By Mary Bibb, BA, IBCLC
Occasionally a breastfed baby will have little streaks of blood in the stool. This is often caused by a tiny tear in the inside skin of the anus called an anal fissure. Sometimes the bleeding is from an irritated intestine (colitis). Colitis can cause mucous and blood in the mucousy and bloody stools. The most common cause of colitis in young babies is allergy. Giving the baby ONLY breastmilk and nothing else for 6 months is the best way to reduce the risk of colitis. If your baby is bleeding rectally for any reason, it is important to have the baby examined by a physician. Colitis can be caused by viral and bacterial infections. Rarely, rectal bleeding can indicate a more serious health problem.
Occasionally, babies will react to food proteins from their mother’s milk react to something that their mothers have eaten. If an exclusively breastfed baby gets colitis, the best thing to do is for the mother to stop drinking cow milk, and eating cheese, yogurt, and anything made with cows’ milk, whey, or casein. In one study, some breastfed babies with streaks of blood in the stool all got better when the mother eliminated eggs and cow milk products from her diet and continued to breastfeed. (Kumagai). Cow’s milk protein allergy has been linked with colitis in some infants. However, new research suggests that cow milk allergy is less common than previously believed. Trial removal of dairy products for 2-3 weeks to see if symptoms improve should be followed by a cow milk challenge (where dairy is re-introduced into the mother's diet). This should be medically supervised and will tell whether improvements have occurred because of the elimination diet. Putting mothers on food eliminations diets is stressful and should be avoided unless clearly required.
The most common allergy-causing foods are cow’s milk, eggs, wheat, and peanuts. Elimination diets can help mothers of allergic babies continue breastfeeding. If you decide to wean to formula, it would be wise to pump frequently for 3-4 weeks so you have the option of resuming breastfeeding if baby's colic worsens. It can take this long for a formula allergy to become apparent.
Tests showed these babies had signs of allergic reactions in their intestines. In the United States, the three most common foods that babies may be allergic to are cows’ milk, soy, and egg whites. Soy and cows’ milk are commonly used in infant formula.
Mother’s milk helps to heal colitis in most cases. Human milk has been used to help babies with damaged intestines heal faster. Breastfeeding also reduces babies’ chance of getting colitis later in life, an important health benefit bonus .
Occasionally, non-allergic babies can have mucous in the stools. This is not a harmful condition. Letting the baby finish the first breast before switching helps baby get more of the fat from the “hind milk.” This coats the infant gut, helping the irritated intestine heal. A professional lactation consultant, along with your doctor, can help you with any breastfeeding and food-related issues so that your baby thrives on your milk.
There is a registry of IBCLC’s at http://www.ilca.org/i4a/pages/index.cfm?pageid=3432
The baby’s overall health is the best way to tell if colitis is serious or not. If baby is gaining well and is happy, the colitis is usually very mild. If a baby with colitis is not gaining weight and is unhappy, talk to your doctor. Rarely, a breastfed baby with colitis has a severe case, and needs to have a special formula for a short period of time. Mom should express her milk with a hospital grade pump to keep her milk supply, because some babies with colitis cannot tolerate even the least allergenic formula. Many babies are able to go back to breastfeeding after a short time (1-2 weeks) on hypoallergenic formula. The best way to prevent colitis is to breastfeed exclusively for 6 months, without cows’ milk or cows’-milk-based supplements.
Barbara Wilson-Clay BSEd, IBCLC
Arvola T. et al. Rectal Bleeding in Infancy: Clinical, Allergological,and Microbiological Examination, Pediatrics 2006; 117(4):e760-768.
Brink S. The successful use of human breast milk in a premature
infant with the surgical short gut syndrome. Am J Dis Child. 1977 Apr;131(4):471.
Corrao G, Tragnone A, Caprilli R, Trallori G, Papi C, Andreoli A, Di Paolo M, Riegler G, Rigo GP, Ferrau O, Mansi C, Ingrosso M, Valpiani D. Risk of inflammatory bowel disease attributable to smoking, oral contraception and breastfeeding in Italy: a nationwide case-control study. Cooperative Investigators of the Italian Group for the Study of the Colon and the Rectum (GISC). Int J Epidemiol. 1998 Jun;27(3):397-404.
Giacoia GP, Williams GP. Rectal bleeding due to nonspecific colitis in premature infants. South Med J. 1995 Jul;88(7):789-91.
Grazioso CF, Werner AL, Alling DW, Bishop PR, Buescher ES. Anti-inflammatory effects of human milk on chemically induced colitis in rats. Pediatr Res. 1997 Nov;42(5):639-43.
Kumagai H, Masuda T, Maisawa S, Chida S. Apoptotic epithelial cells in biopsy specimens from infants with streaked rectal bleeding. J Pediatr Gastroenterol Nutr. 2001 Apr;32(4):428-33.
Lake AM, Whitington PF, Hamilton SR. Dietary protein-induced colitis in breast-fed infants. J Pediatr. 1982 Dec;101(6):906-10.
Lentze MJ. Food allergies. Ther Umsch. 1989 Sep;46(9):645-53.
Strauss RS, Koniaris S. Allergic colitis in two infants fed with an amino acid formula. J Pediatr Gastroenterol Nutr. 1998 Sep;27(3):362-365.
Vonlanthen M, Lactose Intolerance, Diarrhea and Allergy Breastfeeding Abstracts 1998 Feb; 18(2):11-12.