Expert Q&A on cow's milk allergy, with dietician Sasha Watkins: ANSWERS BACK

 

Hello. We're running an Expert Q&A on cow's milk allergy, and offering you the chance to put your questions to dietician Sasha Watkins.

Sasha is a registered dietician with experience in allergy, child nutrition, fussy eating, weaning and gastrointestinal health. She has her own practice and is an active member of the British Dietetic Association.

Cow's milk allergy is the most common baby food allergy but it's often confused with - or mistaken for - other conditions, including colic, eczema and reflux. For more info and online resources, visit isitcowsmilkallergy.

Post your questions about cow's milk allergy for Sasha on this thread by Monday February 3rd, and we'll upload Sasha's answers by Monday February 10th.

This Expert Q&A is sponsored by Mead Johnson

Posts

  • Hi, my little one Archie gets really bad tummy pains often to the point that he is arching his back in pain, which is horrible to watch! image I'm not sure whether this is colic or whether it could be cma? What other symptoms should I be looking for?

  • OH are the symptoms of CMA similar to Colic, my little girl often seems to be in pain after feeding. How can you tell the difference?

     

     

  • I'm lactose intolorent, does that mean I shudnt give my little boy cows milk? I want to stop breastfeeding (he's 6 months old) but I'm v.v. worried it will make him ill.

  • My 6 week old is on 6fl oz every three hours. He scteams if we give him less but throughout the feed he seems to scream like its hurting his tummy. We have tried comfort milk and are using colief in the milk. We are using hungry baby milk now and seeing if this means he doesnt take so much therefore wont hurt his tummy so much. Its heartbreaking when he screams because he arches his back and cant take his milk even though he wants it. Could this be a lactose intolerance?

  • My son who is 2 can tolerate cow's milk in cereal and in mash potato etc, but if I give him cows milk to drink he gets a very sore bottom, as a consequence we are still having to give him formula, any suggestions to help?

  • My doctor has suggested that a cow's milk allergy maybe responsible for my son's colicky symptoms but hasn't said yet about testing for it. Can you tell how this testing is done and how they then make a diagnosis?

  • Thanks for all your questions.

    We'll send them over to Sasha now – and load up her answers next week.

  • Hello everyone. Thank you for your questions, which I'll do my best to answer here, one by one.

    First, LouiseHarris2: Sorry to hear that Archie has been unwell.

    Colic may be caused by several things, of which cow’s milk allergy is one. For more about colic itself, do please see my answer to Hummer, below.

    If your child does have a non-IgE mediated allergy to cow’s milk, it is likely he will have more than just the one symptom of colic and these symptoms may affect his skin, airways and gut. Other symptoms include itchy, red skin, eczema, reflux, loose stools, mucus and blood in his stools, constipation, redness around his anus or genitals, and poor growth. These symptoms are generally delayed for anything between 2 to 48 hours after drinking or eating a food containing milk.

    More immediate symptoms (characteristic of an IgE mediated cow’s milk allergy), which typically occur within minutes and certainly before about 2 hours, include a rash that is red, raised and itchy, swelling of the lips, tongue, roof of the mouth, and/or the area around the eyes or face, itchy eyes or mouth, nausea and vomiting, abdominal pain, diarrhoea, sneezing, a runny or blocked nose, coughing, shortness of breath or wheezing.

    In its worst form, your child may have an anaphylactic attack which is characterised by many of the symptoms above (rash, swelling, breathing difficulties, nausea, vomiting) but they may be more severe in nature and accompanied by a drop in blood pressure or your child may get pale or quiet.

    If you suspect your child has colic or a cow’s milk allergy, it is important that you take him to your GP to get a diagnosis. Unfortunately, little ones aren’t able to describe how they feel, so it's can be a good idea to start keeping a symptom diary (there's a example of one here): it may help you piece together a pattern of when symptoms are occurring that you can show to your GP.

  • Hummer, you asked about your little girl who seems to be in pain after feeding, and wondered how you distinguish between the symptoms of colic and cow's milk allergy...

    Colic may be a symptom of cow’s milk allergy but colic is also recognised as a condition in itself. 

    Your little girl would be classed as having colic if she has inconsolable, intense crying lasting for at least 3 hours a day for at least 3 days a week, for 3 weeks at a time – assuming she's an otherwise well fed, healthy baby.

    Colic usually starts in the first weeks of life, stops between 3-6 months of age and is most likely to occur in the late afternoon or evening.

    Colic may be caused by many things, including excessive wind, constipation, a cow’s milk allergy, reflux or an intolerance to lactose. For more specific info about the symptoms of cow’s milk allergy, please look at my reply to Louise Harris2 above.

    Please go see your GP to get a diagnosis, as every child is different and your GP has the training and experience to determine what might be causing your child's pain. The NHS has also published some helpful information on colic online.

  • Zaksmummy85, I completely understand your concerns but rest assured that, even if you are lactose intolerant, it does not necessarily mean your little boy will have a problem with cow’s milk.

    Hereditary lactose intolerance is not that common.

    Milk is a key component of a growing child’s diet and unnecessarily avoiding it may put your child at risk of nutritional deficiencies.

    If you would like to stop breastfeeding, I would advise that you try him on small amounts of infant formula (all of which are based on cow’s milk) and slowly increase the amounts if he is tolerating it. You may notice some change in his stool consistency or frequency when you change from breast milk to formula, but this is normal.

    If, however, you believe that your child is unwell after trying cow’s milk formula, please go see your GP so he can advise you on how to progress.

  • rose 86: Sorry to hear that your little boy has been unwell. Have you been to see your GP about this?

    It sounds like you could benefit from some medical input and your doctor is best placed to fully assess the situation.

    There are several things that may be causing your baby’s discomfort. Before you go to your appointment, it may help to make some notes to take with you. Things to consider include: your baby’s overall health; when the crying started; how long your baby cries for; what aggravates or improves her crying; if she think she could be hungry, overtired or too hot; what her stools are like; how well she is feeding; details of what formula she is having if you are not breastfeeding; if you have a family history of allergy, and how you are coping.

    Thinking about these things before you see your GP may help him/her with their diagnosis.

    Good luck!

  • Rebecca Taylor2: I am sorry that your son has had a reaction to drinking cow’s milk.

    Unfortunately, it is difficult for me to give you any advice on gastrointestinal problems without seeing your son in person and having all the facts.

    I would suggest you book an appointment with your GP for a proper clinical assessment of the problem and hopefully this will get the problem resolved.

  • Pookey2, you asked about testing for cow's milk allergy...

    The tests your GP will choose to do depend very much on the type of reactions your son has to cow’s milk. Hopefully, your GP has taken a full medical and symptom history, involving questions such as the allergy history of your child’s immediate family, the type of symptoms, when they occur and what foods your child is eating or drinking. After taking a history, your GP may also physically examine your child.

    Your GP will fill you in on the best allergy tests for your child to take but, just so you know, there are two main types of tests: ones for immediate reactions to cow's milk, and ones for delayed reactions.

    Tests for immediate reactions
    Immediate reactions, occurring within minutes or up to 2 hours, are referred to as an IgE-mediated food allergy.

    Skin-prick tests or blood tests measuring levels of IgE antibodies are often used to assist with diagnosis. However, these are not always clear and need to be reviewed by an allergy specialist before a diagnosis can be confirmed.

    If the results are not conclusive, your child may need to undergo a food challenge. This is where small amounts of the food are given to your child and their symptoms are recorded. The amounts are gradually increased to see what amount they can tolerate. A food challenge should always be done in a hospital setting in case your child has a severe reaction.

    Tests for delayed reactions
    If symptoms are delayed for 2 to 72 hours after drinking or eating a food containing milk, then your child may have a non IgE-mediated milk allergy. Skin prick tests or blood tests measuring levels of IgE antibodies cannot be used for this type of allergy.

    The best test is an elimination and reintroduction diet. This involves removing all foods/drinks containing the suspected food for a period of time and then slowly reintroducing the food to see if there is a reaction. 

    If you are breastfeeding, you may be advised to avoid all dairy products from your diet for a period of time.

    Elimination diets are usually done under the care of a dietician to make sure that you/your child are excluding the right foods or drinks and that you/your child still have a nutritionally balanced diet.

    Please avoid tests offered on the high street as these may be expensive and unreliable. All tests should only be done under the guidance of a qualified healthcare professional.

    The NHS has some helpful info online on allergy diagnosis.

  • Thanks for the advice, will book to see gp.

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