Could this be Cmpa?

[Nov2023]

Hi all. My little one has been unsettled and cries a lot since birth. 12 weeks now and is constantly windy, sicking up and gurning with what I presume is silent reflux. He chokes and coughs an hour after being fed and hiccups about 90 minutes after a feed. Also cries in pain before producing very loud, loose, very full poo nappies that leak up the back. He is EBF and GP is only interested in gaviscon as he is gaining weight and in a high percentile. Gaviscon makes him scream in agony with wind and poo issues. GP can't see a Cmpa rash. He has some dry patches. Does anyone recognise these as a mild rash or are they just baby skin? First one is cheek and second is belly.. Wondering should I just hope he grows out of it or stop breastfeeding and give a goat milk formula? I know his weight is great but it is awful seeing him miserable all the time

[Nov2023]

Pictures not great quality but it is hard to put him down for long enough to get a better one!

[Superscientist]

Yes it could be cmpa. My daughter was diagnosed purely based on her being permanently unsettled at 18 weeks. It started at 3 weeks but retrospectively she had other symptoms at less than 1 week.

She also has silent reflux, hers is in addition to her allergies. Our GP fobbed us off with low dose omperazole but she needed high dose omperazole and gaviscon and domperidone and removing all of her allergens from my diet. We only got help when we saw a paediatrician for something else. Because she had good weight gain although at a lowish percentile the GP was very dismissive.

Don't give goats milk formula. It's not suitable for babies with cmpa as about 90% will react to all mammalian milk. If you are breastfeeding you can cut up dairy and limit soya without GP approval. About half of babies are allergic to soya as well as dairy so whilst you are doing the initial removal of dairy it is advised to not use soya dairy or meat equivalents but soya in bread and chocolate is fine it's just the high level soya products like milk, yoghurt and soya mince you need to avoid for the first 4-6 weeks. If there's no or limited improvements in this timeframe you might need to remove all soya in case they are in the 50%. I would keep a food and symptom diary now, I was vegetarian prior to diagnosis and it was super obvious that whenever I had a meal with soya meat replacements she was unbearable about 48h later. It can take 2-72h to see a reaction from a food.

If you want to stop breastfeeding you can buy dairy free formula but it is very expensive. You start with extensively hydrolysed formula. These are formulas that are dairy based but it has been partially broken down and for some babies this is enough to not recognise it as dairy. The next step after these formulas are amino acid formulas which contain no dairy but have all the individual components found in dairy separately. The most commonly prescribed formulas are neocate or alfamino. Babies that react through breastfeeding more often need the amino acid formulas as the dairy in breastmilk is also partially broken down. The down side to these formulas are they are thin so can make reflux worse and often need thickeners

[Nov2023]

thanks for this. Poor little boy is still so unsettled so something has to be causing the reflux. I drastically reduced dairy months ago.. No milk, cheese, butter etc but have been having chocolate and shop bought bread etc so I will need to try a proper elimination. Knowing about soy is helpful too thanks. And back to try and convince the GP that he is not growing out of it yet and I don't think he will without help

[Superscientist]

Unfortunately you have to remove every trace of dairy although may contains or made in the factory labels are fine. You have to check everything and every time you buy it and then to be sure every time you get it out of the fridge. Companies change recipes without any flags and it's very annoying. Twice flora has changed a product we use to add coconut which is one of my daughter's allergies and my favourite chocolate spread has changed the recipe twice with saying. once to add soya and then to take it away again

When try to see if I could get any level of tomato back into my diet my daughter reacted to a barely visible smear of ketchup on a bacon sandwich.

The flora butter range was good but I haven't had it since they added coconut to everything. We use pure for spread and baking blocks in place of butter

Chocolate the lindt range has a lot of dairy free chocolate but do contain soya (can still have whilst limiting soya). The velvet edition by green and blacks are all dairy and soya free except the salted caramel. Natures store if a good chocolate spread. I am still using in even though I'm not dairy free any more.

You need a good calcium supplement my dietician recommended 600-800 a day. Some breastfeeding vitamins have this level or you can buy separately. I did a mix of the two depending on what the pharmacy had in stock.

[Nov2023]

loads of great advice. thank you. A bit of a restricted diet for me might just help with the baby weight too! Your little girl sounds like she has it tough with her various allergies. I hope she grows out of some of them. Luckily restaurants are much more accommodating to dietery needs these days