Where possible, exclusive breastfeeding (i.e. not using ‘top-ups’ of other milk) should be your first choice when it comes to feeding your baby. Research shows that, although any amount of time spent breastfeeding is good for your baby, breastfeeding for six months may be protective against some allergies developing, although this has not yet been proved conclusively.
As well as containing all the nutrients a baby needs, breast milk also contains antibodies from your immune system. When a baby is born, its immune system is still under-developed. Since the immune system plays a central part in allergy, by breastfeeding your baby, you may not only be protecting him or her from illness but from developing allergy as well.
Omega-3 fatty acids play an important part in the development of an infant’s immune system and breast milk is a good source of these. Breast milk also contains prebiotics; these are special complex sugars, the importance of which are only now becoming more widely understood. However, evidence suggests that their interaction with the growing immune system helps prevent allergy from developing. This may be because they promote the balance of beneficial bacteria in the gut which are essential for a normal immune system and help prevent gastrointestinal disease. In the light of this new understanding about prebiotics, some formula milk manufacturers now add prebiotics to their products so that babies who are not, or cannot be breastfed, get to benefit from the effects of these substances. However, we still do not know if prebiotics added in this way have the same benefit as prebiotics found in breast milk.
Breastfeeding is known to be such an important part of preventative healthcare that it is generally promoted by midwives and other organisations concerned with baby health. The National Childbirth Trust can give advice about breastfeeding and can support you in continuing to breastfeed for as long as you decide is right for you and your baby. Call 0870 444 8708 to speak to one of their breastfeeding advisors. Your midwife and health visitor will also be able to help and they can also refer you to lactation specialists. If you wish to breastfeed your baby, but experience difficulty, it is important to use all of this support while you try to establish a breastfeeding routine that works for you and your baby.
Many mothers experience difficulty breastfeeding initially, and can come under pressure to switch to formula feeds. If you explain to your family and friends why you are determined to breastfeed and that, by doing so, you could be making a difference to your child’s health, they will know that you wish them to support you in this.
Current recommendations are to breastfeed for at least six months, but this only happens around 20-30% of the time. For some women, and their babies, breastfeeding is not a viable option. Some women choose not to breastfeed, and some cannot breastfeed successfully. Many cannot breastfeed exclusively due to lifestyle restrictions, and find that breastfeeding some of the time and supplementing with top-up formula feeds works for them. Sometimes, the baby is not satisfied with being solely breastfed, and may need top-ups with formula too. Data has shown, that while exclusive breastfeeding is the ideal, any amount of breastfeeding can be beneficial in reducing the risk of your baby developing allergies.
Alternatives to Breastfeeding
If you are not breastfeeding your baby, and your family is at a high risk of allergy, then there are steps you can take to try to reduce the risk of your baby developing an allergy, even while using formula feeds.
The tendency towards allergy is inherited between generations of a family. If you know your family is at high risk of developing allergies, and your baby has one or more first degree relatives (such as siblings or a parent) with allergy, you may be concerned that cows' milk, a common trigger for allergy, will be a problem.
Since standard formula is based upon whole cows' milk protein, it can be an initial trigger for allergy in babies. There is good evidence that avoiding the introduction of cows’ milk formula into the diet before six months of age can influence the later development of allergy, and if you are concerned about this you should discuss it with your GP.
There are other types of infant formula milk that are available as alternatives to the standard milk formula that is sold in shops. Two types of these formulas have been shown to have an effect in the prevention of allergies in at risk infants. These are hydrolysed formula and amino-acid based formula, also known as elemental formula. Elemental formulas are not used so much for the prevention of allergy, but may be recommended where an allergy to cows' milk has already been established.
Extensively hydrolysed means that the cows’ milk has been treated to break down the protein that causes allergy. These formulas are often used in children who have a milk allergy. Other types of hydrolysed formulas are partially-hydrolysed, where the cows’ milk protein is only partly treated. Thus, the formula may still trigger sensitisation in vulnerable babies and children, and is therefore not suitable for children who have a milk allergy already.
Extensively hydrolysed formulas have been found to be effective in some babies in preventing the development of allergy, but only in high risk infants where a parent or sibling has allergies. While these formulas have an unpleasant taste, this should not be an issue if they are being introduced to a baby under six months of age, as the sensation of taste is underdeveloped at this age.
There is no evidence to support feeding with a hydrolysed formula for the prevention of allergy in preference to exclusive breastfeeding.
Parents should be assured that no formula can be sold as infant milk without containing all the nutrients, vitamins and minerals, including iron, which a baby needs to grow and develop. Other types of milk are available in shops, but only those sold as baby formulas should be used for young babies.
If you decide before the baby is born that you will want to feed using one of these formulas, then it is a good idea to make sure that you take the formula into the hospital when you have your baby. Ask the midwives to ensure that your baby does not receive any other type of milk feed. Remember too that even for those mothers who plan to breastfeed their babies, midwives often need to give babies ‘top up’ feeds for a number of reasons and, unless you have the formula available, they may need to use an ordinary cows' milk formula.
As your baby gets older you may decide to feed them different types of milk. However, even for older babies, specially prepared formulas are the best policy if allergy is a potential tendency in your family. Some milks should be avoided in babies and young children:
Soya milk formula – This is not recommended for babies in the UK, especially those under six months of age, unless there is a specific medical indication. It is thought that some substances in this milk, called phytoestrogens, which are similar to the female hormone oestrogen, may affect the development of children. Research is ongoing into this, but it may be best to avoid soya milk. Some people think soya formula may prevent allergies, but research has shown that this is false. In fact, high risk babies can go on to develop soya allergy instead of cows’ milk allergy.
Soya milk is recommended to provide adequate nutrition for infants of vegan mothers who are unable to, or choose not to, breastfeed. It is also used where infants find all other alternatives unacceptable and where the lactose content of low-lactose formulas is considered too high.
Goats’ milk formula – In the past, this has been promoted as an alternative to cows’ milk for children with cows’ milk allergy and those at risk of developing allergy. However, goats milk and other mammalian milks do not have enough nutrients for young children under one year of age, and the Department of Health recommends that goats’ milk is to be avoided for these children. Furthermore, the majority of children with cows’ milk allergy are also allergic to goats’ (and other mammalian) milk, and so it must not be given to children with an allergy to cows’ milk. It also contains similar levels of lactose, so is not suitable for infants with lactose intolerance.
Other milks - Nut milks, rice milk and oat milk are not suitable for young babies; they are very low in nutrients and the calories needed for healthy development, even when they are fortified with minerals such as calcium.
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Breast milk provides all the nutrition that a baby needs and it is recommended that this is the sole food source for a baby up to the age of six months. Advice from the Department of Health is that it is best to delay introducing solid foods until the age of six months in both breastfed and formula-fed babies. However, the European Academy of Allergology & Clinical Immunology recommends that, in terms of allergy prevention, weaning should take place from four to six months of age.
A number of reasons are given for introducing babies to solid food early:
‘My baby seemed ready for solid food’
Babies develop in spurts and, at these times of growth, your baby may have a greater appetite than usual. Often, this coincides with sleeping through the night, so they need to catch up on feeding during the day. This does not necessarily mean that your baby needs to go on to solid food, it may be a short phase where you and your baby need to adjust to a new feeding schedule. After a while feeding may revert back to the old pattern.
‘Milk isn’t enough for a growing baby’
Breast milk or infant formula is enough for most growing babies up to the age of six months, and is the best source of nutrition that you can give. A mother’s milk changes over time and at different times of the day, and her supply increases on demand from the baby. Sometimes, however, it can take a while for your body to start producing extra milk when your baby first starts demanding it.
‘Eating solids will make my baby sleep better at night’
Research has been conducted into whether or not this is true. The results showed that there was no difference in sleep quantity between babies who had been weaned early and their previous sleep quantity. Breastfed babies often seem to take longer to establish night and day sleep patterns. Breast milk is so easily and effectively digested that these babies may need night feeds for longer than those fed on formula. Although this may be unhelpful to you, this relatively short amount of time keeping up just milk feeds may pay off in the long run in terms of protecting against allergy development.
‘It never did you any harm’
We cannot prove at this stage what implications early weaning had on previous generations. However, we do know that the number of allergies in children has increased dramatically in recent years. Research looking at the link between allergy and introduction of solids suggests that waiting until around six months of age to wean your baby may reduce the chance of their developing allergies.
It is important that, if you feel that your baby does need to be introduced to solid food before six months, you follow the recommendation that the age of 17 weeks is the earliest that a baby should be weaned. When solid foods are introduced at this time, it is important that it should start with what are considered to be low allergenic foods, and foods most likely to cause an allergic reaction should not be introduced before six months. See the section on weaning for more information.
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Milk Feeds After Six Months of Age
If you decide to stop breastfeeding at six months you can consider switching over to a standard infant formula.
Some parents have reported that their babies can be unwilling to change from the taste of breast milk (or a formula milk) to an alternative formula. Up to the age of six months, the baby’s taste buds aren’t very good at telling the difference between different types of flavours. After this, as their taste buds develop, they may be more likely not to accept a different kind of milk drink.
Some suggested strategies include trying to give the milk in a beaker rather than a bottle. Your baby will be used to drinking one type of milk using a sucking or lapping action – either at the breast or on baby bottles. Giving them a whole new experience of drinking, at the same time as introducing a new formula, means they do not expect the same flavour as before. If you are using beakers with valves, these valves need to be taken out, otherwise the baby will be sucking again to get the new drink.
A popular strategy for moving from breast milk is to express some milk and mix it with the formula and, over time, to gradually increase the amount of formula in the mix.
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- Breastfeeding for six months can help protect against allergy developing in later childhood
- Breastfeeding supports the development of your baby’s immune system
- National Childbirth Trust can be contacted on 0870 444 8708 for advice on breastfeeding
- All infant formula food contains the correct amount of nutrients for a developing baby
- If not breastfeeding, and your baby is at high risk of developing allergies, consider using an extensively hydrolysed formula
- Soya-based formula is not recommended, especially for babies under six months old
- The Department of Health advises against the use of goats’ milk formula for children under the age of one year
- Don’t introduce other types of milk as an alternative to cows’ milk – they can all potentially trigger allergy in high risk babies
- Current guidelines suggest weaning your baby at around six months of age may help prevent the development of allergies
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Last updated: March 2012