Cow’s Milk Allergy affects 1 in 20 babies in their first year. Symptoms or reactions develop when a baby’s immune system reacts to proteins found in cow’s milk. Cow’s Milk Allergy (CMA) usually presents when changing from breastmilk to formula or when solids containing milk are first given. Breast fed babies can also have CMA, when milk proteins from mums diet are transferred to the baby in mums milk. Reactions can be immediate or delayed and symptoms vary from mild to moderate, to severe and persisting. Timing around exposure to milk and the onset of symptoms provides a useful indicator of the type of CMA and dietary treatment needed.
Cow’s Milk Allergy reactions and symptoms
Food allergy is an atopic and multi-system spectrum condition. Both immediate and delayed types of CMA are more common in atopic families; those with asthma, eczema or hayfever. Delayed reactions typically involve the gastrointestinal tract and skin. Lower abdominal symptoms eg. loose, smelly, bloody or mucousy poohs, constipation and painful wind. Upper abdominal symptoms include vomiting, reflux, pain after feeding, feeding difficulties and milk refusal. Infants are generally very unsettled, sleeping and feeding often being disturbed. At least two persistent symptoms with delayed reactions are needed to consider a diagnosis alongside an allergy focused history. Immediate reactions happen within minutes of exposure to cow’s milk, with reactions in the skin, respiratory and gastrointestinal tracts being more severe. Happily the majority of infants with delayed reactions outgrow this around 1 year of age. Infants who have immediate reactions should have access to a Specialist Allergy Team, including a Paediatric Dietitan.
Dietary treatment and Management for Cow’s Milk Allergy
Symptoms of CMA are resolved by the complete exclusion of cow’s milk and its products, for between 6 months for delayed reactions and up to 2 years for immediate reactions. The maternal exclusion for breast-feeding babies is an effective dietary treatment, and mum’s should take a daily supplement of 1000mg calcium and 25ug Vitamin D to meet their own needs. Dietary exclusion involves avoidance of all cow’s milk formula, cheese, yoghurt, dairy fats; non-dairy sources of calcium are a high priority for breast feeding mums as well as weaning infants. A key nutrient for infants, calcium is essential for the rapid bone growth taking place around 6-12 months. Paediatric Dietitians have key roles in the dietary management of CMA including are skilled in this area and provide assessment of symptoms resolution and dietary management throughout it course.
- weaning to milk free diets
- weaning advice and the introduction of other food allergens
- suitable milk replacements and formula prescription
- meeting needs for calcium and other key nutrients
- conducting diagnostic challenges
- when and how to use the milk ladder
- residual symptoms and when to change formula
What about lactose intolerance?
Lactose intolerance is a different condition which is sometimes confused with CMA. It is best described as a digestive problem, due to insufficient digestive enzyme lactase. Find out more about the difference between lactose intolerance and cow’s milk allergy.