Breastfeeding
As the saying goes 'breast is best' and the World health Organisation and the Department of Health (2003) recommend that all babies should be exclusively breastfed for the first 6 months and then solids introduced at 6 months (weaning). However for some mothers like me they face a difficult dilemma. It is known that food proteins pass through breast milk and can cause allergic reactions such as rashes, diarrhoea, eczema, vomiting and colic. Having been there, I know that this leads to an unhappy baby and an unhappy mother. In this situation it is best to seek advice from a knowledgeable doctor or dietician with experience in managing allergies before you either eliminate the suspect foods from your diet and continue breastfeeding or stop breastfeeding all together and try a hydrolysed formula. This decision is entirely personal. If you decide to stop breastfeeding, take it slowly as it can be an emotional time and you need to reduce your milk supply slowly. If you continue but change your diet to eliminate food, discuss with a dietician to ensure your diet is nutritionally adequate.
Which milk?
Getting a substitute milk that is nutritionally adequate and suitable to your child's taste is crucial for the weaning process. Soya formula is not recommended for any baby under the age of six months and there is no particular health benefit in using it as a milk drink up to a year of age (Department of Health, 2011). Often babies with cow's milk protein allergy are also allergic to soya so it is not considered sensible for babies with suspected cow's milk protein allergy. Rice milk is not recommended due to risk of exposure to levels of inorganic arsenic and goat's milk based formula is not approved of for use in Europe. Some of the proteins found in goat's milk are similar to those in cow's milk so it is likely that your baby may react to both anyway. The levels of lactose are also similar in both so those with lactose intolerance are likely also to be intolerant to goat's milk (Department of Health, 2011). Hydrolysed formulas must be prescribed by a doctor. They contain modified milk protein and have significantly reduced allergic potential. It is very important to discuss all of your baby's signs and symptoms with the doctor so that the process of allergy investigation can begin and in the meantime a supervised elimination diet can be begun.
Lactose intolerance occurs when a baby does does make enough of the enzyme Lactase which is needed to break down the milk sugar Lactose. If your baby cannot digest the milk sugar they present with abdominal pain, vomiting and diarrhoea and, as a consequence, failure to gain weight. Sometimes children can also temporarily develop this intolerance for a few months after gastroenteritis. With the correct diagnosis, lactose intolerance is easily treated. An allergy to cow's milk can be misdiagnosed as lactose intolerance so if symptoms do not improve quickly, go back and see your doctor.
Zach and Charlie both ended up using Neocate, a nutritionally complete hypoallergenic formula. It is not the tastiest milk on the menu nor the cheapest, but on prescription and with the occasional bit of vanilla essence added in, it worked a treat! It took me a long time to get a prescription however so I used oat milk in the meantime in cooking. Both oat and soya milk are available from the supermarket, come in fresh and long life and have added calcium and vitamins.
Lactose intolerance occurs when a baby does does make enough of the enzyme Lactase which is needed to break down the milk sugar Lactose. If your baby cannot digest the milk sugar they present with abdominal pain, vomiting and diarrhoea and, as a consequence, failure to gain weight. Sometimes children can also temporarily develop this intolerance for a few months after gastroenteritis. With the correct diagnosis, lactose intolerance is easily treated. An allergy to cow's milk can be misdiagnosed as lactose intolerance so if symptoms do not improve quickly, go back and see your doctor.
Zach and Charlie both ended up using Neocate, a nutritionally complete hypoallergenic formula. It is not the tastiest milk on the menu nor the cheapest, but on prescription and with the occasional bit of vanilla essence added in, it worked a treat! It took me a long time to get a prescription however so I used oat milk in the meantime in cooking. Both oat and soya milk are available from the supermarket, come in fresh and long life and have added calcium and vitamins.
As a tip, try to ask the doctor to write out a prescription for multiple tins of your prescription milk. You will find that you go through a lot of it. Always have a back up alternative milk in the cupboard for those disorganised, have run out of milk emergencies, of which I had a few!
Colic
Colic causes a baby to scream and draw it's legs up due to painful stomach spasms, often for hours on end. There is growing evidence to show a link between cow's milk protein sensitivity and colic.
Nutrition
One of my main concerns when I suspected Charlie had a Cow's Milk Protein Intolerance (CMPI) was how I was going to ensure that he had a varied and balanced diet. There is so much focus on ensuring that your baby has the requisite 500-600ml of milk a day so that they get the necessary amount of vitamins and minerals that it became a massive source of anxiety for me.
All the mainstream literature concerning weaning will advise that meals that are rich in milk such as cauliflower cheese or rice puddling all count towards the recommended daily amount. But what if, like Charlie, your child can't have these foods and worse still what if they can't have soya either? What do you do then?
Hopefully the next section of this blog will give you some idea of which key vitamins, minerals and nutrients your child may be missing if you exclude certain foods (allergens) and a list of foods that are rich in these important building blocks will also be provided.
MAIN NUTRIENTS - If you exclude:
VITAMINS - If you exclude:
MINERALS - If you exclude...
Weaning
When I started to wean Zach my excitement was almost overtaken by anxiety as he reacted to some food and was fine with others. I just needed the help of an experienced dietician, but while I was waiting I needed to learn about allergenic food and food groups. This way I couldn't eliminate the risk of allergic reaction but I could help to minimise it.
The very nature of weaning means that you will try different foods. As you do your child may still have an oral reaction which looks like a red shaving rash around the mouth. While it doesn't look nice, it is not a serious reaction. It is still important to write the reactions down and maybe take pictures to show the doctor at a later date. It all helps to build an idea of your baby's reactions and history, all of which could help when you meet with the doctor.
It is recommended that you ideally start to wean your allergic child only with supervision from a doctor or dietician.
How to introduce solid foods in babies with suspected allergies.
It was suggested to me by the paediatrician that a four day wait be followed. This means that you introduce a new food to your baby's diet every four days allowing you to monitor any reactions. I followed this and, even though it really slowed the weaning process down and friend's baby's were onto different tastes and textures way before Zach was, it allowed me to work out exactly which foods were ok for Zach and which he reacted to. I could also monitor how long the reaction took to develop, what the reaction looked like and how long it lasted.
Time of day
Introduce new foods during the morning or early afternoon. Should an adverse reaction occur during the morning/early afternoon, it will cause the least amount of disruption in your baby's sleep and routine.
Which Foods?
It is good to have an idea what the main allergenic foods are so that you can introduce those to your child's diet later or with more caution and in smaller amounts. A tiny pea sized amount of allergenic food is recommended at a time. Below is a list of the allergenic culprits and the safest foods to look out for. Again, please seek professional advice before eliminating any food from your child's diet.Foods most likely to cause an allergic reaction
berries (not blueberries or cranberries)chocolate
cinnamon
citrus fruits
coconut
corn
dairy products
egg whites
mustard
nuts
peas
peanut butter
pork
shellfish
soy
strawberries
wheat
yeast
Foods least likely to cause an allergic reaction
applesapricots
avocados
barley
beets
broccoli
carrots
cauliflower
chicken
cranberries
dates
grapes
honey (not under 1s)
lamb
lettuce
mangoes
oats
papayas
peaches
pears
raisins
rice
rye
salmon
squash
sunflower oil
sweet potatoes
turkey
veal
Signs of an allergic reaction to food
Here are several things to look out for that may indicate that your baby has a potential allergic reaction or intolerance to a food. Reactions can be immediate or develop over a few hours. If you are at all concerned seek immediate medical attention.
- Sudden loose, diarrhea stools and or vomiting
- Constipation
- Colic
- Rashes on the skin (including nappy rash)
- Eczema
- Runny Nose
- Hives
- Irritability and or gassiness after a new food
- Breathing or other respiratory troubles after a new food
- Swelling of the Face, Lips and or Tongue
- Closure or tightening of the throat
Print out the chart in the 'Practical tips and charts' section to document your child's reactions.
