Many thanks for your question about your client who is 3 months old and struggling to keep milk down. I understand he has received antibiotics and is now being prescribed PPIs. Obviously, it is not our role to advise on medications but there may be some intervention that could be helpful and help to reduce or resolve the symptoms and negate the need for PPIs.
Given the importance of the gut microbiota and microbiome in the early stages of life and its potential and real impact on health in the rest of life the use of multiple antibiotics and PPIs in the first months of this baby’s life is certainly not ideal and therefore any nutritional or other non-drug means by which to address the contributors to this baby’s reflux would be ideal for the health of this baby.
Gibson MK, Crofts TS, Dantas G. Antibiotics and the developing infant gut microbiota and resistome. Curr Opin Microbiol. 2015 Oct;27:51-6. doi: 10.1016/j.mib.2015.07.007. Epub 2015 Aug 1. View Full Paper
You mentioned that the mother is breast feeding – I presume she is 100% breast feeding and not supplementing with formula milks. I also presume that the baby previously was tolerating the milk, but it is after the antibiotics that issues have developed. Reflux and colic may be associated with a gastrointestinal disturbance. Gastrointestinal factors that may place a role include faulty feeding techniques, milk protein intolerance, additional allergies or food sensitivities, GI immaturity, intestinal hypermotility, and alterations in faecal microflora.
Clearly with the recent antibiotics there may be disturbances in the gut flora and there will also be gut immaturity. It may also be the case that certain foods the mother is eating is aggravating the condition. Depending on the family health history and the mother’s health history you may wish to look at common allergies such as dairy, gluten, citrus, egg, soy, nuts etc. An elimination diet may therefore be useful for the mother. I would also avoid caffeine including chocolate. Take in to account as well whether the baby was born C section or vaginally as this could also have influenced the microbiota.
SIgA (secretory immunoglobulin A) is crucially important for the health of the gut lining and helps prevent potential toxins from entering the bloodstream. Newborn babies are temporarily deficient in their ability to produce SIgA, but the amount in breast milk can compensate for this lack of production. Obviously, the mother’s diet can affect the quality of breast milk and the amount of IgA the baby receives. To support the production of SIgA various nutrients are required. One of the most important is vitamin A. Thereby, eating food that provides vitamin A or pro-vitamin A (e.g. eggs, leafy greens, butter, liver, apricots, sweet potato, carrots) while breast feeding may help in supporting oral tolerance in the baby.
A healthy immune system and digestive tract requires key nutrients, vitamins and minerals. Any deficiencies could compromise their function which may increase the risk of developing food reactions. This may include vitamin D, vitamin A, essential fats and zinc just to name a few. I would therefore recommend the mother takes a multi that is suitable for breast feeding and increase her intake of oily fish or take a supplement. You may wish to check her vitamin D status and supplement if this is low.
Fermented foods are also recommended and add in prebiotic and plenty of fibre rich foods to support a healthy gut flora. I would suggest the mother could also take a probiotic supplement. She could also empty the capsule and rub on the nipple just before breast feeding or dab her finger in the probiotic powder and then place in the baby’s mouth to support the development of the baby’s gut flora.
In some cases of reflux changing how she feeds may help too. Lie down to breastfeed and don’t wait until the baby is really hungry. Express a little bit of milk before breastfeeding your baby in case the milk comes out too quickly and causes the baby to choke.
The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Saccharomyces boulardii (ARG) – take 1 twice daily – http://tinyurl.com/z27sdwn
BioDoph-7 Plus (BRC) – take 1 twice daily – empty a capsule and place in the baby’s mouth daily
Pre-Natal Pack (BRC) – take 1 sachet daily
I hope this helps answer your question
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