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:
- Cow’s Milk Protein Allergy, the basics
- Management of Cow’s Milk Protein Allergy
- Cow’s Milk Protein Allergy and Complementary Feeding
- Cow’s Milk Protein Allergy, the next steps…
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.
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
- blended vegetables
- 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
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.
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)
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!
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
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)