As a nutritional biochemist, I am always interested in how we can support diet quality and food security, especially for low-income populations. Interestingly, a recent study published in the Journal of Human Lactation looked at 1,226 WIC participants found that breastfeeding duration was associated with improved diet quality for the toddler at 36 months of age. The study was a secondary analysis set up to look at within-individual associations over time. This means that rather than having any type of intervention, the researchers retrospectively analyzed data that was collected for a different study.

In order to measure the diet quality of the toddlers, the study used the USDA’s Healthy Eating Index. After conducting the phone interviews to determine the diet quality, the researchers looked back at duration of breastfeeding and found that the longer the dyad breastfed for the better the diet quality. It is important to point out that these families had nutritional support through their WIC benefits – so this speaks to the WIC program’s ability to support healthy diets for children as well.

This is not the first study to investigate the impact of breastfeeding on diet quality and similar results were found in an Australian study looking at toddler diet quality. This study found that in addition to breastfeeding status, maternal modeling of healthy eating behaviors also impacted the toddler’s diet quality.

Some studies have also looked at the interaction between breastfeeding cessation and toddler diet quality. Another study that was done in Australia found that both early breastfeeding cessation and early introduction of solids was associated with preference for energy-dense, low nutrient foods.

While we certainly don’t have a complete understanding of how children develop food preferences, we do have evidence-based recommendations that encourage children to have a healthy variety of foods in their diet:

1. Exposure: make sure your children see a variety of colors, textures, and cooking styles represented in their age-appropriate foods. Encourage your kids to put foods on their plates even if they don’t want to eat them.

2. Access: make it easy for your toddlers to access healthy foods. This can mean having appropriately sized fruits, veggies, cheese, meats, and whole grains available where they can reach them.

3. Modeling: let them see people they look up to (parents, friends, babysitters, relatives, etc.) eating foods that they may be hesitant to try.

Looking for more information about nutrition during lactation? Download my two page quick guide!

As a nutritional biochemist by training, I absolutely love when my love of nutrition collides with my love of breastfeeding. For this reason, I was so excited when I found this study that looked at maternal consumption of a low FODMAP (fermentable oligo-, di- and mono-saccharides and polyols) diet on associated infant colic symptoms.

What is a low FODMAP diet?

A low FODMAP diet aims to reduce or eliminate gas-producing foods from the diet. This reduction in gas production may help individuals who suffer from diarrhea, digestive disorders, abdominal pain, or bloating. “Gas-producing foods” are foods that contain high proportions of indigestible or poorly digested short chain carbohydrates and sugar alcohols. When foods are poorly digested, they become food for the bacteria living in your gut. When bacteria digest these carbohydrates (e.g. undergo fermentation) gas is a byproduct. Some foods that would fall into the FODMAP category include beans, lentils, wheat, and dairy.

What does this have to do with infant colic?

Colic is defined as crying for more than 3 hours per day, for 3 or more days of the week, over a span of at least 3 weeks and may show signs of gassiness. Much of the evidence that we currently have around infant colic is focused on formula fed infants. In these studies, dietary changes are made to attempt to help with colic. In an exclusively breastfed baby, infant diet (human milk) would be influenced by maternal diet. We don’t have good science looking at maternal diet changes and the associated effect on infant colic symptoms.

How did the study work?

Mothers of infants confirmed to have colic were enrolled in the study. Prior to dietary change, a milk sample and an infant fecal sample were collected. Mothers were then put on a low FODMAP diet for 7 days, and during day 5, 6, and 7, infants were reassessed for colic symptoms. On day 7 new milk and fecal samples were taken.

What did the authors find?

The trial provided a 5g/day FODMAP diet and participants in the study consumed on average 30 grams of FODMAP foods per day.

No change was found in in fecal pH or lactose content of analyzed maternal milk samples was reported.

The study did report a significant reduction in measured crying duration, crying episodes, fussing duration, combined crying-fussing times, feeding duration, and feeding episodes and a significant increase in awake-and-content duration.

What did the moms have to say?

Baby is much more content

Baby can be put down without crying

Baby’s cries are no longer pain-sounding screams

Can now read baby’s tired signs

Applying this to practice

Anecdotally, we have seen many mothers practice elimination diets and see relief in their infant’s gastrointestinal discomfort. Dairy has long been made the culprit of all infant gastro discomfort. This study shows that is may be more complex than “eliminate dairy”.

For mothers of infants with confirmed colic, a low FODMAP diet may translate to decreased infant colic symptoms.

Looking to learn more about nutrition during lactation? Download my 2 page quick guide!

This past weekend I had the absolute honor of speaking at the Ohio Lactation Consultant Association’s annual conference: Breastfest! The experience was extremely humbling, and in addition to speaking, I got to learn from from amazing practitioners and researchers from across the country.

The conference started strong, and the first session that I attended was given by Robin Glass, author of Feeding and Swallowing Disorders in Infancy: Assessment and Management. Robin works as an OT/IBCLC at Seattle Children’s. Some new things I learned during this presentation:

• You can utilize the infant’s palmomental reflex to encourage a wide open mouth by pushing on the middle of their palm
• If you are working with an infant that has low-tone in their tongue, you can tap along the midline from the front to the back of the tongue only as far as you can see from outside the mouth
• Pulling the tongue back/up can be a compensatory strategy for weakness in the neck (when the baby pushes up with their tongue it stabilizes the neck and can help with breathing)
• When baby benefits from bilateral cheek support, you can use kinesiotaping to facilitate cheek stability

Another interesting session that I attended was given by Joni Gray, speaking on the Appalachian/American Cultural Power Code of Formula. This session was intriguing to me, as I went to school in the heart of Appalachia at West Virginia Wesleyan College. I learned quite a bit from this session. I learned that a power code is a behavior that you can engage in that makes you part of a community, and indirectly, gives you power. The context Gray put this in for breastfeeding is that in Appalachia, formula is the majority “power code” – and by choosing to breastfeed you are leaving this community for a smaller sub-community with less power. Gray’s interactive activity was the most interesting part, where we reflected on this Similac commercial:

Think about these things after you watch:

• What is the message of this commercial (overlying and underlying)?
• Does this commercial support the dominant culture of formula feeding?
• How is this commercial portraying breastfeeding moms?
• Do you feel this commercial is contributing to a cultural shift in perceptions of breastfeeding?

The last thing I am going to summarize was my experience learning from Dr. Bobby Ghaheri. The sessions led by him were extremely informative, as he specializes in infant and child tongue tie diagnosis and reversal at The Oregon Clinic. While I cannot summarize everything I learned from him here, I do have an excellent blog post he wrote & you can read it here. Tidbits I learned from Dr. Ghaheri include:

• Always assess for ties with the baby in your lap legs facing away from you and coming from above the infant
• If you are palpating below the tongue [looking for tongue tie] and there is muscle push back, you cannot be sure it is a tongue tie – you need to resolve the muscle tightness before you can determine if a tongue tie is restricting motion
• Lip tie can be recognized with blanching of lip when pulling back, nodule on the bone beneath where the lip is tied to the gums
• Anterior tongue tie is almost always hiding a posterior tongue tie

I want to wrap up this post by taking the time to thank the OLCA Breastfest Planning Committee for such an organized, professional, and intellectually stimulating weekend.