close
Paediatric Nutrition
  • Carine Henry RD
  • Nutritional Assessment
  • Dietary Treatment
  • Blog
  • Get in Touch
BOOK NOW

Infants

cropped-Fotolia_5994085_Subscription_Monthly_M
, , , , , , , , , , , , , , , , , , , ,

making mealtimes better

0 Comments

Making Mealtimes Better : Structure, Nurture & Boundaries

Accessible and full of sensible evidence-based information to support feeding young children well, Making Mealtimes Better is on-line workshop series is designed for parents/carers of young children with a variety of food-related behaviours. Delivered by Carine Henry RD, paediatric specialist dietitian, with 30 years of practical working with children and families, in areas of feeding difficulties, growth faltering and tummy troubles.

Making Mealtimes Better provides a space alongside others to listen, learn, share, practice and develop tools and select strategies to make every mealtime better. Carine uses themes of Structure, Nurture and Boundaries to guide topics including:

  • meeting your child’s nutritional needs : key nutrients and food groups
  • expanding food experience : where you are now, next steps and forward planning
  • giving right attention to food and feeding
  • learning to enjoy food and feeding : agency and satisfaction
  • awareness of how emotions impact food, feeding and caring/parenting

Making Mealtimes Better is intended for young children with heightened sensitivity to foods and feeding, and where nutritional wellbeing and growth may be compromised, such as those experiencing :

  • food refusal, feeding aversion, food fears, feeding anxieties
  • prolonged difficulty with expanding to mixed textures of food
  • difficulty introducing new foods and & limited experience of a range of foods
  • prolonged illness at developmentally important phases in feeding
  • highly selective eating and sensory difficulties
  • tantrums at the table, difficult feeding behaviours

In working in this topic, making changes needs a willingness to make change, and the resources to do so … I aim to provide some useful tools. For example applying mindfulness to parenting is about parenting intentionally, and working with being the parent you’d like to be. It’s about being able to press your pause button, when your young child behaves the way they do, noticing what your reactions are and choosing how to respond.

scale-groceries-slate-background
, , , , , , , , , , , , , ,

Iron Deficiency Anaemia in infancy

0 Comments

Iron deficiency anaemia (IDA) is the most common nutritional problem affecting infants with 60% of 6-12 month old babies in the UK having low dietary iron intake, a key risk factor for developing IDA. Early childhood is a time of vulnerability as iron deficiency anaemia in this period is associated with brain development.   It’s a time of rapid physical growth, and a time when dietary iron needs are at their highest. Various risk factors are known to contribute to IDA: particularly premature birth, very low birth weight and maternal iron deficiency.  Infant feeding practices including the introduction of solids are important considerations.  Iron absorption is limited (by the gut) to around 15-20% and this becomes relevant when thinking about choosing iron-rich foods to offer. Iron contained within plant and animal foods differ, with absorption being higher from animal foods, which can be improved in the presence of Vitamin C. Here I provide some information about nutritional needs, dietary sources and infant feeding practices.

Infants’ Nutritional needs and Dietary sources of iron

An essential micronutrient, iron is required to make haemoglobin, the red pigment in haemoglobin, which carries oxygen around the body within the red blood cells. IDA means that the blood carries less oxygen than the body needs.  Infants with IDA will be pale and tired, have poor resistance to infection and their general health, appetite and vitality is limited.  Typically, infants don’t show any signs in the early stages of IDA, and it commonly goes undiagnosed until they become symptomatic. Iron needs are highest at 6-12 months, when term babies will have used up all their body’s stores of iron, which built up during the last trimester of pregnancy. Dietary iron needs rapidly increase then. Introducing iron-rich foods is critical at this age: to provide essential dietary iron, and to introduce and establish the familiar tastes, smells and textures of iron-rich foods.  Red meat, liver, egg yolk apricots, dried fruits, green vegetables, lentils, avocado, oily fish, seed and nut butters are all food rich in iron. The required daily intake of iron for a healthy, term baby is 7.8mg, half of that needed by a women of child bearing age.

Infant Feeding practices and the Introduction of Iron-rich foods

Breast-fed infants need iron-rich foods on a daily basis from the weaning period,  as breast milk contains very little iron. Drinking iron-fortified formula does protect against IDA, but formula-fed infants also need to become familiar with iron-rich foods to broaden their diet. Becoming familiar iron-rich foods at an early age improves acceptance and continual consumption of these foods, throughout toddlerhood.  This applies to other food too, that have been eaten regualrly during the sensitive period at 6-12 month, and infants are more familiar with those foods and have practiced eating them.  First formula milks, those with a higher ratio of whey, are best suited for all babies until 1 year for many reasons, with improved absorption of nutrients including iron; there is none for follow-on formulas, as all formulas comply with standardised contents for key nutrients.

Fotolia_76927403_Subscription_Monthly_M
, , , , , , , , ,

what’s the difference between lactose intolerance and cow’s milk allergy?

1 Comment

Many people are confused about the difference between lactose intolerance and cow’s milk allergy. Misunderstood as same condition; the terms lactose intolerance and cow’s milk allergy are used interchangeably and incorrectly.  Most likely due to the similarity of symptoms such as bloating, wind and diarrhoea;  both being related to drinking milk and alleviated by avoiding it. When I say milk – I mean mammalian milks such as cow’s (including infant formula) goats, sheep and human milk.  So, here is the main difference:  Cow’s Milk Allergy is an immune system response to milk protein, which drives a spectrum of symptoms affecting the skin as well as the tummy.  In the more severe IgE allergic reactions, the mouth, throat and breathing are affected. Lactose intolerance is not an allergy but a physical response due to lack of digestive enzyme lactase required to digest the milk sugar lactose. This blog will give an overview of symptoms, causes and dietary management of lactose intolerance providing further links on products and nutritional information.

Lactose Intolerance
Is a normal response to the presence of undigested lactose (milk sugar) in the large intestine. When lactose digestion fails in the small intestine the lactose sugar travels onto the large intestine where bacterial fermentation, responsible for the characteristic bloating, discomfort and wind, takes place. In the presence of large amounts of lactose, water and salts are drawn into the large bowel (by osmosis) causing increased water volume, urgency to go to the toilet and explosive stools. Lactose is found in milk and dairy products like soft cheese and yoghurts.  Hard cheeses have naturally low levels of lactose, as do products like butter, margarine and double cream.  Adults and older children with established lactose intolerance can typically eat these foods without any problem. Those small amounts of lactose provide food for the friendly lactobacillus bacteria which normal live in the large bowel.

What are the causes of lactose intolerance?
Lactose intolerance itself does not cause damage to the small intestine; rather it’s the result of tissue damage to the intestinal lining which affects lactase enzyme production.  A temporary condition in infants and young children, it will resolve as the gut cells turnover and repair themselves. Lactase enzyme decreases progressively with age with around 70% of the world’s population with limited lactase activity.  Persistent lactose intolerance is uncommon in infants and young children, due to their high milk intake, which maintains enzyme production. Teenagers however may not regain their lactase activity following small intestinal damage or serious infection.  The most common causes of lactose intolerance include:

  • Gastro-intestinal infection with characteristic diarrhoea and vomiting
  • Allergic inflammation, especially with unresolved non-IgE Cow’s Milk Allergy
  • Small bowel bacterial overgrowth eg. in older children, teens

Products and differences in dietary management 
It’s important to understand that the nutritional composition of milk alternatives make them unsuitable as drinks for infants and toddlers, but can be a useful addition to solids, when a nutritious fluid is needed to blend or mix.  When selecting a milk alternative, always choose one fortified with calcium. Lactose free milks and cheeses made from cow’s milk contain cow’s milk protein, making them unsuitable for those with cow’s milk allergy.  Vegan cheeses, whilst lactose and cow’s milk protein free have poor nutritional value and are not fortified with any calcium.  A low lactose diet to treat lactose intolerance is usually followed for between 2 and 6 weeks (depending on severity of symptoms) and a cow’s milk protein exclusion for CMA for at least 6 months. Use this guidance on reintroducing lactose back into the diet  if you had lactose intolerance but do seek further guidance for Cow’s Milk Allergy in Infancy if feeding is difficult and you are unsure about next steps.

lactose-intolerance-image
, , , , , , , , , , , , , , ,

reintroducing lactose back into the diet

0 Comments

Following a 2 – 6 week low lactose diet to treat lactose intolerance, your child should now be well on their way to recovery from symptoms.  Reintroducing lactose back into the diet in a controlled way is the next step. Starting with low lactose foods, then adding in medium and, once you’re satisfied all is being tolerated, finally adding in high lactose-containing foods. Use the guidance below on lactose content of dairy foods to assist you, taking about 2-4 weeks, gradually increasing, will do several things:

  • stimulate production of lactase, the small intestinal digestive enzyme that digests lactose
  • help establish and then increase the amount of dietary lactose that is tolerated
  • assist in the build up and return of normal lactase production in the small intestine

Re-establishing tolerance to lactose
Re-establishing tolerance to lactose varies from child-to-child, depending on age, habitual diet and degree of severity. Because infants and young children are more dependent on a high milk diet, the lactase enzyme returns more readily and lactose intolerance is usually temporary.  Resumption of a normal diet is somewhere between 2-6 weeks for most infants and children. Referred to as secondary lactose intolerance this is often the result of nasty gut bugs like rotavirus, or can be secondary to small intestinal damage caused by untreated cow’s milk protein allergy or coeliac disease. Individuals including older children and teens may develop primary lactose intolerance or a permanent reduction in lactase enzyme, more typically affecting non-caucasian children and those with a habitually low milk/no milk intake following a similar route via infection of small intestinal irritation.  Amounts of 2 – 4g lactose per day are usually well tolerated despite the lack of lactase enzyme.  Instead lactose is digested by the lactobacillus bacteria, naturally residing in the large intestine.

Other points worth noting about lactose intolerance and reintroduction

Special care with infants
Formula fed babies with lactose intolerance, need a lactose free formula. Lactose intolerance may also occur in breast-fed babies but is less common; only in very rare congenital primary lactase deficiency would there be a need to stop breast feeding and use a lactose free formula. What is important, is to correctly identify if cow’s milk allergy are the cause of the symptoms, to ensure that infants get the right dietary treatment. Products in the shops vary enormously in nutritional composition, and are not suitable to drink because of poor nutritional quality.

Lactose content of dairy foods

Very Low Lactose

< 2g per portion

 Medium Lactose

2-4g per portion

 High Lactose

4-6g per portion
The foods in this group contain very low amounts of lactose and are tolerated by most people with lactose intolerance.  If consuming these foods does not give any symptoms, try medium lactose foods per portion. Continue to introduce lactose containing foods, including foods with medium lactose. If symptoms return, go back to the previous tolerated stage for 2 weeks and try again. In addition to very low and medium lactose content foods, continue to introduce lactose-containing foods, including one portion from the high lactose category.
Cheese 1oz
Most hard cheeses have very small amounts of lactose and are unusually well tolerated. Eg. cheddar, red leicester, caerphilly, stilton, parmasan Cheese spread, cottage cheese, soft cheeses eg. ricotta, marscapone, dolchelate Cheese spread, quark

 
Yoghurts & fromage-frais 60g 125g Larger portion
Greek yoghurt, Goat’s yogurt, all yoghurts and fromage-frais Yoghurts and fromage-frais, Low fat fruit yoghurts, Organic whole milk yoghurt Natural whole or fruit yoghurt, Low fat natural yoghurt, Diet/low calorie yoghurts
Dairy desserts & creams 2oz 4 – 6oz Larger portion
Half fat cream, Single, Double, Whipping, Clotted cream, UHT Spray Cream, Fresh Cheese Cake 1 scoop ice cream, Frozen cheesecake, Trifle with cream, 1 chocolate mousse 2 scoops ice cream, 10mls Angel Delight, 150g tinned rice pudding, 100mls Custard
Hidden milk
1 x small slice cake, 4 chocolate digestives, 1 chocolate coated biscuit eg. 2 finger kit-kat, 100g egg custard tart 1 milk chocolate bar, 125mls whole milk, 70mls evaporated milk, 1 tblsp skimmed milk powder, 40mls condensed milk
Fotolia_76927403_Subscription_Monthly_M
, , , , , , , , , , , ,

good sources of calcium

1 Comment

Infants and children need good sources of calcium in their diets on a daily basis. Calcium absorption in the gut is variable and ranges from 25-50%, increasing when intake is low and reducing when intake is high. Plenty of foods rich in calcium are especially important throughout infancy to support the rapid bone growth and bone mineralisation that occurs at this time. The uptake of calcium by bones is then regulated by Vitamin D, with Vitamin D deficiency limiting bone mineralisation even in the presence of adequate calcium.  Growth spurts during infancy and childhood, from a surge in growth hormone provides a boost to calcium absorption, which further strengthens bone mineralisation. Absorption of calcium from breast milk is very efficient at around 66% and from formula milk around 40%.   For all infants and young children offer them calcium rich foods every day.

  • Dairy products like milk, cheese and yoghurt are the UK’s best sources of calcium for infants and young children
  • Calcium is also found in tinned fish, nut butters, tahini or sesame seed pulp, hummus, figs, dates, and green vegetables
  • White wheat flour is fortified in the UK with 120mg Calcium per 100g
  • Water in areas of hard water like Cambridge contains 120mg calcium per litre
  • For all children with cow’s milk allergy, take care to offer calcium enriched products, checking sources of other valuable nutrients such as protein, iodine, Vitamin D as well as overall calories
  • Prolonged poor calcium intake will lead to brittle bones that break more easily, both in childhood and in later adulthood
  • Exercise and weight bearing activity will also strengthen bone
  • Have a quick check on recommended intakes to check if your child is getting enough calcium
  • Download the portions of calcium rich foods below
  • Infants and young children need a Vitamin D supplement containing a minimum of 10ug daily until 5 years and thereafter for a minimum of the 6 Winter/Spring months to maintain good levels

Recommended Intakes

  • Daily calcium needs during infancy are 525mg 
  • 5-600mls formula provides the majority of calcium during infancy
  • Breast fed infants depend on mum’s diet, and a calcium and vitamin D is advisable for mum
  • Daily calcium needs during early years are 350-450mg; provided by 3-4 portions of calcium rich foods
  • Daily calcium needs during primary school are 450-700mg; provided by 4-5 portions of calcium rich foods
  • For all children with cow’s milk allergy, take care to offer calcium enriched products, checking sources of other valuable nutrients such as protein, iodine, Vitamin D as well as overall calories.

 

IMG_1876
, , , , , , , , , ,

nutritional composition of milk alternatives

0 Comments

If you have a child who has lactose intolerance or cow’s milk allergy, chances are you need to think about the nutritional composition of milk alternatives. Cow’s milk and its products are good sources of calcium and trace elements like iodine in the UK diet.  As someone who takes nutrition seriously, a Paediatric Dietitian and mother of 3 growing teenagers, I would like to point out that the nutritional composition of milk alternatives available in our shops is shockingly poor.  It does not serve consumers well, has insufficient nutrition for infants, children or teens, and for those who depend on the nutrients milk would normally provide.  The missing nutrients and their physiological roles are as follows:

  • calcium – for growth and maintenance of strong bones, blood clotting
  • iodine – for neurological development during pregnancy, control of metabolism, thyroid function
  • Vitamin B2 – for healthy skin, eyes and nervous system, releasing energy from food
  • protein – for growth and repair of all body tissues, immune function
  • Vitamin B12 – assists in maturing red blood cells, absorption of iron
  • lactose – the milk sugar – food for the beneficial lactobacillus genus of bacteria, maintenance of a healthy intestinal microbiota

Exciting range of nut milks
I was quite excited to see such an explosion of nut milks now routinely available; and on researching this recently, felt somewhat aggrieved to see such poor nutritional composition.  Nuts are one of nature’s most incredibly nutritious foods – high in calories, protein, essential fats, minerals like zinc, calcium, iron and magnesium as well as B vitamins. They are also (currently) fairly conflict-free and sustainable. There are not many foods you can say that about! Unfortunately none – and yes I do actually mean NONE – of that goodness is retained in the resultant, washed out and expensive product marketed as milk.  Some have no calcium, no protein, no minerals no vitamins, and poor calories. Mil for mil they are 7 times the price.

Compare the nutritional composition of milk alternatives in the chart below, and take care to ensure that you choose ones with higher calories and protein for young children, ensuring they are fortified with calcium, and where possible Vitamin D and other vitamins.

Type of Milk Calories Protein Calcium Vitamin D Extras
Whole Cow’s Milk 69 3.3 120 Low Wide range of nutrients
Cow’s Milk formula 66 1.3 65 1.2 Full range of nutrients
Mature Breast Milk 67 1.3 35* Varies Wide range of nutrients
Goats Milk 70 2.8 120 Low Wide range of nutrients
Arla Lactose Free Milk 56 3.3 120 Low Wide range of nutrients
KoKo unsweetened 16 0.2 120 0.75 Nothing
Oatly Original 46 1.0 120 1.5 Vitamins
Innocent Hazelnut Milk 72 1.0 0 0 Nothing
Innocent Almond Milk 37 1.4 0 0 Nothing
Alpro Soya Original 42 3.3 120 0.75 Vitamins
Alpro Cashew Milk 23 0.5 120 0.75 Vitamins
Alpro Soya Growing-Up 1-3 64 2.5 120 1.5 Iodine, Vitamins
Rice Dream plus calcium 50 0.1 120 0.75 Not for <5years
  • absorption of calcium from breast milk is extremely efficient, but infants needs for calcium from 6-12 months through are high.  Check out  good sources of calcium if weaning your cow’s milk allergic infant.
abefc505-e97d-49cf-9810-0152fd20afd6-5-e1522352274465
, , , , , , , , , , , ,

innovative treatments in cow’s milk allergy

0 Comments

Innovative treatments in cow’s milk allergy is the last in this 5-part blog series on Cow’s Milk Allergy in Infancy and is best read following positive outcomes for cows milk allergy.

Infants who develop Cows Milk Allergy (CMA) usually outgrow it before they start school. Until recently, dietary treatment was based on strict cow’s milk avoidance for long periods; typically 1-2 years. Introduction is now advised at an earlier age, especially for those with delayed reactions affecting the gut. Starting with tiny amounts of baked milk as early at 9 months, identifies those infants who are ready to start building tolerance. It is now believed that strict avoidance for long periods is unhelpful in promoting tolerance.¹ Infants with more severe (IgE) reactions do take longer to outgrow their allergy, and care needs to be taken to make introductions safely for those infants.

Active Allergy Management
Active Allergy Management is one of today’s most innovative treatments in cow’s milk allergy. It can be described as the deliberate, early introduction of tiny amounts of milk proteins in a controlled way. Effective and safe for the majority of infants with CMA, the timing of this introduction depends upon age and the type and severity of previous reactions. See my blog identifying symptoms of cow’s milk allergy for more information. Tolerance to baked milk is now used as a marker of readiness for the next steps of cows milk reintroduction.²  This step-wise approach is known as the Milk Ladder, the earliest introduction of which can begin for non-IgE CMA around 9 months. Actively exposing an infant and educating the immune system in this way, enables young children to eat a normal diet at any earlier age.

The Infant Microbiota
The infant microbiota describes the total number of microbes living in an infants gut. Recent research shows earlier tolerance to cow’s milk using CMA treatment formulas with the added probiotic microbe strains Lactobacillus rhamnosus or Bifidobacteria breve . Other treatment formulas with added prebiotic co-factors (specialised sugars called oligosaccharides) may also be helpful, by providing food for these beneficial microbes. Breast feeding is known to be protective for food allergy. Although the mechanisms are not entirely understood, the higher numbers of lactobacillus and bifidobacteria which dominate the microbiota of breast fed babies are likely to be involved. Intimately involved with educating the immune system, the infant microbiota has a key role to play in allergy development and management.  Specialised formulas are now available (on GP prescription) which mimic the breast milk provision of those beneficial microbe species alongside prebiotic co-factors that help colonise the infant microbiota, with earlier resolution for children with Cow’s Milk Allergy.

  1.  Dietary baked milk accelerates the resolution of cow’s milk allergy in children, Kim JS et al 2011
  2. Tolerance to baked and fermented cow’s milk in children with IgE mediated and non IgE mediated CMA in patients under 2 years, Uncuoglu A et al, 2017

Next An introduction to the Infant Microbiome

abefc505-e97d-49cf-9810-0152fd20afd6-4-e1522349741874
, , , , , , , ,

positive outcomes for cow’s milk allergy

0 Comments

Positive outcomes for cow’s milk allergy is the 4th in the 5-part blog series on Cow’s Milk Allergy in Infancy and is best read following treatment options for cow’s milk allergy.

Around 50% of infants with non-IgE Cow’s Milk Allergy tolerate milk by age 1. Positive outcomes for Cow’s Milk Allergy depend on a number of factors including the type and severity of symptoms; the length of time taken to confirm a diagnosis; and the infants ability to tolerate exposure to baked and fermented milk. Good ongoing dietary management and support, helps those positive outcomes for cow’s milk firstly by ensuring symptoms are settled and supported with a milk free diet whilst breastfeeding or with the most suitable formula. Mum and baby can then develop confidence with feeding; mum managing the learning curve of a cow’s milk free diet, and baby learning that feeding doesn’t hurt.

Active Allergy Management
Only once there are no residual symptoms for at least 3 months exposure maybe considered; firstly to small amounts of baked milk and then fermented milk or yoghurt.  Active Allergy Management involves the deliberate introduction of small amounts of milk proteins at the right time. This helps to educate the immune system and develop tolerance.  Acquiring tolerance in this way speeds up the return to a normal diet. Considerations then:

Type and severity of symptoms
Infants with severe or immediate reactions (IgE) take longer to out grow their allergy. Those infants should not consume cow’s milk products within the first year after diagnosis, although 75% can tolerate small amounts of yoghurt by age 2.   For delayed reactions (non-IgE) such as reflux – see identifying symptoms of cow’s milk allergy most infants (>50%) have outgrown their allergy by their first birthday.

Length of time taken to confirm a diagnosis
In a 2015 survey, the average length of time taken to confirm a diagnosis was 4-5 weeks and 10 GP visits.  I am now seeing infants at a much earlier stage, due mainly to increased awareness in GP’s and in families. Early intervention is the key to seeing those positive outcomes for cow’s milk allergy at an earlier stage. In general, the longer it takes to identify symptoms, and confirm a diagnosis the longer it will take to acquire tolerance.

Ability to tolerate exposure to baked and fermented cow’s milk
Exposure and tolerance to baked and fermented cow’s milk, with the use of the Milk Ladder has seen more positive outcomes for cow’s milk allergy at an earlier stage. The Milk Ladder provides evidence based stepwise reintroduction of milk products; which can usually begin around 9 months of age. The latest version is available to download from the Allergy UK website.

Next Innovative Treatments in Cow’s Milk Allergy

abefc505-e97d-49cf-9810-0152fd20afd6-3-e1522350090337
, , , , , , , , , , , , , , , , , , , , , ,

treatment options for cow’s milk allergy

0 Comments

Treatment options for cow’s milk allergy is the 3rd in this 5-part blog series on non-IgE Cow’s Milk Allergy in Infancy and is best read following confirming a diagnosis of cow’s milk allergy.

 

Treatment options for cow’s milk allergy in infancy depend on the severity of symptoms and whether breast, formula or combination feeding is the preferred choice for parents.  An allergy focused clinical history taken by a GP or Paediatric Dietitian, will have the key information on which the best treatment options for cow’s milk allergy can be considered for both mum and baby.

Considerations

  • Breast feeding the cow’s milk allergic infant
  • Supplementary calcium, iodine and Vitamin D for mum
  • Advantages of continuing breast feeding for mum and baby
  • Alternative formulas for the cow’s milk allergic infant
  • First line prescription formulas
  • Symptoms requiring a more specialised formula

Breast feeding the cow’s milk allergic infant
Breast feeding can safely continue in the knowledge that it is protective for the allergic infant, with many advantages.  But it’s not without it’s challenges! Strict avoidance of all cow’s milk and it products, including the small amounts hidden in foods, will resolve the symptoms.  Mum needs to follow a well-balanced but strictly cow’s milk free diet at a time when her needs for nutrition are especially high. The widely available range of milks such as soya, oat, rice and nut milks are low in nutritional value and make a poor contribution to mums’ nutritional needs.  Mum needs to be committed and knowledgeable about her own needs.  For mums whose weight is low or who struggle to eat enough, or for mums who are having difficulty coping should seek further advice if they wish to continue breast feeding.  For babies with severe atopic eczema and poor weight gain, a formula milk should be considered.

Nutrition for mum and baby
Cow’s milk (and it’s products) are the principal source of calcium and iodine in UK diets, with needs increased during pregnancy and lactation by around 50-66%. Calcium is of central importance for women’s bone health and iodine for foetal and infant brain development and function.  Vitamin D is limited in foods but essential to ensure calcium is absorbed into bone and together with calcium and iodine should be taken in supplement form.

Breastfeeding Pros for baby Pros for mum
  • Improved immune development
  • Reduced incidence of ear, gut and respiratory infections
  • Enhanced tolerance to new foods
  • Enhanced taste development, facilitating broader weaning foods
  • Development of varied Microbiome, enhancing immune development
  • Bonding with baby
  • Helpful in return to pre-pregnancy weight
  • Reduction in breast cancer risk
  • Convenience and low cost
  • Bonding with baby

Alternative formulas for the cow’s milk allergic infant
Soya or goats milk formula are not recommended as treatment options for cow’s milk allergy in infants: 50 – 66% of infants will have immune reactions similar to those in cow’s milk allergy. Broadly, two types of formula are available as treatment options for cow’s milk allergy in infancy – peptide (EHF) or amino acid (AA).   The first treatment option is an extensively hydrolysed formula (EHF), in which the proteins are hydrolysed, “digested” or  broken down into short chains called peptides. The immune system does not recognise these peptides as cow’s milk protein in 90-95% of infants with non-IgE CMA, and the EHF is well tolerated.  There are a variety of EHF types and brands available on prescription, subtely suited to different needs, and is one area of a Paediatric Dietitian’s expertise.  Current EHF formulas are available with or without lactose (the milk sugar); casein (curds) or whey based protein; first or second (follow-on) milks with added iron and calcium.  Lactose has the advantage of making the formula taste better, but may not be well tolerated in infants with delayed diagnosis. Whey based formulas tend to empty from a baby’s tummy more quickly and may help improve symptoms of reflux. Second or follow-on milks are only suited for babies over 6 months.

Symptoms requiring a more specialised formula
For infants who develop symptoms of cow’s milk allergy during exclusive breast feeding, have severe symptoms or who are symptomatic following a 2-4 week trial on an EHF, an amino acid formula (AA) is indicated.  Proteins in this type of formula are further broken down from peptide chains into individual units called amino acids and are well tolerated by almost all infants.  As an expensive option (£30 per tin) careful consideration is given to its prescription.

Next Positive Outcomes for Cow’s Milk Allergy

abefc505-e97d-49cf-9810-0152fd20afd6-2-e1522077064850
, , , , , , , , , , ,

confirming a diagnosis of cow’s milk allergy

0 Comments

Confirming a diagnosis of Cow’s Milk Allergy is the 2nd in this 5-part blog series about Cow’s Milk Allergy in Infancy and is best read following identifying the symptoms of cow’s milk allergy.

Common symptoms of CMA eg. loose stools, pain/colic and reflux frequently occur in babies without CMA.  This makes the diagnosis a bit tricky.  CMA is more likely when there are at least two significant problems present which impact the baby’s wellbeing, growth or feeding.  In the absence of reliable tests, the following diagnostic pathway is used by GP’s, Paediatricians and Paediatric Dietitians in order to confirm (or exclude) a diagnosis of cow’s milk allergy.

  1. An allergy focused clinical history including questions about family and individual atopy (eczema, asthma, hayfever), infants feeding and growth history, signs and symptoms focused on the gut, skin and respiratory systems, details of previous management.
  2. If the history is suggestive of Cow’s Milk Allergy, determination of whether symptoms are likely to be IgE (immediate) or non-IgE (delayed) and referral for allergy tests if IgE suspected.  The severity and timing of reactions being important. A 2-4 week trial of a strict cow’s milk exclusion diet with suitable formula, or maternal avoidance if breast feeding, with advice on supplementation of 1000mg Calcium + 10ug Vitamin D.
  3. Resolution of symptoms during the exclusion followed by obvious and confirmed relapse on re-introduction (formula or maternal consumption if breast-feeding) confirms the diagnosis.
  4. A diagnosis can only be made following a planned reintroduction of cow’s milk, which has resulted in the relapse of symptoms, mostly commonly in in 4 out of 5 infants following this diagnostic pathway.

Confirming a diagnosis of cow’s milk allergy in a timely manners and ensuring the most appropriate treatment and support is important for a variety of reasons.  For non-IgE CMA (delayed reactions) – gut symptoms resolve, pooh habits improve, tummy’s are more comfortable, eczema improves, feed volumes increase, infants are happier feeding, positive associations with feeding are made.  All of which support growth & feeding development, which in turn makes the next steps in feeding ie. weaning to solids, run much more smoothly.  Sleep is improved for all and parents anxiety is reduced – mostly!  So, just a few things then! Timely treatment also reduces risks to the baby of developing other food allergies, which are related to the presence of atopic conditions such as infant eczema.

Non-IgE Cow’s Milk Allergy is the first and most common food allergy to develop, affecting around 5% of infants in the UK, both in exclusively breast-fed and bottle-fed babies, and usually treated by the GP.  A diagnosis can be made anytime during the first year, and will depend on the severity of symptoms, other co-exisiting conditions eg. eczema and feeding or growth related difficulties.

Next Treatment options for Cow’s Milk Allergy

 

Load More

Asset 38

Join the Community and Receive Monthly Newsletters Straight to Your Inbox

Newsletter
Consent

© Paediatric Nutrition

Website Designed & Developed By Blue Whale Media