Q&A about cow's milk protein allergy with registered dietitian Sasha Watkins - ANSWERS BACK

[HeatherMumsnet]

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.

[JennyTW]

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!

[blondieminx]

My DD is 25th centile and always looks reedy compared with her peers. What are your best tips for helping a child gain weight (she is very active)? In particular foods which will get past the lunchbox police? Thanks in advance and thanks for helping us mumsnetters

[monstergoose]

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!

[CoopedUp]

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?

[SweetTeaVodka]

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?

Thanks :)

[magicturnip]

My son has suspected food intolerances. Could he be intolerant of soya but not dairy?

[blondefriend]

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).
So basically:

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.
   
   Thank you. :)

[BagOfCats]

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

[speedyboots]

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!

[InMySpareTime]

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)

[ellliebelle]

No question but interested in answers as my son has cma

[MegMogAndOwl]

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.

Thanks

[Bamboobambino]

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?

[MrsShrek3]

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.

[Hopezibah]

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

[JenjoAP]

Hi all, has anyone tried probiotic for their lo/digestive issues? We had some success x

[Lucky13]

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?

[lem31]

Hi
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?

Thanks. X

[JKsMum11]

Hi,

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

[gretagrape]

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.

Thanks

[Mitch2212J]

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.
Thank you

[Ragusa]

Hello Sasha,

I have had two babies with CMPA - one I breastfed, one I formula-fed with hydrolysate.

The 'Is it cow's milk allergy?' website is run by Mead-Johnson, who make some of the very expensive hypo formulas that docs can prescribe for children with CMA. Obviously, they're necessary for babies who can't be breastfed for whatever reason but....these companies charge the NHS a helluva lot for these formulas and that's partly why GPs aren't willing to prescribe them IMO. Do you think they're maybe too expensive?

I also think that HVs, GPs and even dieticians and paeds could be better informed about options such as restarting breastfeeding/ relactation. It's not a completely out-there option and can be easier than getting an older baby to accept a hydrolysate! What do you think?

[HeatherMumsnet]

The Q&A is now closed. We will be sending a selection of Qs over to Sasha and will post her answers on 10 October.

[MrsShrek3]

do we have answers yet?