Is your baby unsettled or having trouble sleeping because of allergy?
The research tells us that green stools and mucous in the stool are normal for our babies, whether breastfed or formula fed. Sometimes there can be quite a lot of mucous. But green stools and mucous in the stool aren't signs of worrying inflammation, allergy, lactose overload, gut dysbiosis or gut problems, despite what you might hear. Frequency and consistency of baby stools often vary in the one baby, and this changeability is more pronounced with the introduction of solids. Please see your GP if you find blood in your baby's stool, or have concerns about your baby's health.
Your baby doesn't have sleep problems due to the effects of allergy on the gut
True allergy in a baby, toddler or older child can be a frightening condition which requires parental vigilance and careful monitoring by your little one's GP or other doctor. However, it is also true that allergy and intolerance, most especially cow's milk allergy or intolerance, is overdiagnosed and overtreated in babies and toddlers.
You might worry that your baby is having sleep problems because of allergy or wind pain. You might have heard that allergy and gut dysbiosis will cause her to dial up or cry, interfering with sleep. Parents find it reassuring to know this isn't the case. Eliminating various foods from your diet won't help your breastfed baby be more settled at night or sleep more during the day. The only kind of allergy which might cause disrupted sleep in babies is a very extensive skin rash or eczema, which could wake a little one because of irritation and itchiness.
Unfortunately, when we prescribe unnecessary elimination diets to babies, we increase the possibility that baby will develop an allergy later on. This is because exposure to a low dose of a food protein (which happens through the breast milk) in the early months of life primes the immune system, and stimulates tolerance to that food protein. Babies and toddlers need exposure to the wide range of foods found in their parents' diet, whether through their mothers' milk or once solids are being introduced.
If your baby is fussing and arching his back during breastfeeds, this most likely signals underlying problems with the baby's fit and hold, resulting in an unstable feeding position. But this problem is often misdiagnosed as a sign of allergy. I recommend you seek the support of an NDC Accredited health professional, who will apply the gestalt method to help with positional instability, found here. If your baby is fussing and arching his back during bottle feeds, please read about paced bottle feeding here. Sometimes babies develop a conditioned dialling up with the breast or bottle, which is also often misdiagnosed as allergy.
Allergy is often overdiagnosed and overtreated in our babies
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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.
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Cow's milk allergy is the only kind of allergy which has been linked with babies who cry alot in the first 16 weeks of life (quite a different problem to patterns of excessive night waking in the first 12 months of life).
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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 babies and cow's milk allergy
Even a diagnosis of true cow's milk allergy in your breastfed baby or toddler does not require you to stop breastfeeding, nor to start a maternal dairy elimination diet (except in extremely rare circumstances). Please discuss concerns with your GP.
Cow's milk proteins usually don't occur at high enough levels in the breast milk to trigger allergic reactions in babies, regardless of how much dairy the mother consumes. When a breastfeeding mother is on a dairy elimination diet
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There is a greater chance her baby will develop a cow's milk allergy down the track
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She loses nutritional benefits of dairy (including calcium and vitamin D) and possible enjoyment benefits of dairy foods.
If your baby is formula fed and diagnosed with a true cow's milk allergy, a specialised formula may be required.
What are the different kinds of cow's milk allergy?
There are two main kinds of cow's milk allergy. You can find out more about the mechanisms of immune mediated responses to food proteins here.
IgE mediated cow's milk allergy
A baby with an IgE mediated cow's milk allergy may have one or more of the following.
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Skin rashes (urticaria, eczema)
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Reactive airways
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Vomiting two hours after baby takes in infant formula or a dairy product
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Anaphylaxis (which is life-threatening).
Non-IgE mediated cow's milk allergy
A baby with a non-IgE mediated cow's milk allergy may have one or more of the following.
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Significant and recurring amounts of blood in the stool, also referred to as food protein induced allergic proctocolitis. (Most babies with streaks or specks of blood in the stool do not have cow's milk allergy, and the flecks usually disappear within a month or so. You can find out about blood in your baby's stool here)
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Anaphylaxis (which is life-threatening).
None of these conditions causes a pattern of excessive night waking in your baby. They also do not cause a baby to fuss at the breast or bottle. 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 baby or 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 baby's GP.
Recommended resources
Is your baby unsettled or having trouble sleeping because of lactose?
Is your baby unsettled or having trouble sleeping because of reflux?
It's normal for babies to have green stool and mucous in the stool
When your breastfeeding baby has blood in the stool
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.
Gelsomino M, Sinatti D, Miceli Sopo S. Non-allergic benign infantile proctocolitis: a neglected nosographic entity. BMC Case Reports. 2021;14:e244918.
Gelsomino M, Liotti L, Barni S. Elimination diets in lactating mothers of infants with food allergy. Nutrients. 2024;16(2317):https:// doi.org/10.3390/nu16142317.
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.
Silvatore S, Folegatti A, Ferrigno C. To diet or not to diet this is the question in food-protein-induced allergic proctocolitis (FPIAP) - a comprehensive review of current recommendations. Nutrients. 2024;16:589.
Verhasselt V. A newborn's perspective on immune responses to food. Immunological Reviews. 2024;326:117-129.