Cow’s Milk Allergy and Complementary Feeding

Welcome to part three of a four part overview of how to not just survive but thrive with Cow’s Milk Protein Allergy. Here’s what’s coming up:

  1. Cow’s Milk Protein Allergy, the basics
  2. Management of Cow’s Milk Protein Allergy
  3. Cow’s Milk Protein Allergy and Complementary Feeding
  4. Cow’s Milk Protein Allergy, the next steps…

Complementary Feeding

Complementary feeding is the period when infants no longer get all the nutrients they need via breast milk or infant formula and therefore other foods and liquids need to be introduced1. It is often referred to as weaning or introducing solids but both of these terms can be confusing.

The advice from the World Health Organisation is to exclusively breastfeed until 6 months and then start complementary feeding. However recent evidence has shown that no harm comes to babies with early introduction of solid foods and it can even reduce the incidence of food allergies. The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition2 updated their advice to say that complementary feeding should not begin before 17 weeks (4 months) but also should not be delayed beyond 26 weeks (6 months), so therefore the introduction of pureed food needs to occur between 4-6 months when the infant is showing signs of interest. They should be able to hold their head up without slumping, be bringing their hands to their mouths and showing an interest in food. If you have any concerns about this, talk to a dietitian.

Generally there is no difference to starting complementary feeding with a child who hasn’t got a milk allergy. You can start with baby rice (just check the label for milk as some products do contain other ingredients) made up with breast milk or their hypoallergenic formula. Or start with pureed cooked vegetables and fruit. Banana and avocado don’t even need to be cooked first, you can just puree them as is. You can add pure baby rice to fruit or vegetables that are a bit watery.

We’re avoiding all dairy products but all other allergens are ok. The other things you need to avoid right now are whole nuts (until 5), honey (until 1) and soya (until 6 months).

Infants who have a strong risk of peanut allergy (severe eczema or egg allergy) should be seen by an allergist or a paediatrician with an interest in allergy before having nuts. Introduction of peanut based foods such as peanut butter should be encouraged between 4-11 months for all other infants. Remember children should not have whole nuts until 5 years old due to the risk of choking.

Label Reading

Due to EU legislation, anything that has cow’s milk or soya in will say milk or soya in bold, italics or underlined on the ingredients list. This is law, so if it’s not there it’s safe for your baby. A lot of products have “may contain” or “made in a factory” in an alert under the ingredients. We really have to use our common sense here – if it’s cereal for example it’s unlikely to have much cross-contamination. However something like a chocolate bar may have gone through the same machine. It also depends on the severity of your child’s allergy, if it is a non-IgE allergy or the worst case scenario is diarrhoea you may be happy to risk it.

When you have introduced the basics you can then increase the variety of food your baby eats. Again, nothing is off the menu apart from milk and soya until 6 months. So there’s no reason why you can’t blend food that you are eating or give them combinations such as banana and smooth peanut butter.

Ideas for dairy free first foods:

  • blended fruit and baby rice
  • wheat biscuits or instant oats with breastmilk or hypoallergenic formula
  • soup
  • blended vegetables
  • hummus
  • adult foods without any salt, blended
  • you can add peanut butter to soups/blended vegetables

6 months onwards

From 6 months infants should have the ability to deal with larger pieces of food and they can start enjoying finger foods. To begin remember: the bigger the better, aim for the food to be shaped like your finger. Avoid small items such as whole grapes or coin shaped food which is easy to choke on. It is also best to avoid chunks of apple until later too as apple can disintigrate and chunks come away easily.

Ideal finger foods include:

  • chunks of banana
  • soft vegetables in chunks
  • fingers of toast (you can load these with hummus, dairy free spread, peanut butter or dairy free cream cheese)
  • strips of chicken
  • bread sticks/rice cakes

Baking

You can bake most things as you would do normally. Just use a dairy free spread (Vitalite, PURE, Flora Dairy Free or supermarket own-brands) and if the recipe calls for milk use a plant-based alternative. Oat milk works well as it doesn’t have a strong taste.

A lot of foods are already milk and soya free such as cocoa powder and mayonnaise.

Recipes

Most recipes can be altered to be suitable. Use plant based alternative milks and your dairy free margarine or oil.

White sauces are very easy if you just mix cornflour into any plant-based alternative milk. (Mix a tiny bit in first to form a paste and then add the milk gradually to avoid lumps)

Free printable-4
For my family friendly dairy free recipes click here.

Puddings

Don’t despair that yoghurt is not an option, there are plenty of other puddings. Here are some ideas:

  • fruit (obviously!)
  • You can make custard with your favourite alternative milk and normal old fashioned custard powder.
  • Rice pudding and tapioca also work well with alternative milks.
  • There are lots of manufactured dairy free pudding and yoghurts in big supermarkets, a lot are soya based but there are coconut based puddings too now that it’s trendy! You can also find nut and pea based puddings if you’re lucky. This includes ice-creams. Sorbets tend to be milk free too.

So, dairy free complementary feeding is not as hard as you think, once you get used to label reading it’s a doddle! If you’d like more support from a friendly bunch of people who are going through the same as you join my Facebook Support Community.

And don’t forget to download your free recipes!

Free printable-4
Click here for your free recipes

References

  1. WHO(World Health Organization). 2002. Complementary Feedng. Report of the Global Consultation. Geneva. 10-13 December 2001. Summary of Guiding Proncipes. http://apps.who.int/iris/bitstream/10665/42739/1/924154614X.pdf?ua=1 Accessed March 10, 2017

  2. Fewtrell, M. et al. Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. JPGN, vol 64, number 1, January 2017 (http://journals.lww.com/jpgn/Fulltext/2017/01000/Complementary_Feeding___A_Position_Paper_by_the.21.aspx)

 

Advertisements

Management of Cow’s Milk Protein Allergy

This is part two of a four part overview of how to not just survive but thrive with Cow’s Milk Protein Allergy. Here’s what’s coming up:

  1. Cow’s Milk Protein Allergy, the basics
  2. Management of Cow’s Milk Protein Allergy
  3. Cow’s Milk Protein Allergy and Complementary Feeding
  4. Cow’s Milk Protein Allergy, the next steps…

When you have an infant with cow’s milk protein allergy the main treatment is to avoid the proteins casein and whey. This post covers what to do whilst babies are still solely breast or formula fed. I will cover weaning onto solids in the next post.

Free printable-4
Scratching your head at what to cook on a dairy free diet? Click here!

Breastfeeding

Breastfeeding is the ideal way to feed infants and there is a raft of evidence showing benefits for both mother and child, for a fab summary see this blog post by Charlotte Stirling Reed. This blog post by Dietitian Priya Tew is also excellent and describes the ups and downs of breastfeeding which I can really relate to!

As a breastfeeding mum you could be lucky and not have to alter your diet. Often breastfeeding mums only find out that their baby has a cow’s milk protein allergy when they start complementary feeding (introducing solid food).

However, for the unlucky ones (and that included me) your baby will have symptoms of cow’s milk protein allergy with proteins that are transferred through your breast milk. In this situation the only solution is for the mother to cut out cow’s milk. Remember that your baby can continue to have symptoms for two weeks following the elimination of dairy from your diet. This is a combination of it working through your system and their digestive systems recovering.

The first 2 weeks can be really tough, especially if you’re still dealing with a very unhappy baby, but try to persevere, it does get easier! I have a food allergy and intolerance support community on Facebook, if you want a place to get encouragement and empathy come over and join us (click here).

My top tips for a dairy free diet whilst breastfeeding:

  • Find a plant-based, calcium enriched alternative milk that you like. There are lots to choose from including: soya, oat, hemp, almond, hazelnut, coconut and rice. Just make sure it’s enriched with calcium, any organic milks will not so check the label.
  • Find a dairy free spread that you like. There are plenty to choose from:Vitalite, PURE, Flora Dairy Free or supermarket own-brands
  • Once you have dairy free milk and spreads then you can make most things dairy free – you can bake or convert recipes quite easily.
  • Take a calcium and vitamin D supplement, you need 1250mg of calcium per day and 10ug of vitamin D. You can request a supplement from your GP as it will be difficult to get this from diet alone. Or you can buy supplements in chemists for breastfeeding mums, just check the label.
  • Cocoa and eggs are dairy free so you can make chocolate cake – yay!
  • Look for vegan products and recipes. You can eat anything in vegan cafes and restaurants. Pret a Manger and Boots as well as others have vegan options.

If you need further information or are pulling your hair out drop me a line, we can have a quick, no-strings preliminary chat which wouldn’t cost you anything. I have lived through this so can help! Click here for my contact details. 

Formula Feeding

Not everyone can breastfeed and not everyone wants to. Obviously regular infant formula contains milk and therefore is not appropriate. Babies with cow’s milk protein allergy need a hypoallergenic formula. There are different brands but these are the two main types:

Extensively hydrolysed formulas contain milk protein which is broken down into very tiny bits. Most infants tolerate these and they taste a bit better.

If an infant has blood in their stools or anaphylaxis they will probably go straight onto an Amino Acid Formula. The proteins in these are completely broken down.

Your GP, dietitian or Paediatrician will advise you on the best formula for your child.

If your baby is refusing to drink the formula due to the taste you can try weaning them onto it gradually. If you are giving them 5 ounces you can try 1 ounce of the new formula to 4 ounces of the one they are used to. On day 2 increase to 2:3 and so on until they’re completely on the new formula. As a last resort you can flavour hypoallergenic formulas but in this case it is best to talk to a dietitian for further advice.

Soya formulas are available but are not suitable for infants below the age of 6 months. Again, talk to your paediatrician or dietitian for further information about soya formulas.

Gastro-oesophageal reflux

A lot (not all) of children with cow’s milk protein allergy also suffer with gastro-oesophageal reflux. This can result in vomiting or persistent crying. Some babies do not have symptoms and this can be described as silent reflux. If you are concerned about your child regarding gastro-oesophageal reflux speak to your GP or health visitor and see this link to the Great Ormond Street Hospital website.

Free printable-4
Click here for a printable of 10 really easy and tasty recipes that you’ll be surprised are totally cow’s milk free!

In my next blog post I’ll be looking at weaning infants with cow’s milk allergy onto solid food, also known as complementary feeding. I’ll talk about label reading as well as what to give and when.

If you have any questions or comments, contact me or post them in the comments below.

Cow’s Milk Protein Allergy, the basics

This is part one of a four part overview of how to not just survive but thrive with Cow’s Milk Protein Allergy. Here’s what’s coming up:

  1. Cow’s Milk Protein Allergy, the basics
  2. Management of Cow’s Milk Protein Allergy
  3. Cow’s Milk Protein Allergy and Complementary Feeding
  4. Cow’s Milk Protein Allergy, the next steps…

Background

Cow’s milk protein allergy is pretty common in the UK. The proteins which cause the allergic response are casein and whey. The estimated prevalence is between 2-3% of the population. It is common in infants and young children and effects 2-7.5% of infants below the age of 1 year. It is unusual to develop a cow’s milk protein allergy later in life.

Symptoms often include:

  • Diarrhoea
  • Constipation
  • Nappy rash (secondary to diarrhoea)
  • Mucus in stools
  • Blood in the stool
  • Reflux or vomiting
  • Wind, bloating or abdominal pain
  • Swelling of face, lips or eyes
  • Skin rashes (redness or hives)
  • Eczema
  • Runny nose

In rare cases cow’s milk allergy can cause breathing difficulties and anaphylaxis. If at any point your child is unable to breathe, call the emergency services immediately.

Allergies are split into 2 types: IgE mediated and Non IgE mediated (often called intolerances)

IgE mediated allergies can be diagnosed by a blood test or a skin prick test. When the milk protein’s whey or casein are ingested, IgE antibodies are released to fight off the offending proteins which the body sees as a threat. The symptoms often come on very quickly with an IgE reaction and in severe cases can include anaphylaxis.

Non IgE mediated allergies are still true allergies, they tend to have the same symptoms but they are more delayed and would not include anaphylaxis. They are also caused by the immune system but not a specific antibody reaction. There are no diagnostic tests for non-IgE mediated allergies, to diagnose there needs to be a period of elimination and then reintroduction to prove that the symptoms come back. To be honest, not many parents that I have come across reintroduce allergens on purpose once the symptoms are gone.

Cow’s milk allergy can occur both in breast and formula fed infants and there is often a family history of some kind of allergy such as hay fever, asthma or eczema if not cow’s milk-allergy itself. Children do tend to grow out of this allergy with the majority doing so before the age of 5.

Lactose Intolerance

A lot of people confuse cow’s milk protein allergy with lactose intolerance. Which is not surprising considering the similarity of the symptoms and that they both are a reaction to cow’s milk. In lactose intolerance it is the milk sugars that cause the problem, not the protein. With lactose intolerance the sufferer is lacking in the enzyme lactase and is therefore unable to break down the sugar lactose. This means that lactose carries on through the digestive tract causing trouble. Undigested sugars cause symptoms such as: bloating, wind, diarrhoea, constipation and abdominal pain.

Lactose intolerance is often temporary following a gastrointestinal infection. However, there are people who are born unable to digest lactose and they will need a low lactose diet for life. A low lactose diet is not too difficult and is catered well by supermarkets.

Lactose free dairy products are not suitable cow’s milk protein allergy sufferers as they still contain milk proteins.

This printable infographic summarises the differences between cow’s milk protein allergy and lactose intolerance: Cow’s Milk Protein Vs Lactose Intolerance

What do you do if you think your child has a cow’s milk protein allergy or Lactose Intolerance?

The first port of call should be your GP or Health Visitor or you can speak to a Registered Dietitian. Uncomplicated cow’s milk protein allergy can be managed by your GP and it is best practice to be referred to a Dietitian. They will refer you to a Paediatrician or allergy centre if needed. This tends to be if a child has multiple allergies, eczema or asthma.

How to treat Cow’s Milk Protein Allergy

Following a cow’s milk protein or dairy free diet is the only way to treat cow’s milk protein allergy.

Breastfeeding mums may need to eliminate cow’s milk protein from their diets if the infant has symptoms with her milk alone.

Formula fed babies will need to be switched to a specialised hypoallergenic formula. This would need to be discussed wth your GP, Dietitian or Paediatrician. There are soya formulas on the market but these are not recommended in babies under 6 months of age. It is better to speak to your GP, Dietitian or Paediatrician initially.

My next blog post in this series will look in depth at the cow’s milk free diet and management.

Free printable-4Click here for a printable of 10 really easy and tasty recipes that you’ll be surprised are totally cow’s milk free!

References

http://www.bsaci.org/guidelines/milk-allergy

https://www.allergyuk.org/food-intolerance/allergy-or-intolerance

http://www.nhs.uk/chq/Pages/Could-my-child-be-intolerant-to-cows-milk.aspx?CategoryID=62&SubCategoryID=63