“Skye 8 months has started to really refuse to be fed but it’s hit and miss (in terms of how much she actually gets into her tummy). I find if I let her be in charge fully she will only eat 1/3-1/2 of what she would usually eat (which isn’t much already!). There are better days but mostly watching her play with food and chat and how long should I let her eat?”
OK, here’s some tips on what to do with Skye. Independent eaters are incredibly common and I see a lot of these. The danger in feeding her by spoon when she’s telling you that she doesn’t want this, by clamping her mouth shut and growling at you, is that it will make her angrier. I hear about growling children at mealtimes a lot! When we do something that goes against our baby’s or children’s desire and they get angry at us it’s the opposite of good relationship building. I wrote a blog about attunement ages ago and I’d like to raise it again. I think attunement is possibly one of the most important things in building a healthy relationship with your baby and child. I’d do finger foods totally for mains but every food has to be high calorie, protein and low GI carb so that every mouthful is helping her with energy intake and therefore sleep. Try and steer clear of too much fruit and veg, they fill up and don’t give enough calories. It will be very messy at first and more food will end up on the floor than in her mouth! Within 2 weeks Skye should have developed all those necessary skills to be an effective self-feeder.
Peanut butter and other nut butters and avocado on wholemeal toast soldiers (spread thickly) or cruskits
Hummus and other dips with brown rice crackers
Adding foods that have a high fat content will double the calories that carbs have. So she may not be taking the same volume but it’s calorie dense. eg butter, cheese, cream, mascarpone, ricotta, nut butter, avocado, oily fish, coconut cream.
Also always eat with her and turn the TV off. Mealtimes can take around 30 minutes. After that, as soon as she starts playing with/throwing food then mealtime is finished.
Allowing them to self-feed is so important for many reasons
Promotes fine motor skills
Attunement and relationship building
Maintaining a healthy diet and healthy food choices
Also, do you want to be feeding your now child as an adult? Thought you’d say that!
So it will happen! Patience! Within a week I think Skye will be eating heaps, we just have to have the patience to allow this to happen. It’s a very important part of parenting, allowing your child to become independent.
Is your baby making lots of ‘urrrgghhh, urrrgghhhh, urrrggghhhh’ noises and squirming a lot? Then read on…this may be the very reason why.
Your baby may have lots of pooey nappies and they may be sticky or mucousy.
They have tummy ache or colic and it may be worse at night time.
They may be gaining weight or not.
Why your baby might have an unsettled tummy and have problems sleeping.
It may be cows milk protein intolerance or allergy.
With my sleep work as a baby whisperer, I meet a lot of babies with food allergies, intolerances and reflux (GORD). Many of these babies have a family history of an atopic disease – asthma, eczema and hay fever.
We know that approximately 16-42% of babies with GORD show signs or symptoms of cows milk protein allergy (CMPA). 15–21% of children with suggested or proven gastro‐oesophageal reflux disease (GORD) or CMPA suffer from both conditions. CMPA is also linked to colic and approx 10% of babies with colic will have CMPA.
Between 5-15% of infants will display symptoms indicating cows milk protein intolerance (CMPI) whilst 2-7.5% of infants will have a prevalence of Cows Milk Protein Allergy (CMPA).
Elimination of cow’s milk protein from the infant’s or mother’s diet and challenges are the gold standard for diagnosis.
CMPA can be easily missed and misdiagnosed. These are very unsettled young babies and they present in a variety of ways. Often it can be misdiagnosed as reflux, colic as well as a myriad of other conditions.
Reactions to other foods, especially egg and soy, but also wheat, fish, peanut and other foods may occur in combination with CMPA. This means that complementary feeding and, preferentially, all supplementary feeding should be avoided during the diagnostic elimination diet.
Exclusive breastfeeding during the first 4–6 months of life reduces the risk for CMPA and most severe allergic diseases during early infancy. CMPA is lower in exclusively breastfed infants compared to formula‐fed or mixed‐fed infants. Only about 0.5% of exclusively breastfed infants show reproducible clinical reactions to CMP and most of these are mild to moderate. This might be related to the fact that the level of CMP present in breast milk is 100 000 times lower than that in cow’s milk. In addition, immunomodulators present in breast milk and differences in the gut flora in breast‐fed and formula‐fed infants may contribute to the prevalence of CMPA in breast‐fed compared to formula‐fed infants.
While in some young infants there is a strong association between atopic dermatitis and CMPA, many cases of atopic dermatitis are not related. The strength of the association depends on the age and severity of atopic dermatitis: the younger the infant and/or the more severe atopic dermatitis, the stronger the association.
It is so important that health professionals, GP’s and Paediatrician’s take a thorough history of
Feeding – breast and or formula (which formula) – how often and how much
Stools – how often, colour and consistency
A family history of food intolerances or atopic disease – asthma, eczema and hay fever. The risk of atopy increases if a parent or sibling has an atopic disease (20–40% CMP and 25–35% CMPA, respectively), and is higher still if both parents are atopic (40–60%)
Weight measurements are important. The earlier the CMPA presents the greater effect on growth retardation.
What are some of the signs and symptoms of cows milk protein intolerance?
Poor weight gain
Irritability and crying following feeds
Can be constipation
And symptoms of Cows Milk Protein Allergy?
Blood in stools, often looking like redcurrant jelly
Angio-oedema, swelling around the eyes and vocal cords, coughing post feeds
An elimination diet is the only way. It’s very restrictive. Mums often complain a lot about it and it’s important to be managed correctly so as not to cause any nutritional imbalances.
Elimination diet of at least 2 weeks and up to 4 weeks in cases of allergic colitis and atopic dermatitis.
Elimination of all milk products and egg are recommended. Less proven is an elimination of wheat, peanuts and fish. The mum will need calcium supplements of 1000mg per day divided into several doses.
If symptoms improve substantially or disappear during the elimination diet, one food per week can be reintroduced to the mother’s diet.
If symptoms do not re‐appear on the reintroduction of a particular food to the mother’s diet, the elimination of that specific food can be discontinued.
If symptoms re‐appear, the food responsible should be eliminated from the mother’s diet as long as she is breastfeeding. If solid foods are introduced into the infant’s diet, care should be taken to ensure solids are free from the food proteins that the infant is allergic to.
If CMP is the responsible allergen, the mother should continue to receive calcium supplementation during the elimination diet. If the mother is on a CMP‐elimination diet for a long period, appropriate nutritional counselling is required.
When the mother wants to wean her infant, the child should receive an extensively hydrolysed formula (eHF) with demonstrated clinical efficacy.
If your baby is formula fed which infant formulae are suitable for babies with CMP intolerance?
NAN HA Gold or Karicare HA Gold – this is more for prevention.
Karicare Allerpro – this is more for treatment and especially combined with atopic dermatitis.
And CMPA allergies?
An extensively hydrolysed infant formula, soy or amino acid-based formula usually only available on prescription and from a paediatric gastroenterologist (in Australia) such as Neocate, Alfare, Pepti-Junior, Allerpro and EleCare.
After 6 months it is reasonable to try a soy infant formula.
So will my child grow out of their allergy? That’s the 100 dollar question.
For the majority of children their cow’s milk, allergy will resolve.
50% of children with cows milk allergy will resolve within 2 years and 80% by 3-4 years after diagnosis.
The doctors will determine whether your child has grown out of their allergy by a combination of skin testing and food challenge with milk.
Skin tests may be repeated to monitor your child’s allergies. A positive skin test to milk does not always mean your child will have symptoms when they have milk or milk products, therefore a challenge may be the only way to determine if your child has grown out of their milk allergy.
Challenges may need to be done in a hospital by experienced medical staff. Do not do challenges at home unless instructed to do so by your doctor.
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It is an inflammatory process and can affect up to 1 in 3 Australian’s at some time in their life. So it’s an extremely prevalent disease. It’s something that can last a long time and in some cases is a chronic disease, i.e. it is always present. Its irritated dry skin and there are different types of eczema and they all react differently to different lotions and potions. It depends on the type of eczema and if it’s wet or dry as to how its best treated. There is not a one size fits all approach. Babies usually grow out of it by childhood. Their skin repairs itself so well there is usually no permanent scarring.
How does it look?
Eczema on the skin of the kid’s hand
The skin often feels rough and scaly to the touch. Young babies often develop it on their faces and their cheeks feel hot, dry and look very red. They may develop it in their skin creases, particularly behind the knees and elbow folds and then it spreads to other parts of the body. Some babies have wet and weeping eczema that can start as tiny blisters underneath the surface of the skin. Other babies may have discoid eczema that looks like a circle of tiny blisters and/or rough scaly skin.
Seek medical advice. Check out your baby’s skin with your GP or Paediatrician, to confirm or not if, it is eczema. It is important to do this as you may be treating a different skin condition.
Here’s a previous blog you might like a look at. It was Miss Kit and the hat and her wool hat had led to eczema on her face.
Environmental factors – dust mite, moulds, grasses and plant pollens, amount of moisture in the air, pollutants in the child’s’ environment e.g. what you wash the babes clothes in, clothing type (wool and acrylic), pet fur (dog and cat), bath and skin products, overheating and air-conditioning, cigarette and tobacco smoke
Genetic causes. There may be a family history of eczema, asthma and/or hay-fever. If both parents have eczema there is an 80% chance the children will too.
Stress – very important your baby has a good restful sleep. This has been shown to reduce cortisol (stress hormone) levels.
How do you prevent an outbreak of eczema?
Many preventative things can be done to avoid an eczema outbreak. Most importantly, the skin should be kept moist by using a daily moisturiser.
Wearing 100 percent cotton or soft fabrics such as merino wool – avoiding rough, scratchy fibres and tight clothing. Acrylic and some wool fibres are rough and abrasive on the sensitive and delicate skin.
Having lukewarm baths, using a non-soap cleanser or hypoallergenic bath oil such as BABE atopic bath gel or QV oil. It takes 10 minutes to get the oil in the bath into baby’s skin so your bath should not be so short that this cannot occur or so long that it has the opposite effect and dries the skin out.
Gently patting, not rubbing, the skin dry with a very soft towel
Applying a moisturiser within three minutes after bathing to “lock in” the moisture – such as BABE emollient lotion with calendula, Dermaveen, Dermeze, Sorbolene, MooGoo, Calendula, etc. Apply in a downwards direction following the hair follicles. This minimises abrasion on the skin.
When possible, avoiding rapid changes of temperature – so not too cold or too hot. In Australian summers using a fan for sleep is helpful.
Removing carpets and rugs from houses (if possible) and keeping pets outside or vacuum up daily and use a vacuum cleaner that has a HEPA filter such as a Dyson. Vacuum beds and couches.
Ventilating the house as often as possible
Avoiding stuffed toys which harbour dust mites
Changing bed linen regularly, using specialized dust mite prevention covers
Avoid using Napisan to soak clothes and bed sheets.
Use a non-biological detergent to wash baby’s clothes such as Lux Flakes or Aware (see below).
Avoid perfumed moisturisers. I’ve found Johnsons products and baby products that are scented and have sodium laurel sulphate and lots of additives are not great for babies with eczema.
Reducing daily stress and making sure your baby has good quality sleep. Lots of love and cuddles will help as well!
Learning your baby’s eczema triggers and how to avoid them.
Avoid using wet wipes that have an ingredient MI – see link below for more info
Moisturise the skin 4-6 times a day with a good quality moisturiser that is the right one for your baby’s eczema skin type. Never allow the skin to dry out. Once that occurs it cracks and allows bacteria to penetrate the skin and then the eczema is really hard to heal and may need antibiotics. I’m liking BABE emollient lotion. I’ve tried it on my own bad eczema and it is very gentle. Many clients report to me that it’s great for their baby’s eczema too. I’m also using calendula cream on my eczema in between steroids with success. It’s a case of different ointments and cream work for that individual baby or child’s’ eczema. A lot of parents like MOOGOO – this has calendula in it or Mustela, Stelatopia.
You’ve got to experiment and find what works. What’s good for one child’s’ eczema may not be for another.
Use an emollient (oil such as QV or QV flare up) in the bath
Oatmeal in the bath http://itchybabyco.com.au/shop/bath-soak/natural-bath-soak-with-coconut/
Cotton clothing next to the skin
Manage flare-ups with a mild steroid ointment/cream used topically on the skin, as directed by your GP, Paediatrician or Dermatologist. This may be 1% hydrocortisone such as Sigmacort or Dermaid. Use 3 times a day for 3 days to get eczema under control and use a moisturiser in between times and as well as.
Try to continue breastfeeding. It has been shown to reduce the risk of eczema. If your baby has mucous poo or eczema outbreaks it is worth trying a 2-4 week elimination diet and removing all dairy products and soy from your diet to see if this helps your baby’s eczema.
If formula feeding give an HA formula with a probiotic. There s research to show that a partially hydrolysed formula may reduce the risk of atopic disease in infants. Such as Nan Ha or Karicare Ha. Talk to your doctor or child and family health nurse about this. Karicare Allerpro is a great choice for particularly severe eczema as it is a ‘treatment’ formula. http://pediatrics.jwatch.org/cgi/content/full/2010/512/1
It may be a good idea to introduce a probiotic into your baby’s diet. These can be given from newborn as a powder mixed with a little milk and fed to the baby. Baby Biotics by Bioceuticals is a good brand.
Be careful how you introduce solids to your baby. Talk to your doctor or child and family health nurse about this. ASCIA is a helpful guide http://www.allergy.org.au/health-professionals/papers/ascia-infant-feeding-advice
I know it’s a long list of things to do but eventually, it all becomes second nature. As I said different eczema responds to different lotions and potions. There is not a one size fits all but keeping that skin moisturised is key.
I’ve used all sorts of things in my search for a cure including chickweed infusions, calendula ointment and vaseline. And for the past few years I’ve been lucky not to have had a major outbreak but maybe that’s because I keep my stress under control!
Following the guidelines above will help. It may take a while to get things under control but you’ll get there and your baby gets lots of lovely skin massages along the way. How good is that?
At my previous GP Practice Nurse job I met a mum was desperate. She’d tried everything. Her little girl had refused all lumpy foods. She’d gagged and baulked at lumpy purees. Mum felt stuck and didn’t know where to go.
She’d tried the purees in a sachet and had done what many mums have…fed her straight from the tube. Aha! Now I was getting to the bottom of it! A lightbulb moment.
Now, those sachets are everywhere and I feel not being used in a good way. I’ve seen a lot of parents squeezing them straight into their baby’s mouth. What’s wrong with that you’re asking?
By not putting food into a dish and using a spoon we’re missing out a whole stage in development for baby.
Squirting it into her mouth had activated the sensitive gag reflex, caused the reaction and then voila, the heels are dug in and the whole problem had started. She wouldn’t take any lumpy food AT ALL.
We need to feed either with the spoon, so teaching the baby to move food from the front of their mouth to the back (this is essential for speech development) OR we do Baby Led Weaning where the baby feeds them self (see the previous blog on BLW).
Here’s are some videos demonstrating baby led weaning:
It was fairly easy to sort out, now we knew the cause. We sat her in the Bumbo and let her go for it. She fed herself entirely. Picking up a whole banana, cruskits and both spoons. Yes, it was messy … very … but we fixed the problem. Mum breathed a very big sigh of relief and asked me to write a blog about it. So here it is. Thank you, mum
Are you looking for a heap of NEW baby food ideas?
Hop on over to the Nurture & Nourish section of my new Nurture Sleep Program. There is an amazing eBooklet with 219 pages of nutritious recipes to promote your baby’s sleep.
You can also access even more of my 3 decades of experience as a registered midwife and child and family health nurse via the Nurture Sleep Program. You can take your baby from sleepless to slumber in up to 7 easy lessons across 3 age groups once you join.
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It will stop the guesswork and give you: ✅ A tried and tested approach (20 years of helping families with baby & toddler sleep) ✅ Evidence-based ✅ Gentle baby sleep methods ✅ Holistic assessment ✅ Nurture & Nourish nutrition program – all recipes have sleep-inducing ingredients and a perfect balance for a good nights sleep ✅ Access to a closed Facebook group for one on one support from Karen and 90+ timecoded Facebook Live videos ✅ Prevention for under 4 months so no need to do sleep training ever ✅ And all at a low $97 for a very limited time
This is not quite a cat in the hat blog or an Agatha Christie mystery but something stopped me in my tracks last week and got me scratching my head! A cute little baby called Kit came into see me last week at my practice nurse/GP job. She had a really bad, red rash, on her forehead. When I touched it, it felt warm and very dry and scaly. Now I know these pictures don’t quite do it justice and I’ve posted them with mums permission. And she is sooooo cute isn’t she?
Now remember in our Southern Hemisphere, of the land of OZ, it’s winter. Get the picture? Feeling warm? No? Well it suddenly hit me! As soon as I realised it was winter I knew exactly what had caused that inflamed dry forehead and no it wasn’t cradle cap – not a scale in sight. It was of course the beautiful pure wool home knit hat! Wool (ust like acrylic) has rough fibres and can trigger eczema in those that are prone to it or have a family history of atopic disease (asthma, eczema or hayfever).
So what did I advise mum to do?
Use a mild steroid such as DermAid, over the counter from the phramacy. It’s 1% hydrocortisone so use sparingly. Apply a pea sized amount over the affected area up to 3 times a day for 2-3 days. In between times use an emollient 4-6 times a day such as sorbolene, aqueous cream, MooGoo or an ointment based product.
Work out which works best on your babies skin. Never let the skin dry out as once it dries out it can crack and then get infected. If it doesn’t improve in a couple of days seek medical advice from your GP. I’m also a fan of Jurlique’s Calendula ointment. I have eczema and whilst this stuff is not cheap its a winner. Like I said find out what works for the skin type.
So does that mean Miss Kit has to abandon her hat wearing? No, mum just needs to try it out with a cotton one underneath or just use plain cotton ones full stop. The same goes for cots and prams. You can still use the wool blanky on top and put a cotton one next to baby’s skin. Another win-win. Mystery solved!!!
Nurture Parenting's Karen Faulkner is a baby sleep and toddler expert who brings calm and sleep into families and gives parents their confidence back.
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