[Dysphagia] lactation and infant reflux

[SuzMorris at aol.com (SuzMorris@aol.com)]

 There is little doubt that what a mother eats during her pregnancy and 
lactation is transmitted into her breast milk during nursing.?? There are many 
journal articles that substantiate this thesis.? The work of Julie Menella and her 
colleagues at the Monell Chemical Senses Center in Philadelphia is especially 
pertinent to our understanding of infant feeding and acceptance of new 
foods.? They have studied many other aspects of infant behavioral responses to 
things such as garlic and alcohol in the mother's diet which shows clearly that 
infants do indeed respond to what their breastfeeding mother eats.

The question of the affect of maternal diet and allergy in the infant is not 
as clear-cut.? Almost all of the research is on atopic allergy (i.e., eczema 
and other allergic skin conditions) and none address gastrointestinal effects 
such as reflux or any other aspect of allergy.?? I've included some of these 
studies below.?? A Cochrane Database Review, published in 2003, showed that 
there wasn't a clear-cut relationship between restricting the maternal diet and 
the incidence of atopic eczema and that much more research was needed.

For me the bottom line is the effect on the individual infant.?? There are 
many, many babies who clearly benefit anecdotally from changes in the mother's 
diet during breast feeding.? There are other babies who do not.?? This is such 
a benign intervention and one that does not involve drugs, surgery or other 
radical intervention.?? I would start here to see if it makes a difference.? To 
me there is nothing to loose as long as the mother eats a nutritiously 
complete diet when she eliminates specific common foods from her daily diet.

Suzanne


********

Pediatrics. 2001 Jun;107(6):E88.
Prenatal and postnatal flavor learning by human infants.
Mennella JA, Jagnow CP, Beauchamp GK.

Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA. 
mennella@monell.org

BACKGROUND: Flavors from the mother's diet during pregnancy are transmitted 
to amniotic fluid and swallowed by the fetus. Consequently, the types of food 
eaten by women during pregnancy and, hence, the flavor principles of their 
culture may be experienced by the infants before their first exposure to solid 
foods. Some of these same flavors will later be experienced by infants in breast 
milk, a liquid that, like amniotic fluid, comprises flavors that directly 
reflect the foods, spices, and beverages eaten by the mother. The present study 
tested the hypothesis that experience with a flavor in amniotic fluid or breast 
milk modifies the infants' acceptance and enjoyment of similarly flavored 
foods at weaning. METHODS: Pregnant women who planned on breastfeeding their 
infants were randomly assigned to 1 of 3 groups. The women consumed either 300 mL 
of carrot juice or water for 4 days per week for 3 consecutive weeks during the 
last trimester of pregnancy and then again during the first 2 months of 
lactation. The mothers in 1 group drank carrot juice during pregnancy and water 
during lactation; mothers in a second group drank water during pregnancy and 
carrot juice during lactation, whereas those in the control group drank water 
during both pregnancy and lactation. Approximately 4 weeks after the mothers began 
complementing their infants' diet with cereal and before the infants had ever 
been fed foods or juices containing the flavor of carrots, the infants were 
videotaped as they fed, in counterbalanced order, cereal prepared with water 
during 1 test session and cereal prepared with carrot juice during another. 
Immediately after each session, the mothers rated their infants' enjoyment of the 
food on a 9-point scale. RESULTS: The results demonstrated that the infants 
who had exposure to the flavor of carrots in either amniotic fluid or breast 
milk behaved differently in response to that flavor in a food base than did 
nonexposed control infants. Specifically, previously exposed infants exhibited 
fewer negative facial expressions while feeding the carrot-flavored cereal 
compared with the plain cereal, whereas control infants whose mothers drank water 
during pregnancy and lactation exhibited no such difference. Moreover, those 
infants who were exposed to carrots prenatally were perceived by their mothers as 
enjoying the carrot-flavored cereal more compared with the plain cereal. 
Although these same tendencies were observed for the amount of cereal consumed and 
the length of the feeds, these findings were not statistically significant. 
CONCLUSIONS: Prenatal and early postnatal exposure to a flavor enhanced the 
infants' enjoyment of that flavor in solid foods during weaning. These very early 
flavor experiences may provide the foundation for cultural and ethnic 
differences in cuisine.

*********

Br J Nutr. 1994 Feb;71(2):223-38.
The immunological and long-term atopic outcome of infants born to women 
following a milk-free diet during late pregnancy and lactation: a pilot study.
Lovegrove JA, Hampton SM, Morgan JB.

Division of Biomedical Research, School of Biological Sciences, University of 
Surrey, Guildford.

Infants born to atopic parents have been found to be at high risk of allergy 
development. The present study investigated the effect of a maternal milk-free 
diet during late pregnancy and lactation on the immune response and allergy 
incidence in at-risk and control infants. Atopic mothers were randomly 
allocated into an intervention group (n 12) or an unrestricted-diet group (n14) and 
compared with non-atopic mothers following an unrestricted diet (n 12). The 
intervention involved a maternal milk-free diet during late pregnancy and 
lactation. Infants were followed up for 18 months postnatally. A significant fall in 
maternal serum beta-lactoglobulin (beta-Lg)-immunoglobulin G (IgG) antibody 
levels (P < 0.05) was observed after a 7-week milk-exclusion diet. In maternal 
and cord serum samples the levels of beta-Lg-IgG and alpha-casein-IgG antibodies 
were significantly correlated (r 0.89, P < 0.0001 and r 0.71, P < 0.001 
respectively). Higher levels of beta-Lg-IgG (P < 0.05) were observed in the cord 
serum samples compared with paired maternal serum samples. Single-blind allergy 
assessment by a paediatrician at 12 and 18 months showed that the infants born 
in the non-atopic group had a significantly lower allergy incidence compared 
with the infants born in the atopic group following an unrestricted diet (P < 
0.008 and P < 0.02 respectively). The allergy incidence in the infants born in 
the atopic diet group was significantly lower compared with that of the 
atopic group following an unrestricted diet (P < 0.04). It was observed that the 
atopic nature of the parents significantly affected the allergy incidence in 
their children. A trend towards a beneficial effect of a maternal milk-free diet 
during late pregnancy and lactation was also observed in infants born to 
atopic parents.

*************

Clin Allergy. 1986 Nov;16(6):563-9.
Influence of maternal food antigen avoidance during pregnancy and lactation 
on incidence of atopic eczema in infants.
Chandra RK, Puri S, Suraiya C, Cheema PS.

One hundred and twenty-one women with history of a previous child with atopic 
disease were randomly allocated during the next pregnancy to antigen 
avoidance or control groups. Dietary advice consisted of almost complete exclusion of 
milk and dairy products, egg, fish, beef and peanut throughout pregnancy and 
lactation. A total of 109 completed the study. Maternal antigen avoidance was 
associated with reduced occurrence of atopic eczema and the skin involvement 
was less extensive and milder. The beneficial effect was observed mainly in the 
breast-fed group. Among the fifty-five who completed the trial of antigen 
avoidance, seventeen infants developed atopic eczema, five out of thirty-five who 
were breast-fed and twelve out of twenty who were formula-fed. Among the 
offspring of fifty-four control mothers given no dietary restriction, eczema was 
observed in twenty-four infants, eleven out of thirty-six breast-fed and 
thirteen of eighteen formula-fed. Avoidance of common dietary allergens during 
pregnancy and lactation enhanced the preventive beneficial effect of exclusive 
breast feeding on the incidence of atopic eczema among infants at high risk.

*******
Br Med J (Clin Res Ed). 1985 Oct 5;291(6500):932-5.
Egg and cows' milk hypersensitivity in exclusively breast fed infants with 
eczema, and detection of egg protein in breast milk.
Cant A, Marsden RA, Kilshaw PJ.

Forty nine eczematous infants who were still solely and exclusively breast 
fed and who had never received anything but breast milk were studied for 
evidence of sensitisation to foods. Thirty four similar infants without eczema formed 
a control group. The eczematous infants were divided into three groups 
according to clinical criteria: (1) definite atopic eczema; (2) possible atopic 
eczema; (3) atopic eczema unlikely. Twenty three infants showed cutaneous 
hypersensitivity to foods, usually egg and cows' milk. Seven of 14 infants in group 1 
and nine of 20 in group 2 were sensitised compared with four of 15 in group 3 
and three of 34 controls (p less than 0.01). Ovalbumin was detected in breast 
milk from 14 of 19 mothers tested after ingestion of egg, the concentrations 
being the same for mothers feeding eczematous and

********

BMJ. 1989 Jul 22;299(6693):228-30.
Influence of maternal diet during lactation and use of formula feeds on 
development of atopic eczema in high risk infants.
Chandra RK, Puri S, Hamed A.

Memorial University of Newfoundland, Janeway Child Health Centre, Canada.

OBJECTIVE--To examine the effects of maternal diet during lactation and the 
use of formula feeds on the development of atopic eczema in infants at risk. 
DESIGN--Mothers who planned to breast feed exclusively were randomly allocated 
to either a restricted diet (avoiding milk and other dairy products, eggs, 
fish, peanuts, and soybeans) or a diet without restrictions. Mothers who did not 
plan to breast feed were randomly allocated to using one of three formula 
feeds. SETTING--Child health centre in Canada. SUBJECTS--97 Mothers who chose to 
breast feed and 124 mothers who did not. INTERVENTIONS--Restricted diet for 49 
mothers who breast fed. Casein hydrolysate formula, soy milk formula, or cows' 
milk formula for infants not breast fed. MAIN OUTCOME MEASURE--Development of 
eczema in babies. RESULTS--Infants were followed up over 18 months and 
examined for eczema. Eczema was less common and milder in babies who were breast fed 
and whose mothers were on a restricted diet (11/49 (22%) v 21/48 (48%)). In 
infants fed casein hydrolysate, soy milk, or cows' milk 9/43 (21%), 26/41 (63%), 
and 28/40 (70%), respectively, developed atopic eczema. CONCLUSIONS--In 
families with a history of atopic disease [corrected] mothers who breast feed 
should avoid common allergenic foods during lactation. If they choose not to breast 
feed a hydrolysate formula should be used.

PIP: To examine the effects of maternal diet during lactation and the use of 
formula feeds on the development of atopic eczema in infants at high-risk, a 
group of 97 mothers who chose to breastfeed and 124 mothers who did not were 
examined at a child health center in Canada. Mothers who chose to breastfeed 
exclusively were randomly allocated to either a restricted diet (avoiding milk 
and other dairy products, eggs, fish, peanuts, and soybeans) or a diet without 
restrictions. Mothers who did not plan to breastfeed were randomly allocated to 
the use of 1 of 3 formula feeds. Their choices were either casein hydrolysate 
formula, soy milk formula, or cows' milk formula. Infants were followed for 
over 18 months and examined for eczema. Eczema was less common and milder in 
babies who were breastfed and whose mothers were on a restricted diet (11 of 49 
[22%] vs 21 of 48 [48%]). In infants fed the casein hydrolysate formula, soy 
milk, or cows' milk, 9 of 43 (21%), 26 of 41 (63%), and 28 of 40 (70%), 
respectively, developed atopic eczema. In families with a history of atopic eczema, 
mothers who breastfed should avoid common allergenic foods during lactation. If 
they choose not to breastfeed, a hydrolysate formula should be used.

**********

Cochrane Database Syst Rev. 2003;(4):CD000133.
? Maternal dietary antigen avoidance during pregnancy and/or lactation for 
preventing or treating atopic disease in the child.
Kramer MS, Kakuma R.

McGill University, Faculty of Medicine, 1020 Pine Avenue West, Montreal, 
Quebec, Canada, H3A 1A2. michael.kramer@mcgill.ca

BACKGROUND: Some breastfed infants with atopic eczema benefit from 
elimination of cow milk, egg, or other antigens from their mother's diet. Maternal 
dietary antigens are also known to cross the placenta. OBJECTIVES: To assess the 
effects of prescribing an antigen avoidance diet during pregnancy and/or 
lactation on maternal and infant nutrition and on the prevention or treatment of 
atopic disease in the child. SEARCH STRATEGY: We searched the Cochrane Pregnancy 
and Childbirth Group trials register (October 2002) and contacted researchers 
in the field. SELECTION CRITERIA: All randomized or quasi-randomized 
comparisons of maternal dietary antigen avoidance prescribed to pregnant or lactating 
women. We excluded trials of multimodal interventions that included manipulation 
of the infant's diet other than breast milk or of nondietary aspects of the 
infant's environment. DATA COLLECTION AND ANALYSIS: We extracted data from 
published reports, supplemented by additional information received from the 
trialists we contacted. MAIN RESULTS: The evidence from 4 trials involving 
approximately 451 participants does not suggest a protective effect of maternal dietary 
antigen avoidance during pregnancy on the incidence of atopic eczema during 
the first 12 to 18 months of life. Data on allergic rhinitis/conjunctivitis and 
urticaria are limited to a single trial each and are insufficient to draw 
meaningful inferences. Longer-term atopic outcomes have not been reported. The 
restricted diet during pregnancy was associated with a slightly but 
statistically significantly lower mean gestational weight gain, a nonsignificantly higher 
risk of preterm birth, and a nonsignificant reduction in mean birthweight.The 
evidence from 3 trials involving approximately 210 participants suggests a 
protective effect of maternal antigen avoidance during lactation on the incidence 
and severity of atopic eczema during the first 12 to 18 months, but 
methodologic shortcomings argue for caution in interpretation.One crossover trial 
involving 17 lactating mothers of infants with established atopic eczema found that 
maternal dietary antigen avoidance was associated with a nonsignificant 
reduction in eczema severity. REVIEWER'S CONCLUSIONS: Prescription of an antigen 
avoidance diet to a high-risk woman during pregnancy is unlikely to reduce 
substantially her child's risk of atopic diseases, and such a diet may adversely 
affect maternal and/or fetal nutrition. Prescription of an antigen avoidance 
diet to a high-risk woman during lactation may reduce her child's risk of 
developing atopic eczema, but better trials are needed.Dietary antigen avoidance by 
lactating mothers of infants with atopic eczema may reduce the severity of the 
eczema, but larger trials are needed.


Suzanne Evans Morris, Ph.D.
Speech-Language Pathologist
New Visions
1124 Roberts Mountain Rd.
Faber, VA 22938
(434) 361-2285 ext. 5
www.new-vis.com


In a message dated 2/10/05 10:59:16 AM, otto@email.chop.edu writes:

> Monitoring her diet was my first thought as well, although I get mixed
> messages here about the validity of doing that- Suzanne do you have any
> literature references that support doing that?? We had a very similar
> case recently but when I began conversations about mom's diet they were
> blown off by our lactation and nutrition folks.? Oddly enough this baby
> had much less reflux activity with thickened breast milk through the ng
> tube- again, a practice NOT supported by literature but clinically with
> quite a significant improvement (the baby in this case was fed ng due to
> identified aspiration... not a suggestion for this particular child,
> just a comment)
> 
> I appreciate any references you have Suzanne and good luck with this
> situation, Laura
> 
> Staci Otto MS CCC-SLP
> Children's Hospital of Philadelphia
> 215-590-7959
>