My Registered Nutritionist and Pre- and Post Natal Exercise specialist, Emma West joins me for another blog post, this time we are talking all about CMA (cows milk allergy - also know as CMPA (cows milk protein allergy))! This is such a big topic at the moment, and one I seem to discuss with almost every parent I know! Emma shares her professional advice on this very common issue.
What is Cows Milk Allergy?
Emma: "Cows Milk Allergy (CMA) is when the proteins in the cows milk cause an abnormal response by the body’s immune system. The body thinks the proteins are a threat, which can cause allergic symptoms. Cow’s Milk Allergy is the most common food allergy in the UK but it is still rare."
Is there more than one type of dairy allergy?
Emma: "Yes, there are actually two types of allergy:
IgE medicated food allergy where symptoms are quick to appear, sometimes within minutes of consuming cows milk or up to two hours.
Non-IgE medicated food allergy where symptoms are slow to appear and tend to develop from two hours up to 72 hours after consumption. This is the most common type of Cows Milk Allergy."
Is lactose intolerance the same thing?
Emma: "This is a different type of reaction to milk - an allergy and intolerance ARE NOT THE SAME THING! This is when your body is unable to digest lactose the natural sugar found in milk and milk products ( as your gut lacks an enzyme). As a sufferer of this myself symptoms can be similar but are not life threatening, just uncomfortable!
"Lactose intolerance can also be temporary - such as if you have a tummy bug. Having a lot of diarrhoea basically clears out the gut, taking the enzymes you need with it. But don’t worry they will build themselves back up again!
"The amount of intolerance varies from person to person - some people can tolerate eating a certain amount of dairy products compared to others. Symptoms can be diarrhoea, vomiting, stomach rumbling, pain and wind.
"If you think your baby might have lactose intolerance or a CMA your doctor may refer your baby for some tests depending on their symptoms. If your baby has a suspected or diagnosed allergy to cows milk protein or lactose intolerance you may be advised to follow a milk free diet."
What are the symptoms of Cows Milk Allergy?
Emma: "These often start in the early weeks or months after being born and there are many different symptoms, since it can affect different parts of your body. Symptoms can also vary in severity. It is also important to know that symptoms such as colic, reflux and constipation are all commonly seen in babies and doesn’t always mean your baby has a CMA.
Skin reactions: such as an itchy red rash anywhere on the body, swelling of the lips, face or around the eyes.
Digestive problems: stomach ache, vomiting, colic, diarrhoea or constipation.
Hay fever like symptoms: such as a runny or blocked nose.
Eczema that doesn’t improve with treatment."
"Delayed onset of symptoms from non IgE food allergy can be:
Eczema rash or persistent red or sore skin, including severe nappy rash.
Reflux (persistent vomiting or bringing up feeds).
Colic or being unsettled after feeds.
Persistent food refusal and being irritable, especially when feeding.
Diarrhoea or persistent loose stools in otherwise healthy child.
Stools with blood or mucus present.
Poor weight gain.
"Severe allergic symptoms that come on suddenly such as swelling of the mouth or throat, wheezing, coughing, shortness of breath, or difficult noisy breathing."
Is there treatment for CMA?
Emma: "If your baby is diagnosed with CMA, you will be offered advice from your GP or an allergy specialised. Treatment will involve removing all cows milk from your child’s diet for a period of time. If your baby is formula fed, your GP can prescribe special infant formula. If your baby is breastfed, the mother will be advised to avoid all cows milk products.
Do not give your child any other type of milk without first getting medical advice.
Your child should be also be assessed every 6-12 months to see if they have grown out of their allergy."
My baby is weaning or eating solid foods, how do I follow a milk free diet?
Emma: "A milk free diet is completely free of cow and other mammalian milks and excludes both milk proteins and lactose. Which means excluding all cow’s milk and all foods made from milk such as cheese, yoghurt and regular baby formula. You should be reviews by a paediatrician or paediatric dietitian to ensure their diet is balanced.
"When buying products in shops, checking the food labels will become your new best friend. If a product does contain milk, it will always be listed in bold in the ingredients list. Check all the food before you buy and you will soon learn what does and doesn’t contain milk. This also includes: buttermilk, ghee, milk protein, whey protein, casein or an dairy product. Also ensure the product has calcium added to it."
What about breastfeeding?
Emma: "Since breast milk is providing everything your baby needs, you may be asked to exclude cow’s milk and products from your own diet. But this should only be done after discussing with your doctor or dietitian to ensure you have enough calcium to meet you and your babies needs."
Any advice for formula feeding babies?
Emma: "All babies under the age of 1 with a cow’s milk allergy should have a specialised milk free formula or prescription. Children over the age of 1 may continue to have their prescribed formula or may move on to commercially available milk substitutes with added calcium - such as Alpro junior growing up milk age 1-3 years."
Which milk substitutes can I give my child?
Emma: "Below is list of which milk substitutes you can give your child from the age of 1:
From 1 year old:
Soya milk
"This is not recommended as a main milk subsititute until age 1 year, due to the phyto-oestrogen content. But from age 6 months you can use soya milk and soya products in your baby’s weaning diet (e.g. in recipes) alongside breast or prescription formula.
Try:
Alpro Soya Junior Growing up Milk
Wysoy (by SMA)
Infasoy (by Cow and Gate)"
From 2 years old:
Oat milk
"This is suitable if your child is on a milk and soya free diet - look for calcium enriched products.
Almond milk and hazelnut milk
"Not suitable for diagnosed or suspected nut allergy.
Try:
Oatly
Alpro Oat
Oat Dream
Alpro Fresh Almond Original
Alpro Fresh Hazelnut Drink"
From 5 years old:
Rice milk
"Not suitable for children under 4.5 years due to concentration of inorganic arsenic (Foods Standard Agency).
Try:
Alpro Rice
Rice Dream
"Other animal milks such as goat or sheep are NOT suitable, as the proteins in the milk and similar to cows and could trigger an allergic reaction.
"NOTE: Babies with a cows milk allergy can also react to soya, so be vigilant when introducing soya foods into your baby’s diet."
Which foods are safe for my CMA baby to eat?
Emma: "It can be overwhelming trying to figure out what products to choose. As well as choosing the milk substitutes listed above, look for dairy-free products such as:
Soya or dairy free cheese substitutes.
Soya, oat milk based, pea protein or coconut milk based yoghurts and desserts.
Dairy-free margarines and spreads.
Milk-free baby purees.
Milk-free baby cereals such as Heinz Pure baby rice or first porridge (remember to serve other breakfast cereals such as Weetabix, Ready Brek and Rice Krispies- with milk a substitute!).
All fresh, frozen, tinned and dried fruit and vegetables.
Bread products (breads, rolls, breadsticks etc) that contain NO milk ingredients
Pasta.
Plain rice and rice cakes
Meat-free proteins such as beans, lentils, tofu and soya (avoid Quorn based products).
Milk-free biscuits, oatcakes and crackers.
What are milk-free sources of calcium?
Emma: "Its not just milk and milk product substitutes that are good sources of calcium. Bread, cereals and cereal bars can also be fortified with calcium. Tinned pilchards, sardines and salmon (with bones), whitebait, prawns, scampi in breadcrumbs, tofu, baked beans, kidney beans and soya beans. Fruit and vegetables can also contain calcium: brocolii, curly kale, spring cabbage, spinach, okra, watercress, currants, dried mixed fruits, dried figs, dried apricots and oranges. You can also buy calcium enriched orange juice and squash
Make sure your child’s diet includes 3 servings of milk substitute/ milk substitute products per day to meet their nutritional requirements. Check the labels of all foods to ensure they don’t contain any milk and to also see if they are fortified with calcium."
Thank you so much Emma, once again really clear and positive advice, and good to hear it straight from a professional! Emma is based around Loughton, Essex, and offers pre and post-natal sessions tailored specifically to your needs. If you are looking for personal training sessions she will also bring the gym to you! Sessions take place in the comfort of your own home.
Visit Emma's website for more information or to get in touch, and read her advice on weaning, pre- and post-natal exercise, and pre- and post-natal nutrition right here on my blog!
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