Tips for Keeping a Food Diary – Breastfeeding With CMPA

For some of us our allergy journeys have been fairly straightforward, in that it has been quite simple to confirm which allergens are causing a problem – usually by eliminating and then challenging. Hopefully you have found that by cutting out dairy your baby’s symptoms have completely resolved and you’ve been able to get back to having a happy and healthy little one. For some though it isn’t as straightforward as this unfortunately, and some families will find that their babies are still showing symptoms after making this dietary change. I’ve written a long post about what to do when going dairy free doesn’t work, and after ruling out some simple stuff (ensuring you’ve trialled the exclusion diet for long enough, double checking absolutely everything you’re putting in your mouth) my top tip is to keep a detailed food and reaction diary. Hopefully by doing this for a period of time you’ll be able to find possible patterns and draw up a list of possible suspects or rule things out. After writing that post I was asked for some more tips on actually doing that, how to best record the info and how to analyse it, so I’m going to go into some more detail below.

Keeping a Food Diary – Information to Include

The first thing you need to do is decide how you’re going to record the information. Some people prefer to do something handwritten, some use the notes section of their phone or an app, some may type up some kind of table or spreadsheet on a computer, and some might prefer to purchase a specific notebook designed to keep a food diary. However you choose, you need to make sure there is room to include all of the relevant information.

This is the kind of information you’ll want space to include:

  • Meals – Breakfast, Lunch, Dinner and Snacks including the time you’re eating them. If your baby is weaning you’ll need space for your food, and space for what they’ve eaten too. It helps to include as much detail as you can – remember your baby could be allergic to anything, not just the top 14 main allergens but these are the most likely. You may find using a code for certain ingredients makes this easier and saves space – W for wheat, E for egg, Co for coconut etc. I’d also include whether it was food from a cafe/restaurant, or if you ate a friend or family member’s house. If you’re eating something prepackaged I wouldn’t list every ingredient when you’re just starting out, because this is something you could look up at a later date. For example you could write ‘Tesco Bourbon Biscuits (W)’. I don’t think that including portion size is necessary, but you may want to keep a note if you ate a lot of something that you wouldn’t ordinarily.
  • Drinks
  • Any medication, vitamins or supplements that you/your baby may be taking
  • Symptoms – this will vary slightly depending on what kind of symptoms you are seeing. You may find it useful to record how many dirty nappies your baby is having each day, or a description of the contents (mucous/hard stools/etc) if you’re seeing gastro symptoms. If you’re seeing rashes or eczema you might want to have a space to record how their skin is every day, and I would record any time they vomit, any intense periods of crying, upset or poor sleep/frequent wakes, any noticeable wind and anything else you notice. Loads of these things are totally normal for young babies (to a degree) so not a reason to be extremely concerned in isolation – but if via your diary you notice it happens every time you eat egg/wheat/whatever then that could indicate a problem.
  • Other relevant information – you’ll also want to include if your baby has been unwell in any way – cold, stomach bug, etc, and if they’ve recently had any vaccinations or been on antibiotics or other medication. Also if you suspect they may be teething it’s important to include this, if you’ve slipped up recently or if you recently eliminated something then make a note of this as it could explain some symptoms while it leaves your system.
  • You could also keep a note of which soaps and lotions you are using, if you’ve been around any animals or any change in washing powders etc if you’re concerned that it could be an environmental allergy.

The Food Diary Co

I recently came across The Food Diary Co and their food diary really appealed to me. Designed by Laura as a way for her to help others find their food triggers it’s really nicely designed and easy to use/analyse. I love the style and it would easily slip into your changing or handbag, and each page provides a straightforward way to record your information. The food diary is not designed for a breastfeeding mum, but it is very easy to adapt it to make it work. I think the space for sleep and medicine is helpful, and there is a nice space for extra notes on each page as well as a separate notes section. Each diary has three months worth of pages, and there are also great monthly round up pages to help you analyse the data and find any potential patterns.

If your child is also eating solids things to become a bit more complicated, and if they are eating different things to you then you will need to record this. Depending on how many differences there are you could opt to squeeze it onto one page, possibly by using a code like your initials to record who had what. Alternatively you could opt to use two pages per day, one for your own food diary and one for your little one’s. However you choose to record, be consistent and make sure it will make sense when you are looking back on it a few weeks later.

If you’d like to try out The Food Diary Co food diary you can get 10% off your purchase with code DILAN10

How to Remember to Fill in Your Food Diary

Quite a few mums in my Breastfeeding with CMPA Facebook Support Group expressed that they find it really hard to remember to fill their food diary in, and I can really relate to this. When you’re a busy parent with lots and lots going on it can be really difficult to commit to recording down everything you eat. Here are a few tips on remembering to fill in your food diary:

  • Get started as soon as you can. The best way to create a habit like this is just to start doing it. The longer you keep a food diary the more of a habit it will become, and once it’s ingrained into your routine it will be much easier to keep up with. In the beginning it’s very likely that you will occasionally forget or miss things off and that’s okay – something is better than nothing. Remember that this is a tool that’s going to help us look for patterns, it’s not something that’s going to give you all the answers so if it’s not perfect it should still be useful.
  • Use your phone. I would imagine that most of us have our phones with us for a lot of the day, especially when we are out and about. If you’ve chosen to keep a paper food diary you can still use your phone to record stuff throughout the day, and then transfer it to your food diary when you have time. It’s very easy to forget things if you’re completing your food diary from memory hours later, so making some notes while you eat will help you make sure it’s complete.
  • A great tip from The Food Diary Co is to set alarms on your phone for the times you usually eat, as a reminder to pick up the diary. The more you do this the less you’ll actually need the alarms.
  • Keep it in sight. It’s easy to forget about something that’s tucked away in your bag or a drawer, so keep your food diary somewhere that you will see it daily. You could keep it on the counter, or even stick it to your fridge. If this isn’t practical then how about having a post it note in those places reminding you to go write your meal down. Again as time goes on you’ll be less likely to need these reminders.

Understanding Your Food Diary

Completing a food diary consistently is one thing, but being able to effectively interpret this data is a whole other ball game. As with so many things allergy related, it isn’t easy. A few points to remember:

  • A non IgE reaction can take place within 72 hours of exposure. No one really knows how long allergens can take to reach your breast milk and it is affected by a lot of variables, but we can estimate about 4-6 hours to give you some kind of guide. This means you could be looking for something you ate between around 6 hours before the symptom, and three days.
  • IgE reactions are generally instant or within a few hours of exposure. If you’re seeing something like hives then I would be considering things they were in contact with at the exact moment the hives occurred.
  • Because of the huge time period you could be looking at, you really need to focus on looking for patterns rather than looking at one incident. If over the period of two weeks there have been three days of mucous nappies and wind then look at the three days previous for each of these periods. Maybe on all three of those occasions you’ve eaten egg the day before. Hopefully this will allow you to begin to narrow down what it may be.

What Next?

Keep a shortlist of possibles and choose one to trial eliminate. Treat each challenge the same way you would dairy – eliminate it for a period of time and then challenge with a large portion of the allergen. You probably won’t need to eliminate for 6 weeks for most allergens but give it a reasonable time period like 2-4. Ideally you’ll see those remaining symptoms disappear, then return once you challenge, and hurrah you will have found the missing allergy!

If you see no change after eliminating the allergen, and no increase in symptoms when you challenge you can cross this one off the shortlist, and move on to trialling the next.

It’s not an exact science, it’s hard and inevitably will be made harder by things like teething/bugs/colds and loads of other things. There really is no way to know for sure that something is teething or a reaction, except by looking for patterns and confirming/ruling out everything you suspect. Keeping the food diary is the time consuming bit, so make a start straight away if you’re struggling to get reaction free. Once you’ve got a few weeks of data feel free to reach out to us in the Facebook group and get a fresh eyes on it to find any patterns/problem areas.

Hopefully this has given you some tips and helpful guidance on what you should be including in your food diary, but if you have any more questions feel free to get in touch on social media or leave a comment below and I will do my best! Many thanks to Laura at The Food Diary Co for sending me a food dairy to take a look at!

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