Milk intolerance and allergyMILK PROTEIN ALLERGY A: It does sound as though your daughter may have a cow's milk protein allergy. However, it sounds as though her symptoms have not completely settled since she was changed to soya milk at six months. It may therefore be that there is milk or other dairy foods 'hidden' in some of the foods that she eats. Cereals, pasta, commercial baby foods, and bread and cakes, can all contain milk. As your daughter has dropped through the centiles it would be quite reasonable for your GP to arrange a referral to a paediatrician to confirm the diagnosis of cow's milk protein allergy and to establish whether there might be any other reason for her poor weight gain. If there is any suspicion that your daughter is anaemic a blood test will quickly establish whether this is the case or not. Her bowel habit is not necessarily abnormal but is compatible with
either cow's milk protein allergy or other conditions which affect
bowel function. Her continued vomiting also points to an ongoing
problem, and I would suggest that you arrange to see your GP again to
discuss this issue and to express your concerns. If you are worried
about doing this for whatever reason you might find that your Health
Visitor could speak to your GP and suggest that a referral is made. MILK INTOLERANCE A: Any change in diet can lead to a change in bowel habit, and this is likely to explain the change that you have noticed over the last month. If your daughter is otherwise well there is nothing to be concerned about. Cow's milk protein intolerance is the commonest food intolerance. Symptoms can range from those that occur quickly after eating or drinking the food e.g. wheezing, watery eyes, sneezing and facial rash; to those that are more chronic and less easily linked to the food eg. diarrhoea, vomiting, abdominal discomfort and poor weight gain. Only by cutting out the offending food can you be sure of the diagnosis. Some children with this problem have trouble only if they have milk itself, whereas others cannot even cope with related foods such as yoghurt and cheese. Milk is often present in processed foods and may be listed as whey, casein or sodium caseinate. Cocoa mixes, gravies and sauces often contain milk. Initially the advice is usually to cut out all dairy foods and if the symptoms improve, a gradual reintroduction of foods can begin. For those who are unable to have dairy products, calcium is present in good quantities in fish, eg. salmon and sardines, in dried fruit, eg. raisins and apricots, and also in green vegetables and soya products. It would certainly do no harm to use a follow-on formula and to
introduce cow’s milk slowly in a few months. REINTRODUCING MILK TO MILK_INTOLERANT BABY A: I do not think that you have too big a problem here,
although I would say that your son is probably receiving too much milk,
rather than not enough and he needs to move away from jars of baby food
on to family foods. At this age your son should be taking more or less
the same food as the rest of the family. Commercial baby foods and milk
is not enough to keep him satisfied, this may be why he is crying more
lately. It is a good idea to start mixing foods in with the jars, so
that he can move away from baby food on to family foods. I think that
you should speed up the process. He should have milk with his breakfast,
8oz is fine, to have a drink and mix with cereals. Then he only needs
6-7oz at night. If you want him to have milk products in the day, you
can cook with soya milk, so that he could have milk puddings, milk
jelly, sauces etc. It sounds as though he is not ready to start taking
cows milk products yet, and I would not introduce any more until you see
the doctor in August and explain about the problems your son has
experienced with milk. It will not be a problem to keep him on soya milk
for a while longer. If you are concerned about his diet, you could ask
your doctor to refer your son to a paediatric dietician, who will help
you to ensure that he is receiving a good diet. The dietician will also
be able to advise you about how and when to re-introduce cows milk
products and appropriate dairy food substitutes. Gluten and wheat intoleranceGLUTEN/WHEAT INTOLERANCE SYMPTOMS A: Allergic reactions to wheat and gluten vary from severe and dramatic to mild and vague. The most serious reaction to gluten is that which occurs in children with coeliac disease. This is a condition in which there is an abnormality of the gut, such that when gluten is ingested, there is a response in the lining of the gut. The result of this is that absorption from the gut is then dramatically impaired. The usual symptoms of irritability, frequent foul-smelling stools, abdominal swelling, and failure to grow properly, usually appear in the first two years of life. Less severe dietary intolerances can occur, and vomiting, diarrhoea, eczema, and poor growth, as well as allergic skin rashes and difficulty with breathing can all result from such intolerances. When reactions occur quickly after ingesting a particular food, it is often straightforward to determine the cause of the reaction, but sometimes symptoms appear slowly and are less easily linked to the offending food. Food allergies do change. They may lessen as the child gets older, though some worsen; others disappear entirely. Sometimes the effect is related to the amount of the offending food ingested, while sometimes even the tiniest hint of the food will cause a reaction. If you have serious concerns that your son may be intolerant or
allergic to wheat or gluten, it would be wise to discuss this with
your GP. He or she may advise that you are referred to a paediatrician
with a special interest in allergies in children. AVOIDING GLUTEN AND DAIRY PRODUCTS Gluten should only be given to babies over four months of age, but
as the official advice is only to commence weaning from four months,
it does not really matter as much as it used to in the past (when
babies could start weaning from three months of age). However, gluten
should only be excluded on medical advice. I feel that this goes for
dairy products as well. It is very difficult to exclude dairy products
from a diet and this should only be attempted on medical advice. Your
child needs a good varied diet in order to grow and develop healthily.
The exclusion of any type of food needs to be done carefully and under
the supervision of a dietician.
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