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Q&A about cow's milk protein allergy with registered dietitian Sasha Watkins - ANSWERS BACK(45 Posts)
We're running a Q&A this week about cow's milk protein allergy (CMA) with registered dietitian and food coach, Sasha Watkins. Sasha is a media spokesperson for the British Dietetic Association (BDA) and on the BDA Communications and Marketing Board. She was recently awarded the BDA Roll of Honour (2011) and is registered with the Health Professions Council, Dietitians in Obesity Management (DOMUK) and the Freelance Dietitians Group. Post your questions about CMA to Sasha before Thursday 3rd October and we'll upload her expert answers to this thread on 10th October.
Did you know, CMA is the most common allergy that develops in babies? If a child has a milk allergy, their immune system mistakes the proteins in cow’s milk to be a threat. It then releases certain chemicals, which trigger the signs and symptoms of an allergic reaction which are most commonly colicky abdominal pain, eczema, vomiting and diarrhoea. This means it is easily mistaken for other common conditions such as colic and baby eczema. Parents of babies with undiagnosed CMA are left confused, frustrated, tired and worried, whilst they try to find the cause for their babies constant crying and discomfort.
A new survey was recently carried out online with 2,026 mothers as part of a new campaign: Is it Cow’s Milk Allergy? The campaign is designed to provide parents with online resources with a dedicated website, www.isitcowsmilkallergy.co.uk, which helps them to assess whether symptoms displayed could be CMA and collect the right information for an informed and productive discussion with their GP speeding up the diagnosis process.
My ds is 11 months and has CMPA which was not diagnosed till he was 6 months although I knew he had something wrong from day 2 of birth. His behaviour, comfort levels and eczema cleared up within a couple of days of being put on nutramigen AA formula. However his bowel problems have not. He has trouble passing solids and and is costantly on movicol(think that's how you spell it).
Do you think this is linked to his allergy or could he have a different problem? I do not want him to end up with a lazy bowel later in life due to prolonged use of such products as the doctor is not much help.
Thanks in advance
I am pleased that your son has found some relief by changing to a hypoallergenic formula. Unfortunately it is difficult for me to give any advice on gastrointestinal problems without seeing your son in person. I would suggest you book an appointment with your GP or paediatrician for a proper clinical assessment of the problem and hopefully they can help you resolve the problem.
Hello. My son was diagnosed with a cows milk allergy and since I stopped breast feeding he's been enjoying Nutramigen. Our GP suggested I tried to introduce a small amount into his diet which I did but it noticeably upset his tummy. Since then the HV and GP have suggested trying again every 6 months. I would welcome your suggestion on how best to re-introduce it into his diet and at what rate.
Most children with cow's milk allergy do outgrow it by the age of five years so your GP is absolutely right that you do need to do a trial reintroduction to see if your son has developed tolerance. Guidelines advise a reintroduction trial after a cow's milk free diet until 9-12 months of age or after at least 6 months without cow's milk.
To do a milk challenge safely at home, it is important that your doctor first gives the 'go ahead' and your child does not have eczema at the time of reintroduction nor a history of acute allergic symptoms.
If your child does have eczema or has had an acute allergic reaction at any point, then a supervised challenge may be needed in hospital.
Generally we advise a gradual introduction of milk following a 'milk ladder' where milk is introduced in a baked form and if this is tolerated, less cooked forms are trialled. This is based on the observation that many children with cow's milk allergy may tolerate food containing baked milk before less cooked forms as heating changes the shape of milk proteins and may reduce allergenicity. If your child can tolerate baked milk and you can include it in his diet, this may also help him grow out of his cow's milk allergy.
An allergy dietitian can give you more advice about milk challenges, which foods to start with and how much. Each child is different so the dietitian will be able to assess where your child would need to start in the ladder and at what rate reintroduction should take place.
Hi, this is very timely for me as I have been thinking about this and wondering whether to post on MN! DS is 4 1/2 months old and EBF. We have self-diagnosed a fairly mild dairy intolerance - the only symptoms were being very unsettled at night, drawing knees up and grunting in pain. I have cut out al dairy and seen these symptoms disappear. I'm starting to think about solids and am wondering if he should not be given dairy to eat? Also I'm thinking about introducing a bottle of formula every day once he has started on solids, but is it likely that formula will cause problems too? Thank you!
Some of the symptoms you mention could indicate cow’s milk allergy but it is really important that you do get a firm diagnosis from your GP. He/she will be able to assess your child's allergy and rule out any other possible problems. Dairy is an important part of an infant's diet so it is important that you get the right advice to make sure your son is not avoiding it unnecessarily. Your doctor will also be able to advise you on suitable hypoallergenic formulas as there is a wide range of different products available in the UK.
A dietitian will be able to look at your son's growth and diet and ensure it is nutritionally balanced, if he does need to remove cow's milk from his diet. A GP can also give you advice around weaning. If you have removed dairy from your diet, please make sure you are getting enough calcium and vitamin D from other food sources.
My dd was diagnosed at 8 weeks and is now nearly 6. Her symptoms have eased to a point where she will get a stomach upset on day 2 and her general behaviour is tolerable (it used to give her severe adhd like symptoms). Is it possible that she could grow out of it still, as we were told 5 is the cut off age?
Do you know of many children where it induces behavioural issues? I know 2 others, but most people think we make it up until they witness the transformation in our children?
There is research to show that some children may still grow out of their milk allergy as teenagers but it does become less likely as they get older.
It is important to do a milk challenge every now and then to see if your child has developed tolerance. You may want to see an allergy dietitian and see which forms of milk your daughter can tolerate. Studies have found that if your child can tolerate baked milk and you can regularly include it in her diet, this may also help her grow out of cow's milk allergy. Your doctor should be able to give you a referral to an allergy dietitian near you.
Unfortunately I have not come across children that have developed ADHD as a result of a cow's milk allergy so I would definitely advise you speak to your doctor about that.
Hi. My son was diagnosed with suspected CMA at 8 weeks (being breastfed) due to lack of sleep, unable to lie flat, constant vomiting, constant wind, 8-10 runny poos per day, cradle cap covering whole head, hives on face and chest, congestion after feeding - think that was it!
I went dairy free then after 10 weeks we moved onto Neocate as although there were improvement, some symptoms (poos and eczema on face) seemed to be getting worse again. Since going on Neocate the poos are still liquid (though only 1 a day) and the eczema is worse than ever.
We had first skin prick tests last week (age 6 months) and it confirmed allergy to egg, peanut and cat fur, BUT cow's milk didn't react. We've been told to still avoid dairy because they believe that his allergy is what they called a "delayed onset" allergy so can happen several hours after ingestion rather than on immediate contact. (Soya also came up negative so she said to go ahead and give him soya - I said but the lack of reaction to soya could be a "delayed onset" allergy and she agreed but didn't really give further advice about whether I should then also avoid soya).
Is this correct? I'm really concerned that we are avoiding a major food group based on circumstantial evidence only - all the symptoms that have cleared (mainly temperament-based) could be put down to him just maturing as a baby. The consultant said that she was confident in her diagnosis because we had taken him off his reflux meds and he wasn't vomiting, but again that could just be him maturing as a baby and growing out of the reflux.
We've been given an appointment for another test in May when my son will be 13.5 months - but what will they do if it comes back negative again? Still say the diagnosis is right and make us wait until he is 2?
Isn't there any kind of definitive test that can be done to rule in/out CMA? Or shouldn't they be getting us to try dairy in some form to gauge his reaction? I don't want him to become ill, but at the same time I don't want him missing out on important foods for potentially no reason.
There are two forms of cow's milk allergy (CMA) reactions: acute onset (also called IgE mediated) and delayed onset (non-IgE mediated). Your child may have either of these or even a mix of the two. Your doctor is right as unfortunately skin prick tests and blood tests can only help with the diagnosis of acute onset CMA and even then, they are not 100% reliable. There are no validated, definitive tests for delayed onset CMA other than the complete avoidance of milk followed by a milk challenge.
In your son's case, it sounds like he has multiple allergies so a food challenge should only be under the supervision of your doctor in a hospital setting. 25-60% of infants with non-IgE mediated CMA (delayed onset) also react to soya so this may explain why they advised you to avoid soya. Please speak to your doctor about doing a food challenge if you want to ensure he is not unnecessarily avoiding milk or soya. Your doctor would not want him to follow a restricted diet either if it were not completely necessary.
Hi there. I have a question about getting a correct diagnosis and formulas.
My baby boy struggled from a few weeks with colicky symptoms, back arching and wind. He seemed upset and in pain after normal first milk (aptamil) He was started on lactose free formula by the GP, against my better judgement, as I don't think this is primary lactose intolerance as he has been gaining weight well, and my understanding is that this is a RARE diagnosis. He had no skin reactions or other stuff to suggest CMPI other than the symptoms above. Anyway, oddly, he was a lot better and has thrived and gained weight on lactose free formula. I tried him back on 1-2 bottles a day of aptamil, but this caused a recurrence of the wind and colic at 15 weeks. He is now 17 weeks and I am starting weaning in the next month and I have a few worries.
1) I am concerned about him staying on LF formula in case he doesn't develop his ability to digest lactose properly. Should he be moved over to the extensively hydrolysed formulas used for CMPI or should I push for a paediatric/dietetic appointment to see if he has been misdiagnosed, and should simply be switched back to normal milk.
2)What about weaning and introducing dairy? How fast can I do this or should I seek specialist advice first?
Please do go back to your doctor or paediatrician to confirm if it is lactose intolerance or cow's milk allergy as the management of these two conditions does vary. Your doctor will then be able to guide you on the best formula for your son's condition and age. Once diagnosis has been confirmed, your doctor or an allergy dietitian can provide advice on milk reintroduction and weaning.
My lo has been put on neocate for suspected cmpi as he has severe reflux. His ranitidine seems to not be working anymore or at least not effectively, despite increased dose as he is in pain when feeding again. This week I'm struggling to feed baby (he is 16 weeks) as he is in pain, often not feeding for 9 hours, or just taking a couple of oz, but then will suddenly neck 6oz in the evening.
When he does eat it he appears to be very sick.
My questions are these:
Could it be the thin consistency of the milk increasing his sickness, and if so what can I do?
His eczema and facial baby acne have cleared up within 2 days - does this confirm cmpi?
Should his reflux improve on this milk and if so how long until I should see an improvement?
Also thinkingif starting weaning next week to help his weight. Would you consider this a good idea if he isn't thriving, even though its only at 4 months?
Please go back to your doctor if your little one is still in pain, being sick and not thriving. We would expect to see some improvement in symptoms such as reflux within 2-4 weeks of starting a hypoallergenic formula but please do not hesitate to go back to your doctor if you have any concerns.
Current UK guidelines do not advise weaning before 6 months but your doctor can also advise you on weaning in light of your child's specific concerns.
My ds1 is almost 13yo and I have yet to meet a hcp who knows anything about cows milk allergy (apart from blood testing to diagnose - eventually after being dreadfully ill at 21mo)
We have a ds2 who is cmpi (not allergic) now 10yo. All Paeds, dietitians, nurses, hv's we have met, tell me "just carry on what you're doing"
I would love to find someone who can tell me how to make sure my boys have a good enough intake of calcium through their teens. ds1 quite strangely seems to react badly to anything cow related including beef and even beef gelatin; since we cut out everything bovine 14 months ago he has been much better. Pointers would be very gratefully received. They are fine with soya products.
Sorry it has been a rocky road to diagnosis. It sounds like your son may have an allergy to cow's milk as well as an allergy to beef. Allergies to red meat, whilst rare, do exist and it may be helpful to see your doctor and get a skin prick test to aid diagnosis. Has your son ever been bitten by a tick? It is thought that exposure to ticks may cause an allergy to red meat.
An allergy dietitian can offer advice on how to completely avoid beef and suggest suitable substitutions. A dietitian can also fully assess your boys' diets to see if they are nutritionally balanced and will be able to suggest any dietary changes if not. They should be able to give you some meal suggestions to ensure your boys grow up to be happy and healthy men.
My daughter (18 months) is still breastfed morning and evening. Until now, when I am not around she has been having formula milk. However, as she is now old enough, last time I wasn't here in the evening hubby gave her ordinary full fat cows milk instead of formula.
The next morning she was sick. We thought it was a tummy bug at first but there was only one big bit of sickness and no-one else became unwell in the family.
It has made us wonder whether it could be a reaction to the cows milk. She does have cows milk at other times (e.g. as a drink during the day and with cereal etc) without any problems - but our theory is that perhaps it did affect her when it was instead of breast milk as she had nothing else in her stomach first so was affected immediately by the cows milk.
Your opinion / advice would be appreciated as we have gone out and bought more formula to avoid the risk of it happening again.
thanks so much. x
There is cow's milk in normal infant formula, which it sounds like she has no problems with. It also seems that she can tolerate cow's milk at other times so it is highly unlikely she has an allergy to cow's milk. It may have been a tummy bug but please do go see your doctor if the problem persists or if you have any other concerns about your daughter's health.
My DS has been put on dairy free diet for suspected CMPI. How soon should I notice a difference, if the diagnosis is correct? Thank you
We would generally expect to see an improvement within 2-4 weeks of completely avoiding cow's milk. For the best assessment of whether cow's milk is a problem, it needs to be a complete avoidance (even small traces of milk may be causing a problem) so please be vigilant reading food labels or get advice from a dietitian if you are unsure of which foods to avoid.
Hello. My son was diagnosed with cows milk allergy following a hospital stay for bronchiolitis. That was 5 years ago and we have raised a healthy tall young man on a dairy free diet thus far. I've followed an elimination diet, and we know when he has been 'buttered' But despite our vigilence he complains about tummy aches and some meats give him bad wind. Can you also be intolerant or allergic to sulphates? How do I figure out what else his tummy doesn't like without eliminating all meat? GP has prescribed antacids and IBS medication to treat the tummy aches with little success. I don't know if the tummy aches are to do with anxiety, and at the moment we're just trying to jolly him along to get through the school day. Where do I go next?
That is great news that you have been able to follow the elimination diet and your son is doing well avoiding dairy. Yes, it is possible to have an allergy to sulphites. They are routinely added as preservatives to some foods such as soft drinks, sausages, burgers, dried fruit and vegetables. Sulphites are not used in all meat products so does your son react specifically to processed meats such as sausages and burgers or is it other types of meat that are causing a problem? Some sausages may also contain cow's milk.
Is it possible he may have developed an allergy to something else? Since the antacids and IBS medication are not helping, it would be a good idea to go back to you GP or get a referral to see a gastroenterologist that has some allergy experience. They should be able to determine what else may be going on.
Hello there, Sasha! This is a question re a friend's 18mo daughter. She's always had really bad colic and wind, which wasn't helped by her tongue tie. Still lots of broken nights and discomfort.
Now her mum's taken her to a kinesiologist who reckons her daughter's got a candida infection in her digestive tract.
The k. recommends a 6-week dairy-, yeast- and sugar-free diet, and also no oils or gravy. Her mum's in two minds about it: reckons the elimination of certain things may help, but worried about lack of nutrients / taste.
Is this something that sounds sensible (or odd) to you? Is there such a thing as a candida infection of the digestive system? Or what else could explain all that wind and pain? Many thanks for any advice!
Sorry to hear about your friend's little girl and the difficult time she is having. Yes, candida infections do exist but it sounds like she may possibly have cow's milk allergy (colic and wind are two symptoms) but it is impossible to make a diagnosis without more information about her symptoms, family history and her diet. Wind and pain are symptoms associated with several other conditions. Please encourage your friend to take her daughter to a GP so she can get to the bottom of what is going on and get a firm diagnosis. I would also be worried about such a strict elimination diet for a child if it was not absolutely necessary.
My dd has just turned 2 and was been diagnosed with cmp allergy at 6 months. She has been drinking alpro junior 1+ soya milk for the last year. The normal sweetened soya milk states it is suitable as a main drink from 2 years. It is lower in calories and doesn't seem to have any iron added.
Is it ok to swap her to this as I'm having problems getting the alpro junior. She eats well and is on the 50th centile so no concerns with her calorie intake. I'm just not sure she'd be getting enough iron.
I am pleased that your daughter is growing well despite her allergy and having to avoid cow's milk. It is difficult to say whether your daughter is at risk of low iron levels without analysing her full diet. Please get a referral from your GP to see a dietitian. She will then be able to take a full diet history and assess whether your daughter's diet is nutritionally balanced.
My dd (7.5 mo) is cow milk protein and soy intolerant and I've cut it out of my diet for the last 4m as I've been BF. Now she's weaning I'm concerned about getting enough fat and fat soluble vitamins into her as I've noticed I've lots a lot of weight going dairy free. She's just below the 9th percentile and is tracking it well so far but I'm concerned as she takes less BM she'll start to drop weight.
Can I add extra olive oil/Marg to her diet to increase the fat or is it not great for her arteries? Are there any particular foods I should try to get into her?
Also my dietician didn't seem to be concerned about calcium intake for her (she put me on a Ca supplement though) but as my dd starts to drop milk feeds should she also have a supplement? I try to get green veg/ tahini etc into her but is that enough?
Thanks in advance!
As you approach weaning it would be useful to get some more nutritional input. Please get a follow up appointment with your dietitian. She should be able to take you through the weaning process and recommend key foods to introduce to ensure that your daughter is getting all the nutrients she needs. I would not add more fat into her diet without getting a full dietary assessment by your dietitian.
Are you giving her any vitamin supplements? The Department for Health now advises that all children aged six months to five years should take vitamin drops containing vitamin D. Please speak to a pharmacist to get advice on which vitamin drops you should be giving your daughter. You may qualify for free vitamins from the Healthy Start scheme. Here is a link for more information: www.healthystart.nhs.uk
Hello, my BF daughter is 8 months old and we have suspected food intolerance since starting weaning - we've seen the GP and he agrees that her symptoms and food diary suggest a CMA. We've been referred to the paediatricians and dietician and are awaiting appointments. In the meantime I would like to remove cow's milk from my diet to see if I can provide DD with some relief from the dry skin and abdominal pain she's had all her life, but I'm feeling at a loss as to where to start. What type(s) of milk/cheese etc should I use instead in my cooking?
That is great that you have been referred and I can completely understand that you may want to start eliminating cow's milk from your diet if that can help your daughter's symptoms. Unfortunately it is quite difficult for me to list all the foods you should avoid and suggest suitable alternatives on this forum. I am also wary about advising any elimination diets without the proper medical advice, especially when you have not got a firm diagnosis of cow's milk allergy. It would be best if you can wait until you see the dietitian and paediatrician.
If you are concerned that the appointments are too far away, please go back to your GP and explain the situation. You may also be able to call the paediatrician or dietetic department and get on the waiting list for an earlier appointment.
My son is CMPI (diagnosed at 6 months after months of projectile vomiting and tube feeding) as well as soya intolerant. He is now 3 and we don't really know how to reintroduce foods. We tried a soya yogurt about 1 year ago and he woke up in pain 5x that night, was wheezing by morning and covered in a rash by day 2. We tried a dairy yogurt 6 months ago and he had a very smelly nappy followed by mad behaviour (happy but shouting, throwing, kicking etc).
1) When should we try introduction again? What and how much?
2) Should I worry about his calcium/vit D levels? They were within normal levels in a blood test 12 months ago and he has enriched oat milk on cereal and as a night-time drink.
It sounds as if your son has had some acute reactions to soya. Considering the symptoms you have described I would recommend that you do not do any more reintroductions at home until you have seen your doctor. Your GP may want to do some further tests to assess possible tolerance and may consider doing a supervised reintroduction of milk or soya in a hospital setting.
Your doctor will also be able to advise on your son's calcium and vitamin D levels. The Department for Health now advises that all children aged six months to five years should take vitamin drops containing vitamin D. You may qualify for free vitamins from the Healthy Start scheme. Here is a link for more information: www.healthystart.nhs.uk
My son was diagnosed as allergic to cow's milk when he had an anaphylactic reaction to a jar of rice pudding on weaning.
He's been dairy free since, and is now 12 years old.
He hasn't had a reaction for a couple of years, but we're unsure how to reintroduce dairy, as he's never had a chance to develop a tolerance, and will probably dislike the taste anyway by now.
How do I get him to a level of tolerance where he won't suffer from eating food with traces of milk, or food that contains stealth dairy (e.g. Knorr Stock cubes or ketchup)
Most children with cow's milk allergy do outgrow it, so you do need to do a trial reintroduction to see if your son has developed tolerance. Guidelines advise a reintroduction trial after cow's milk free diet until 9-12 months of age or after at least 6 months without cow's milk.
To do a milk challenge safely at home, it is important that your doctor first gives the go ahead and your child does not have eczema at the time of reintroduction nor a history of acute allergic symptoms. If your child does have eczema or has had an acute allergic reaction at any point, then a supervised challenge may be needed in hospital.
Generally we advise a gradual introduction of milk following a 'milk ladder' where milk is introduced in a baked form and if this is tolerated, less cooked forms are trialled. This is based on the observation that many children with cow's milk allergy may tolerate baked milk containing foods before less cooked forms as heating changes the shape of milk proteins and may reduce allergenicity.
If your child can tolerate baked milk and you can include it in his diet, this may also help him grow out of cow's milk allergy. An allergy dietitian can give you more advice about milk challenges, which foods to start with and how much. Each child is different so the dietitian will be able to assess where your child would need to start in the ladder and at what rate reintroduction should take place.
Sasha's answers have now been posted. Thank you to everyone who participated in the Q&A.
No comment on the ethics of specialist formula manufacturers, then? Harrumph.
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