Tuesday, November 15, 2016

Allergic Proctocolitis in the Exclusively Breastfed Infant

Dr. Boies answers question at a recent San Diego Breastfeeding Coalition meeting.

Can food protein induced allergy happens to exclusively breastfed infants? The answer is yes, according to Dr. Eyla Boies (MD, FABM, FAAP), a clinical professor of pediatrics at UCSD.

Many confuse allergy wit tolerance. There is a difference. A true food allergy causes an immune system reaction that affects numerous organ in the body. It can cause a range of symptoms. In some cases, an allergic reaction to food can be severe and even life-threatening. In contrast, food intolerance symptoms are generally less serious and often limited to digestive problems.

The most common foods implicated in food allergies in breastfed infants include cow's milk, egg, soy, wheat, peanuts, tree nuts, fish, shellfish, sesame seeds, and corn. Other common foods include pork, tomatoes, onions, cabbage and berries. Cow's milk protein(CMP) is the most common food allergens in young children, with 2% of children under four years old allergic to CMP. The severity of a food reaction is generally related to the degree of baby's sensitivity. Meanwhile, cow's milk allergy is uncommon in adults; less than 0.5% of adults are allergic to CMP.

Food protein can induce enterocolits, protocolitis and enteropathy. When food protein induced enterocolitis and enteropathy happen, there will be an acute vomiting pallor one to four hours after food ingestion, and a chronic moderate to severe bloody stools with chronic diarrhea. Both diseases are rare in breastfed infant: Currently there are only 14 cases in the literature. Breastfeeding is likely to protect babies from them. Food protein induced protocolitis is considered a milder form of the spectrum of food induced allergy. It seen to be more often in breastfed infants (less than 60%) whose mothers are consuming cow's milk, sometimes soy or egg, compared to formula fed infants.

Food protein may also plays a role in gastroesophageal reflux disease (GERD), colic and eczema. Colic may be a result or an allergy to make protein in formula fed babies. Much more rarely, colic may be a reaction to specific foods in mom's diet in breastfed babies. An 1983 study found that cow's milk proteins can cause infantile colic in breastfed infants. Another 2005 study found that exclusion of allergic foods from the maternal diet was associated with a reduction in distressed behavior among breastfed infants with colic presenting in the first 6 weeks of life.

Management plans for food protein allergies in the exclusively breastfed infant can be formulated. DR. Boies recommends a careful history and exam including mother's diet and medications and then elimination diet for the mother as with food protein induced proctocolitis. DR. Boies also recommends counseling about nature course of colic and GERD, such as positioning including prone for period while awake, and less reliance on medications for GERD. The most important thing when treating GERD and colic is ensuring proper growth.

While food protein induced allergy can happen to exclusively breastfed infants, breastfeeding plays an important role in the prevention of allergic diseases(AD). Overall, breastfeeding less than three months is not protect against the development of AD. A 2004 study found that exclusive breastfeeding for at least four months can lower incidence of CMP allergy until 18 months. But a more general long term impact of breastfeeding on food allergies remains to be determined.

KellyMom provides a useful resource for mothers on dairy and other food sensitivities in breastfeeding babies, including how closely mother needs to watch what she eats, recognize possible signs of food allergy from normal baby fussiness, and find out what foods are most likely to be the problem.

This is an original post to SDCBC by To-wen Tseng.

Friday, November 11, 2016

The day after the election


This August in our neighborhood playground, a child threatened my toddler son, saying “Trump will kick you out of here when he becomes President.” For the past two months I’ve been praying for the victory of Hillary Clinton, so that I can tell my child “hate never wins”. The polls gave me some hope. But on the night of November 8, as the election results rolled in, I saw a very different America than the polls had predicted.

I put my child to bed that night right before the Canadian immigration website crashed. I stayed up late, thinking about how I would explain this to him. Before I was ready, he woke up full of questions. He asked me if she had won. I told him no.

“But I want Hillary to be my president!”
“I know, baby.” I held him tight. He is too young to understand the candidates’ policies; all he knows is that if Donald Trump is in the white house, the bullies in the playground get a good line to yell at him. 
Once again, I assured him, “We are American, this is our home, no one is going to kick us out of here, not even Trump.”

I’ve been repeating this to him for the past two months. Apparently it’s not good enough. He asked me if we’re moving to Asia to be with his grandparents. I told him no.

“But I don’t like Drump!” He mispronounced the president-elect's name as always.

“But you do like America, don’t you?”

He thought about it carefully and then nodded.

“That’s right, baby. As long as it doesn’t change, we’re here to stay.”

“But I’m upset.”

“That’s okay, baby. I’m upset, too. We all get upset sometimes. But we’ll be fine,” I told him.
“If anybody ever tells you that Trump will kick you out of the country, just say, ‘No, I am American, this is my home, no one can kick me out of here.’” 
He practiced the sentence a couple of times and seemed to be comforted.

There is so much more that I wanted to tell him. I wanted to tell him it’s not the end of the world. I wanted to tell him that human beings are resilient. I wanted to tell him that we can do better than running away. I just don’t know how to make a 3-year-old understand all of these things.

In spite of all the frustrations at this moment, I still believe in America. Sure, the election had modeled the exact opposite of the values I believe in and hope to instill in my children. The xenophobia that came directly out of Trump’s campaign has harmed my family. But I see that most of my fellow American don’t believe in the racism and sexism either. Clinton won the popular vote. Which means the majority of American believe that women should be paid the same as men, they care about climate change, they don’t want the implementation of aggressive surveillance programs that target certain ethnic groups.

This is the moment not to sit down with frustration, but to stand up against discrimination, bigotry and hate. And there is so much we can do. We can volunteer. We can donate. There is Showing Up For Racial Justice that combats racism, Planned Parenthood that gives women the opportunities for proper healthcare, ACLU that upholds the individual rights guaranteed by the US Constitution. Most of all, as parents, we can continue teaching our children the values we believe in: honesty, race and gender equality, love. The election changed none of that. Just like President Obama said on election day, “The sun will rise in the morning.”

This is an original post to World Mom Network by To-Wen Tseng. Photo credit to Mu-huan Chiang.