Hi everybody its Dr Renee and I'm back for this weeks VLOG. So what I'm going to do
this time is Cow's Milk Protein Allergy in babies. And guess why I'm going to be
doing that? Yes we discovered that my beautiful munchkin, 9 weeks old, has this.
And I have a confession to make as a GP. I must confess that I've been
unconvinced by this in the past because I haven't had much training on it and
because it just seemed to me that perhaps all babies cry and it's
something that they grow out of. And I feel really guilty about that... that's the
honest answer, because now I've had two babies and this one was entirely
different to the last one and it was clear after some time that something was
wrong. And now we fixed it she's a different baby so I am completely
converted and I feel guilty about my attitude in the past. And it's amazing
how we learn by personal experience! So what is it?
CMPA you'll probably see as an abbreviation for cow's milk protein
allergy and it's the most common type of food allergy in infants and young
children. It develops usually in the first year of life, sometimes immediately
that they're born (as it did with mine) and it is allergy to the proteins in
cow's milk. And the symptoms can occur immediately after the feed or they can
happen hours to days later, and so one is an immediate reaction and one is a
delayed reaction. And it can happen in both formula-fed and breastfed babies. So
don't think just because a baby's breastfed it won't get this, because of
course mum has cow's protein in her diet and baby gets it that way.
So what causes it? We don't really know. It's really poorly understood, as so many
things are. It's an immature immune system in the
baby that's reacting in the wrong way and it's actually seeing these cow's
milk proteins as enemies, as it were, and attacking them. Its more common in
families that have allergies, so atopic families, but it still can occur in
children where there is no allergy at all in the family. It affects between 2
and 7.5% babies under 1 year old, so that's quite a lot of babies! As I said,
there are two main types; there is immediate cow's milk allergy,
which is where the symptoms begin as soon as the baby feeds and that has
implications for the baby because they start making associations between the
symptoms and feeding and quite often reject the feed. Or there's delayed cow's
milk allergy where the symptoms begin several hours later. And this is what
happened to my little one. So after the feed my little one will be perfect;
absolutely still, calm, happy. And after about an hour things start to change.
It starts to get really uncomfortable. So what are the symptoms that we see ?
So they divide up into different areas of the body systems.
There's digestion; (so this is where we first saw it with mine) stomach pain and
then grimacing and straining, vomiting, colic, diarrhoea or constipation or a mix
of both. Their skin can be itchy. So itchy red skin. Then lips or face swelling. (My
little ones eyes were swelling). They can have red itchy skin around their eyes.
Nasal symptoms; so snuffles, sneezing, blocked nose. And my little one was sneezing,
and she had a blocked nose all the time. Conjunctivitis; (which mine still has).
And eczema not improving with the normal treatments. So if your baby's got eczema,
which lots of babies get, it might not be due to cow's milk protein allergy
but if it's not responding to the normal treatments then it may well be.
And then occasionally these babies can have a severe allergy, one where their
mouth and throat swells up, they wheeze, they cough, they have difficulty
breathing, or shortness of breath, that's life-threatening and that needs to go to
hospital immediately. But fortunately that's quite rare.
So there's often a crossover with cow's milk protein allergy and lactose
intolerance. And lactose intolerance in babies is not an allergy and it's
usually short-lived, they usually grow out of it by about three to four months.
It's rare as a standalone, so it's rare that your baby's born lactose intolerant,
but it can come after they've had a tummy upset or gastric infection and we
call it transient lactose intolerance at this point. And it gets better on its own,
but there is often a crossover. And lactose intolerance can make them
vomit and it can make them dribble, make bubbles, get hiccups and be in pain.
So it's very similar. How do we diagnose Cow's milk protein allergy? So mainly it's
on symptoms. So obviously you need to take little one along to a doctor.
Your GP, if they're going to treat it, will normally refer you to see a paediatric
allergy specialist and from there they will taking a history, possibly look at
a nappy, possibly do some skin prick tests. However the NICE guidelines
state very clearly that there is low-quality evidence that these are at
all useful in the diagnosis. So in the main it's from symptoms and what's
happening. And sometimes baby's not putting on weight because it's not
digesting the food well enough or it's refusing food and that's quite a big
symptom. So back arching, refusing food, losing weight... all of those need to be
addressed quickly. You'll probably be referred to see a dietitian because
we'll need to think about how we get baby to transition in the future to cow's
milk. And also to look at mums diet if you're breastfeeding. So treatment; how do
we treat it When we've decided that one of these poor little mites is in pain because of
what we're feeding them? So the first thing to do is remove all cow's milk
protein from a diet, the baby's diet. And there are two ways
of doing that. So there are two formula milks if we're talking about formula fed
babies or half-and-half. Initially there's the extensively hydrolysed
formulas and these are things like aptimil pepti 2, cow and gate pepti 1,
junior, Nutramigen lipil 1 & 2, etc.
These are all extensively hydrolysed. So the cow's milk proteins
are treated in such a way that they shouldn't cause baby a problem although
they might. And if you're breastfeeding even if it's just one feed a day,
mum has to cut dairy
out of her diet entirely, and trust me I've been there and it's really really hard.
There is cow's milk protein in almost everything, and I mean almost
everything! I went on a train journey last week and from the menu there was
not one thing that did not have cow's milk in it in one form or another, so
it's really hard. So it's a new diet for you and for baby. Now if baby has been
reacting whilst you've been breastfeeding there's a very high chance
that hydrolysed formulas won't work because breast milk is hydrolysed and so
it means baby is still reacting even though it's hydrolysed and in that case
your paediatrician may put you straight on to the next level of foods which are
amino acid formulas (AAF). So they have no cows milk in them at all, in any way and
these are things like; Nutramigen nutramigen 2 nutraminin Puramino, Neocate LCP, Neocate syneo, Alfamino. you're a virgin to a new trouble jumper
These have to be prescribed, I mean you can buy them,
they are very expensive but once you've got the
diagnosis they can be prescribed. There are other milks of course, and people
often ask me this 'well can I not just use soya'? So you can't use soya in a baby
before six months old and you also have to be really careful because the
absorption of minerals and trace elements might be reduced by the phytates
in soya. And the other thing to think about is that soya milk has an
appreciable oestrogenic effect and oestrogen is a female hormone and we
don't really want to be giving babies of any sex, male or female, but especially
male estrogen. So soya, I would say isn't worth doing, but I know some people do it.
After six months and you have to ensure that the baby doesn't have a soya allergy.
Because there is some crossover between cow's milk and soya so do that very
carefully if you're going to do it! Rice milk: people ask me about, you can't give
a child rice milk until they're at least four and a half so that one's a no no
really. Pea, oat. coconut, cashew or any of those which
you know are very popular now and very easy to get... not until they're two!
And then goats, Buffalo, horse are not
recommended ;they're not really adequate and there might be a crossover and
allergy between those as well and cow's milk . So the answer really is; if your
baby is poorly with this there isn't another alternative apart from
exclusively breastfeeding and making sure your diet is dairy free or using
one of the formulas, the hydrolysed or the amino acids. So what does
the future hold for these babies? Because that's what mums worry about. Obviously
weaning starts at six months.. is it going to be impossible? Most children, and this
is the good news, will grow out of this. So that's the really good news, some
don't but most will. You'll do a milk challenge around ten months old to see
whether or not you can achieve tolerance of cow's milk for your little one again.
And it's called a milk ladder and it's very very well set out. There are twelve
steps and it's a different food to introduce each time and it tells you how
much and how to do it. It actually starts with baked milk products, believe it or
not, like malted biscuits because these are the least likely to cause an
allergic reaction. And then each time they've accepted one and not had a
reaction you move up to the next step and so on. I'm going to put a link for
that in the notes afterwards because it's really useful and interesting to
look at . So in summary, if you have a baby with any of these symptoms and you are
exclusively breastfeeding cut out all cow's milk. It might take two weeks for
baby to settle but if they do settle then you've got an answer. And I can tell
you that my little one did settle with the half-and-half
formula of breastfeeding but still had some issues and the moment we went
totally to the formula she was a different child and she's not in pain anymore!
So this is what you need to think about, otherwise if you weren't
breastfeeding you'll probably go on to an extensively hydrolysed formula trial.
If that doesn't work you'll be stepped up to an amino acid. sSee your GP
if you're at all worried and want some answers and tests. And to work
out how to go through it and then remember the first challenge that
they'll have with cow's milk again in the future is around ten months and
you'll do that with a dietitian guidance. Don't do it on your own, do it with help,
and the milk bladder is there just for your perusal really so that you can have
a look at it and see what it will involve. So hopefully after the first
challenge at ten months they'll work their way happily through the twelve
steps and be absolutely free to eat whatever they want including any cows
milk and and that's what happens in most cases. And though as I said there are
some children that keep allergies or develop other allergies as well.
So hopefully that's helped and any doubts at all please see your GP. When you've got a baby
you need to obviously be more vigilant than we are because we're tougher and
bigger and older and if you're at all worried about anything just seek a
doctor's advice. Any questions please don't hesitate to ask me just; jot them
in the comments afterwards, I'll always answer them and I'll put some interesting
information for you so that you can have a read through yourself.
Thanks as ever for watching, it's really
appreciated and I'll see you again in a couple of weeks with our next topic .Okay
take care!