Food sensitivities or food (chemical) intolerances are quite different mechanistically to a true food allergy. Lactose intolerance (enzyme deficiency) and carbohydrate malabsorption (i.e. fructose) are other types of food intolerances but are not discussed in this article. Although there are different types of food intolerances, this article focuses on what’s known as a pharmacologic reaction which can cause symptoms by irritating nerve endings in different areas of the body. Unlike food allergy these food intolerances do not involve the immune system and there is a dose and cumulative effect which may not be obvious until 2-24 hours later. Reactions or symptoms can be unpleasant but are rarely serious or life threatening. The reasons why a baby has food sensitivities vary, but can include genetics and being born with a sensitive constitution as well being more vulnerable to strong flavours and chemicals due to an immature gastrointestinal and nervous system. Babies can also react to these food chemicals through the mother’s breast milk and when they start solids it is a double dose of potential triggers. Reactions can become obvious when they are first given liquid Panadol, teething gels or antibiotics as these products are highly flavoured, coloured and often preserved.

What are these food chemicals and where are they found?

Potential food triggers include naturally derived food chemicals found in everyday foods such as salicylates, amines and natural glutamates. Foods that have lots of flavour are the likely culprits. But really sensitive babies can also react to foods such as carrots and apples. There are also some known food additives such as artificial colours, sulphites and MSG that can cause issues as well as whole food groups such as dairy (not just lactose), soy and wheat/gluten. Three common food chemical intolerances include: Salicylates – berries, avocado, honey, citrus, tomato, vegemite, herbs, stone fruit, juices Amines – tuna, pork, vegemite, hard cheeses, avocado, bacon, chocolate, tomato Glutamates – mushrooms, soy sauce, tomato, Vegemite, aged cheeses, grapes It is important to note that it is common to react to more than one chemical and that these chemicals can also be found in toiletries, medications, cleaning products and supplements. Small amounts might be OK but larger doses and more variety in the diet as your baby gets older might be an issue.

What are some of the common symptoms of Food Intolerance in babies

- Wind/Pain/Colic

- Reflux

- Colitis/Mucus in stool

- Eczema/Rashes

- Unsettledness/Irritability

- Poor sleep or sleep disturbances

- Constipation/Diarrhoea

- Vomiting

- Faltering Growth (Failure to Thrive)

- Fussiness/Picky eater/Food refusal

- Refusal to breast feed or pulling off

- Nappy rash

How is a food intolerance diagnosed?

If you suspect a food intolerance you may wish to speak to your Health Professional first to rule out other causes of your baby’s symptoms such as poor milk supply if breastfed, lactose intolerance or reflux. They will then take a detailed history to help identify possible causes, triggers and reasons for symptoms. There is no scientifically proven laboratory test for a food intolerance. It is diagnosed based on a supervised diagnostic elimination diet for 2-6 weeks which may also include the breastfed mother, then formal challenges or introduction of separate food chemicals to see which ones elicit a reaction. Some babies may be started on very low chemical plain solids like potato, rice cereal and pear if food intolerances are suspected from symptoms described earlier. Your Health Professional will work with you on introducing appropriate foods as tolerated. There are many unorthodox food intolerance tests around so for further information see: https://www.allergy.org.au/patients/allergy-testing/unorthodox-testing-and-treatment The diagnostic elimination diet should be supervised by an experienced Accredited Practicing Dietitian (APD) to ensure growth and nutritional adequacy of the diet is not compromised. To find an APD, see https://dietitiansaustralia.org.au/find-an-apd/. When making an appointment make sure you check if they have experience in food chemical intolerances especially in growing children.

Long Term Management

Babies with food intolerances often improve with growth and maturity. It is important to work with your Health Professional and slowly liberalize their diet as tolerated.

Further Information

https://www.slhd.nsw.gov.au/rpa/allergy/ https://www.allergy.org.au/patients/food-other-adverse-reactions/food-intolerance https://paediatrix.com.au/ https://bluemountainsdietitian.weebly.com/