Does allergy cause toddler sleep problems?

Green stools and mucous in the stool aren't signs of worrying inflammation, allergy, lactose overload, gut dysbiosis or gut problems in babies and toddlers, despite what you might hear, although a bout of loose frequent stools might be diarrhoea due to a gastroenteritis! Frequency and consistency of stools often vary in the one toddler from day to day, depending on the food he's eating. Please see your GP if you find blood in your toddler's stool, or have concerns about your toddler's health.

Your toddler doesn't have sleep problems due to the effects of allergy on the gut

True allergy in a toddler or older child can be frightening, and requires parental vigilance and careful monitoring by your little one's GP, paediatrian, or allergist.

However, you might worry that your toddler is having sleep problems because of allergy causing gut pain. Parents find it reassuring to know this isn't the case. Eliminating various foods from your diet won't help your breastfed toddler be more settled at night or sleep more during the day, even though you might often hear this said. The only kind of allergy which might cause disrupted sleep in toddlers is a very extensive skin rash or eczema, which could wake a little one up because of irritation and itchiness. It's true that allergy, most especially cow's milk allergy, is often wrongly blamed for unsettled behaviours in otherwise well children, including during the nights.

Toddlers need exposure to the wide range of foods found in their parents' diet. You can find out more here.

Allergy is often overdiagnosed and overtreated in toddlers

• Cow's milk allergy is the most common allergy in babies and toddlers, but occurs only occasionally, and continues to be very commonly overdiagnosed and overtreated.

• Soy, egg, and grain protein allergies may occur in babies and toddlers, but also very uncommonly, and are similarly often overdiagnosed. They don't cause sleep or crying problems.

Breastfed toddlers and cow's milk allergy

Even a diagnosis of true cow's milk allergy in your breastfed toddler does not require you to stop breastfeeding, nor to start a maternal dairy elimination diet (except in extremely rare circumstances). Please discuss this situation with your GP.

Cow's milk proteins usually don't occur at high enough levels in the breast milk to trigger allergic reactions in toddlers, regardless of how much dairy the mother consumes. A breastfeeding mother eliminating dairy from her own diet loses the nutritional (including probiotic, calcium, and vitamin D) benefits and also the possible enjoyment benefits, of dairy foods.

If your toddler is diagnosed with a true cow's milk allergy, elimination of cow's milk protein from her diet may be required.

What are the different kinds of cow's milk allergy?

There are two main kinds of cow's milk allergy.

IgE mediated cow's milk allergy

• Skin rashes (urticaria, eczema)

• Hayfever

• Reactive airways

• Vomiting two hours after your child (directly) ingests cow's milk protein or a dairy product

• Anaphylaxis (which is life-threatening).

Non-IgE mediated cow's milk allergy

• Constipation

• Anaphylaxis (which is life-threatening).

None of these conditions causes a pattern of excessive night waking in your toddler. They also do not cause a toddler to fuss at the breast, or indeed at the bottle if your toddler is still bottle feeding.

A pattern of excessive night waking is typically caused by a disrupted body clock, and is dealt with by the steps in The Possums Sleep Program. Parents can find it very reassuring to find out that their toddler's disrupted sleep and fussy behaviour isn't caused by gut pain or allergy, despite everything they might have heard.

If you do have concerns about allergy, please talk this over with your little one's GP.

Selected references

AL-lede M, Sarhan L, Alshrouf MA. Perspectives on non-IgE-mediated gasrointestinal food allergy in pediatrics: a review of current evidence and guidelines. Journal of Asthma and Allergy. 2023;16:279-291.

Allen HI, Pendower U, Santer M. Detection and management of milk allergy: Delphi consensus study. Clinical and Experimental Allergy. 2022;52:848-858.

Banerjee A, Wood R, Dunlop J. Rates of new peanut allergy and discontinuation following introduction in high-risk infants. Journal of Allergy and Clinical Immunology in Practice. 2023: https://doi.org/10.1016/j.jaip.2023.1011.1035.

McWilliam V, Netting MJ, Volders E. World Allergy Organization (WAO) diagnosis and rationale for action against cow's milk allergy (DRACMA) guidelines update - X - Breastfeeding a baby with cow's milk allergy. World Allergy Organization Journal. 2023;16:100830.

Mehta S, Allen HI, Campbell DE, Arnsten KF. Trends in use of specialized formula for managing cow's milk allergy in young children. Clinical and Experimental Allergy. 2022;52:839-847.

Munblit D, Perkin MR, Palmer D, Allen K, Boyle RJ. Assessment of evidence about common infant symptoms and cow's milk allergy. JAMA Pediatrics. 2020;174:599-608.