Qu about supply / demand and bf, different types of milks and a 14 mnth old - all those in the know please!

[UpSinceCrapOClock]

I'm assuming that with the theory of supply and demand, that if I am bf a 14 month old on demand - who normally has a bottle (240ml - ish) of cow's milk once a day, but currently isn't, then as long as I am feeding on his cues - then he will build up my supply to get what he needs (ie, replace the cow's milk with breastmilk)? Is that right?! (Want to make sure I haven't misunderstood somewhere - so many thoughts at the moment that I'm starting to confuse myself with information!)

To give the background (although this is long, sorry, perhaps would have been better posted in 'Allergies'?, and possibly not relevant but I welcome any thoughts or experience from you all) - ds (14 months) was exclusively bf til 6 months, weaning went well (no obvious reactions) and at just after a year old, he started having a bottle of cow's milk before bed (for various reasons) and has otherwise been bf on demand. There are quite a few allergies in both my and dh's family (mainly asthma type allergies in mine, plus some food sensitivities and a few food sensitivities in dh's family) and there is also a lot of excema and dry skin problems in my family.

Ds started developing dry patches on his legs (circles) a couple of months ago and i have been moisturising him in a rich cream every morning and night (have to do this for dd, age 3, as well). Recently, they have started to get much worse and last week (Mon), he developed an excema type of rash all over his body (torso, arms, legs and under the chin especially) almost looking like severe sunburn. This literally happened from one day to the next and I took him to the Dr Tuesday morning. She said it wasn't at all an illness, and looked more like excema and referred me to a skin specialist who we are seeing next week. Friday night, ds had his bottle of milk, went to bed, then (very out of character) woke up a few hours later, wasn't interested in bf (normally if he wakes at night I bf him), fussed for a few minutes and then vomited all over himself, the bed and me. I moved him off the bed and then he vomited all over the floor. No other symptoms (no fever etc) and after everything was cleaned and I'd cautiously given him some water, and then cautiously bf him, nothing happened and he went happily back to sleep. Was fine the next day, but the next evening (Sat), exactly the same thing happened.

After speaking to a GP relative on Sunday, they mentioned the possibility of a cow's milk allergy and said I should speak with my GP, but that a common way to test for this is an exclusion diet for 2 weeks, slowly reintroduce cow's milk and see what happens in terms of symptoms disappearing, reappearing etc. He also said that sensitivities to cow's milk is actually not that uncommon (not least because it's designed for calves who have different stomachs to humans ). Rang my GP the next day who, over the phone, said that allergy to cow's milk is incredibly rare and that I should wait and see what the skin specialist says next week.

In the meantime, ds hasn't had cow's milk since Saturday, I have just bf him on demand, he hasn't vomited and to me and dh (and another friend of ours who knows ds well and sees him regularly) it seems like the excema is actually starting to clear up. Even the dry patches on his legs (which no cream has cleared up in the past couple of months).

So now I feel a little confused. Of course all of this could be coincidence, but now I don't quite know what to do. My Dr made me feel a bit like an hysterical mum (which I don't feel? But then it's difficult to judge oneself of course ) and thinks the allergy idea is nonsense. Maybe it is, but surely doing the exclusion diet properly won't hurt and might even give us some answers one way or another? Ds has only had milk from me (for drinking) and a tiny amount of cow's milk in cooking (in porridge for breakfast twice) since Sat night. I guess he is getting enough milk-wise from me in the meantime? Or should I try another type of milk (soya or something?) I'm not even sure if I should just ignore the Dr and try the exclusion diet off my own back (and if so, then maybe run the risk of shortchanging him somewhere nutrition-wise - or am I overestimating the 'wonders' of cow's milk?), or if I should try and go back to our normal routine and bring the cow's milk back?

To be honest, I feel like I've confused myself all the more by googling the subject, confused myself by speaking to 2 different healthcare professionals with conflicting points of view and in the meantime, of course, it's important to try and get to the bottom of this for ds' sake. Hence mumsnet!

Sorry - I think that must have been my longest post on mn ever! (and I'm not even sure it was the right topic? But people here do seem pretty knowledgeable about nutrition and breastfeeding is part of it all).

Allergy and intolerance are different afaik.
If someone has an intolerance it's possible that small amounts, or only occasional, in cooking for instance can be tolerated, but a whole glassful every day could set them off.

Definitely post on Allergies board for more knowledgeable posters, but I suffer from occasional mild self-diagnosed dairy intolerance and my advice is to stick with what you're doing now if it's cleared up.

Are you dairy-free? If you want to do the exclusion diet properly, you'll need to go dairy-free for that time too afaik.
But as it's not an allergy and it's getting better, I don't think 'd go that far.

Soya milk isn't really milk so shouldn't be used til age 2 I think.

Thanks - will copy and paste on the 'Allergies' board!

I am not completely dairy-free (so in that sense haven't properly been doing the exclusion diet - have only cut out ds' 240mls of cow's milk every day) - although I am not a big fan of dairy products and only have milk in my porridge and butter on sandwiches at lunch and occasionally cheese (not every day), and, erm, chocolate

Thanks for your reply (he has never had soya or any other type of milk and, tbh, I'd rather get to the bottom of this first before I start faffing about with the possibility of getting him used to different types of milks)

I'm sorry to hear your DS redecorated you and your bedroom. Milk sick is never nice to get out!

On the exczema front, I have the following musings:-

1. Exczema can be cyclical in nature just when you think you have it licked it rears it's ugly head again.

2. My DD's exczema has gotten worse just before going down with a bug. Now I don't know if this is because the bug was causing a heightened immune response making the exczema flare up in response or if the exczema flare up made DD more susceptable to a bug (open sores on skin = good entry point for all kinds of nasties).

3. If your DS had a tummy bug a cows milk INTOLERANCE can occur. This will be temporary and in fact the best medicine tends to be your milk as it has lots of those lovely antibodies and prebiotics in it to allow the gut to heal itself.

see item 10 for details This link was posted by another MNer on a thread today about overfeeding so thank you whoever that was.

In answer to the supply/demand q. you can make more milk anytime you need it. It's not a case of you can make up to X amount of milk when they are 6 months old and at 1 year you can only make up to X-10 amount of milk. You can ramp up production when you need it by nursing more frequently (exclusions apply to this i.e. if you are pg it would be very difficult to change supply amount at least in my very humble experience).

I have managed to exclusively feed a 1 month old and a 22 month old for about 3 days when they and I were ill with a nasty cold. Obviously my 22 m/o DD had previously been on 3 proper meals and snacks as well as bfing but she quit eating and just upped the nursing. It did work!

Ok DD2 did have 40mls of formula syringed into her but that was because I was doubting my ability to make that much milk - she puked it up quickly enough!

An allergy can develop at any time - you can be eating something with no effect for years and then start to get a reaction to it. Therefore cows milk allergy is a possibility and unfortunately most doctors, especially GPs are extremely dismissive of allergies (which makes me really ).

You can test allergy to some extent yourself (with caution and baring in mind this is not fool-proof). Day 1, rub a bit of milk into a clear patch of skin and wait 15 mins or so, look for a skin reaction, if OK wait a day then Day 2 rub a couple of drops of milk onto the outside of the lips, wait for a rection, if OK Day 3 rub a couple of drops onto the inside of the lips, wait etc, Day 4 give a few mls to drink, Day 5 give more to drink (assuming all OK and no reaction on earlier stages). Its very time consuming, but you do need to take care and not re-expose the body too quickly. Of course, faster would be a skin-prick test from the hospital, but referals can take a long time (as can convincing GP's that a referal is necessary in a child under 2 years old ).

If you are going to drop the cows milk you'll need to give something else in the meantime. Don't be tempted to give goats or sheeps milk as approx. 95% of children with CMPA have allergy to milk from other animals too. As a temporary measure upping BF is probably preferable as standard soya milk is very low calorie, soya formula tastes horrid plus soya is also a major allergen.

Hope that helps!

Hi - sorry, I disappeared for a while!

Verity - thanks for confirming about the supply / demand qu. my common sense told me that would be the case (after all, why should a 14month bf baby be any different to a 2 week bf baby in that respect?!) but I think I had just gotten myself into a tizz and needed someone to just tell me plainly that of course it works that way! Anyway, we worked on it, and ds is now getting all of his milk drinks from breastfeeding

AcademicMum - thanks for that info. Interesting what you say about allergies developing later. I also posted about this on the allergies board, and as I wrote there, ds has been exposed to milk products for quite a while (eg, butter, milk and cheese based sauces for pasta, butter on toast, yoghurts etc) but it is only now, it seems like there is a reaction to it? But it also seems like the vomiting just happened after he guzzled a large bottle of milk, and otherwise he didn't vomit after eating, for example, some porridge cooked with milk, or butter or cheese on bread?

Anyway, so far he hasn't had cow's milk to drink since the last time he threw up after some (week and a half ago) and his excema has almost entirely cleared up. I haven't changed anything else (not using any fancy new creams or anything). He has had a tiny bit of milk product in other foods (eg, it was dd's birthday at the weekend and he had a piece of birthday cake which had butter in it) but otherwise nothing (and I have been mainly dairyfree too, although I also had some cake!). Thanks for allergy test guidelines. After this weekend, it will have been 2 weeks that he and I have been (virtually!) dairy free, so I think then I'll try and see what happens following those guidelines. In the meantime, I think good old breastmilk is the safest bet as his source of milk as at least I don't then need to worry about nutrition (I looked at some alternative, vegetable-based, milks and they are all virtually fat-free!) and so far he hasn't vomited everything up after breastmilk!