It’s easy to get confused between lactose intolerance or an allergy to cow’s milk. But the two are very different and can cause different symptoms in babies whose main nutrition comes from milk. It’s estimated around 1 in 10 young children react when they drink cow’s milk, either because of an intolerance to the lactose (sugar in milk) or the protein in cow’s milk.
Put simply, lactose intolerance is a problem in the gut and cow’s milk protein allergy causes a reaction in the immune system.
Cow’s milk what?
The first time many mothers hear of a cow’s milk protein allergy – CMPA is when it’s suggested their baby may be affected. This is often suspected when a baby is very unsettled and doesn’t calm with usual soothing strategies. Both breastfed and formula fed babies can have CMPA.
Symptoms of cow’s milk protein allergy
Irritability or ‘colic’, vomiting, blood and mucous in the stools (poos), skin reactions including eczema and a bloated, distended tummy are common symptoms of CMPA. There can also be other symptoms affecting the baby’s breathing, such as wheezing, a runny nose or a cough.
Reactions to cow’s milk protein are generally mild to moderate, but sometimes a child can have a severe allergic reaction or anaphylaxis. Parents need to carry an Epipen if their child has been diagnosed as having anaphylaxis to milk and dairy foods.
The only way to avoid CMPA symptoms is to avoid all cow’s milk, and foods which contain milk, until the child outgrows the allergy. It’s estimated that 50% of children outgrow CMPI by 1-2 years and 80% before the age of 4.
What exactly is CMPA?
Cow’s milk protein allergy is one of the most common allergies in the first year of a child’s life. It happens when the baby’s immune system responds in an abnormal way to the proteins in cow’s milk. The baby is exposed either through breastfeeding, or from formula which is made from cow’s milk. Reactions can happen immediately, or after few hours – even up to 48 hours after the baby has ingested the milk.
It can take a while to diagnose a baby with CMPA because the symptoms can be similar to other issues.
But I’m breastfeeding!
Babies with CMPA need to have all cow’s milk protein removed from their diet. Sometimes, breastfeeding mothers are advised to exclude all milk and dairy foods from their own diet, though this isn’t always helpful. It also places her at risk of not getting enough nutrition to support her own health. A referral to a dietician is beneficial if a mother has been advised to avoid eating dairy foods.
Mothers who do remove all dairy from their diet need to take calcium and vitamin D supplements daily.
I’m formula feeding my baby – what milk can they have?
Babies who are not breastfed need to have a suitable formula. Alternative milks for babies with CMPA are readily available, though some need a prescription from a doctor or paediatrician. Most babies with a CMPA are able to tolerate soy milks, unless they’re allergic to soy as well.
Often, babies with CMPA are prescribed cow’s milk formulas which have been ‘hydrolysed’. This means the milk powder has been treated with enzymes to break down the cow’s milk proteins. Amino acid-based and rice protein based formulas are other options, if a baby reacts to hydrolysed cow’s milk formula.
Remember
It’s important not to assume your baby has an allergy to cow’s milk or has other intolerance issues e.g., lactose. Only a qualified health practitioner, such as a paedatrician or allergy specialist can diagnose a true food allergy by taking a thorough history and doing allergy testing.
Babies rely on excellent nutrition to meet their growth and developmental needs. Excluding nutrients and fats from their diet can affect them in many ways. This is why it’s important to always see a tertiary qualified health expert before making any changes to your baby’s diet. Doctors, paediatricians, child health nurses and dieticians are all qualified to offer evidence based guidance on managing your baby’s feeding.
For more information check
Allergy Testing – Australasian Society of Clinical Immunology and Allergy (ASCIA)
Cow`s milk (dairy) allergy – Australasian Society of Clinical Immunology and Allergy (ASCIA)
Milk intolerance in babies and children | Pregnancy Birth and Baby (pregnancybirthbaby.org.au)
Written for Infacol by Jane Barry, Midwife and Child Health Nurse, February 2022.
