Diarrhoea after introducing formula - normal adaptation period?

[CoalCraft]

DD is 4 mo, corrected to 2.5 mo if you account for prematurity. Until a few days ago she was exclusively fed expressed milk, but pumping is getting increasingly impractical as DD gets more alert, and its reached a point where I feel the benefits of breast milk are outweighed by the drawbacks of being ignored for 2+ hours a day (I really disagree with leaving her to cry, but if she gets upset while I pump, which is often, that's not much I can do about it) and having a mum that's knackered and frazzled from having to pump twice in the night.

So I've decided to trial formula with a view to winding down the pumping. She had her first bottle of it (Cow & Gate) on Friday, then two bottles yesterday. She's been gassy and uncomfy since yesterday morning, then this morning she had a bout of diarrhoea.

Is this a normal part of transitioning to formula or a sign of something more sinister like cow milk protein allergy? I know she's been exposed to cmp via my milk, but she has always been quite gassy. Also back when she was in hospital she was given breast milk fortifier (made with cow's milk) and got severe constipation. Cmpa was not investigated though.

I really want her to be okay on formula because I'm really struggling with the pumping now, but I don't feel like I can start winding down until I know she's tolerating formula well.

Uch, now she has a rash. Nappy area but doesn't look like typical nappy rash, and there's a bit on her face too. Really afraid it might be cmpa

She had her 16 week jabs on Thursday and I'm hanging onto the hope that they could be causing it but seems unlikely doesn't it? I can't find anything about them causing a rash nowhere near the injection site.

Think I will stop the formula for now, see if the symptoms clear up, then try again. If the symptoms come back I'll be asking the GP to test for cmpa... The GPs are so useless though, I hate having to talk to them.

Feel I'll at the thought of having to keep pumping but looks like no choice.

Call your HV for advice but it could just be their stomach adjusting.
I ve FF from birth and he certainly took time for his stomach to adjust to milk in generally.
If you don't enjoying pumping anymore let yourself stop and don't let health professionals palm you off. I ve never forgotten the numerous amount of times my mum cried after being bitten by my sister and having no time alone if she needed, I wished she d have made the decision that she mattered too.

Ah I don't have much expertise but didn't want to leave it, my 4.5 month old is mixed fed and doesn't have these reactions to formula, definitely get formula poo and breast milk poo but I couldn't call it diarrhoea. It does sound like shes affected by it somehow. Hopefully someone with CMPA experience will come along shortly. Please don't worry about seeing your GP, they never mind to see little babies.

Well done on pumping so long, waking up twice to pump a night is some Herculean effort in my world and hope you can wind it down soon.

I don't have direct experience, but my understanding is that a switch to formula would generally introduce constipation rather than diarrhoea, so I think that CMPA could be a possibility. Sorry...

Thanks for the responses all. I'm definitely not going to let anyone guilt me out of stopping pumping. I actually spoke to the GP before first giving formula as I wanted to know what would happen regarding DD's prescription supplements, and thankfully she didn't bat an eye when I said I was going to convert. Quite possibly because I fibbed and said my supply was dwindling...

Am reluctant to call HV as I've always found her a but disengaged and flakey, but maybe I will tomorrow depending on how DD is.

Am definitely going to stop formula for now and make sure symptoms clear up... Niggling voice in mind saying what is it's something serious that just happens to have come along at same time...

In the meantime... Moooo 🐮 😁

Would love to hear from people with FF cmpa babies... What was the testing process? Can you get a prescription for hydrolysed formula?

I'm breastfeeding a cmpa baby. We weren't diagnosis until 4.5-5 months as it's quite rare in bf babies and our symptoms were a bit vague. Inconsolable crying and reflux mostly although now we have got on top of most of the allergies we notice rashes on her face and thighs when she's reacting to something.

I had a bit of trouble initially getting formula prescribed partly as they were sceptical that allergies were the cause of her symptoms but got some a couple of weeks ago, unfortunately she had a reaction to the formula as she has other allergies including coconut which is in the formula.

@Superscientist Thanks for replying. Sorry your little one reacted to the formula too, how frustrating for you. Glad you've got on top of her allergies now though.

DD's rash has mysteriously disappeared in the last 4 hours 🤷 I did put sudocrem on it but wouldn't have thought it would make that much difference to an allergic rash. So confused about what's going on. Think I will ring HV tomorrow and see if she can shed any light as I feel stumped as to what to do.

Secretly hoping DD does another poo so I can see if the diarrhoea was a one-off... Ah parenthood!

I've had two children with CMPA and those symptoms do sound like CMPA could be a strong possibility I'm afraid.

"If the symptoms come back I'll be asking the GP to test for cmpa"
There are two types of CMPA, Ige and non-ige, and while there's a test for ige reactions, the result could be negative and baby could still have non-ige. So the only way to diagnose it is to eliminate dairy (if breastfeeding, cut all dairy out of your diet for 6 weeks, and if formula feeding, give hypoallergenic formula - not sure how long but I think it would be 3 weeks) if symptoms improve, that indicates CMPA, and to confirm it, you would give one portion of dairy (if breastfeeding, eat yoghurt or drink some milkshake or something, and if formula feeding, you would give a bottle of normal formula) then if symptoms return it confirms the diagnosis.

You can ask your GP for hypoallergenic formula. They are likely to start with Nutrimagen which most babies with CMPA will tolerate. However, some don't tolerate it and they need Neocate instead. I think there are others, those are just the two we had. (DC1 was mostly breastfed but also had some formula.)

Can I ask why you're expressing and not breastfeeding directly, was it because baby was premature? Would you like to try breastfeeding directly or do you feel that ship has sailed?

Anyway. Some helpful info about CMPA here www.allergyuk.org/information-and-advice/conditions-and-symptoms/469-cows-milk-allergy

@NameChange30

Thank you for that, really useful information. To quickly address your last question, yes it's to do with DD being premature, and yes that ship has definitely sailed. It's a huge shame and one of the many reasons that I'm so upset about her coming early, but here we are.

Even if she were directly breastfed, this issue would have come up soon anyway as I'll be back to work shortly and always intended to stop breastfeeding (or pumping, as it's turned out) then.

I'm very much hoping that if DD does have cmpa, that it's a relatively mild case, as I've been eating dairy with most meals since she was born and while she's always been quite a gassy baby and had mild reflux, she's not had any substantial cmpa symptoms untill now. There was even a two-week period after a particularly gassy spell where I did completely eliminate dairy, and it didn't make much difference, but maybe that want long enough (two weeks was what HV advised).

There's a big difference though I'd assume between getting a small amount of allergenic protein via breast milk and having that protein be a principal component as in standard formula! But at least hopefully the first choice hydrolysed formula will be suitable. I do still cling to hope that DD will do a nice normal poo in the morning and this will have just been a weird adjustment blip - there's no allergy anywhere in mine or DH's family and that mysterious short-lived rash is still gone - but it's a pretty faint hope.

Am so disappointed. Wanted to be free of it soon but I'm just getting her off to sleep now, then it's on the pumps again

Sorry for being so melodramatic, it's just good to rant, haha. Thanks again for your help xx

It's not melodramatic at all! It's awful when you need a break and you can't just give normal formula I'm sorry you wanted to breastfeed and weren't able to You have done amazingly with the pumping. I do think it's the worst of both worlds, such hard work, but you have been giving DD breast milk which is great.

You're right, two weeks wasn't long enough to go dairy-free, it has to be six weeks as I said. If you're continuing to pump, you should really cut out dairy again, but given that you don't really want to pump any more (fair enough!) my advice is to call the GP today and ask for hypoallergenic formula on prescription.