“Although breastfeeding is best for most children, very sensitive babies can have allergic reactions. This may because they react to the small amounts of cows’ milk
proteins that pass from mother to baby in the breast milk”
down into smaller pieces and so baby’s immune system is less likely to identify them as harmful.
Most infants with cMa will be able to tolerate hypoallergenic formulas, but for those who still have symptoms on an extensively hydrolysed formula, an amino acid formula is required. This formula is not based on cows’ milk at all and the protein is completely broken down.’
Soya formula
Soya infant formula is not recommended for babies under six months of age, due to the
phytoestrogen content. In babies over six months of age, it is best not to use soya formula, soya milk or soya products until this has been discussed with a gP or midwife.
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• have a family history of milk or other food allergy. Studies have proved that a person’s risk of developing a food allergy such as cMa increases if one or both parents have a food allergy or another type of allergic disease, such as hay fever, asthma or eczema. • have atopic dermatitis. children who suffer from this condition – a common, chronic inflammation of the skin – are at much greater risk of developing cMa.
unfortunately, children are at increased risk of developing cMa due to their young age. as they mature, their digestive systems mature and they may grow out of the reaction to milk.
Sources of cows’ milk naturally there are obvious sources of cows’ milk. These include:
• Whole milk, low-fat milk, skimmed milk, buttermilk
• Butter • yogurt • Ice cream • cheese and anything that contains cheese
Worryingly, however, cows’ milk is often used as an ingredient in processed foods including baked products and processed meats. as such, ‘hidden’ sources of cows’ milk include: • Whey • casein
12 - ScOTTISh PharMacIST
• Ingredients with the prefix ‘lact’, eg, lactose and lactate
• Sweets such as chocolate and caramel
• Protein powders • artificial butters
even if a food is labelled ‘milk free’ or ‘non dairy’, it may contain allergy- causing milk proteins and so anyone affected by cMa should read labels very carefully.
So what’s the alternative? Well, for young children, who have cMa, parents are advised to either breastfeed or use hypoallergenic formula, which can help to prevent allergic reactions.
Breastfeeding
Breastfeeding has long been acknowledged as the best source of nutrition for babies, since research has shown that breastfeeding reduces baby’s risk of developing chronic conditions, such as Type I diabetes, coeliac disease and crohn’s disease.
The World health Organization (WhO) recommends breastfeeding exclusively for the first six months as breast milk contains antibodies which will help a baby’s immune system develop and protect against certain infections. normally babies will not develop allergic symptoms while being exclusively breastfed.
although breastfeeding is best for most children, very sensitive babies
can have allergic reactions. This may because they react to the small amounts of cows’ milk proteins that pass from mother to baby in the breast milk. If this happens, the mother should be advised to eliminate cows’ milk, dairy products, and all products containing cows’ milk from her diet.
Hypoallergenic formulas If breastfeeding is not possible, then hypoallergenic formulas are generally recommended. These formulas hydrolyse or break down milk proteins such as casein or whey. Some hypoallergenic formulas aren’t milk based but instead contain amino acids.
unfortunately, it can be difficult to get a baby or young child to accept a different formula. hypoallergenic formulas also have a different taste and smell to ordinary infant formula. Most babies under three to four months of age will, however, readily accept the change.
If babies are refusing the change in the formula, then it can be introduced gradually over a few days by being mixed in baby’s usual milk. In babies who are solely infant formula fed or are given infant formula in addition to breast milk, the formula will need to be changed to a hypoallergenic (low allergy) infant formula. extensively hydrolysed infant formulas still contain cows’ milk protein, but the proteins are broken
Soya-based formula is fortified to be nutritionally complete, but some children with cMa also develop an allergy to soya and so this type of formula may be a non-starters.
Symptom resolution If a baby or young child has been diagnosed with cMa and cows’ milk protein has been successfully eliminated from their diet, then an improvement should be noted almost immediately in terms of allergic reaction. If, however, the cows’ milk- free formula is stopped when symptoms have disappeared or if the mother consumes cows’ milk protein as part of her own diet, then it is possible for symptoms to return very quickly.
Milk substitutes for older children
alternative milks can be used in cooking and on cereal in babies from six months of age. These alternatives include those based on plants such as oat, coconut, hemp, quinoa and pea, and can be given to a baby or young child provided they have not previously reacted to these foods.
nut-based milks such as almond and hazelnut should only be used as a substitute where nut allergy does not exist and on the advice of a gP or midwife.
rice milk should be restricted due to its naturally occurring arsenic content and is not suitable as a main milk drink for children under four and a half years of age.
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