.