<< Milk allergy

Milk intolerance and allergy

MILK PROTEIN ALLERGY
Q: "Between one and six months my baby's weight was consistently between the 25th and 50th centile. She is now a year old and her weight has dropped to the 9th centile. She is allergic to cow’s milk protein - while I was breastfeeding if I ate dairy products she would react with vomiting, severe abdominal pain, streaming nose and diarrhoea. I weaned her onto soya milk at six months and it’s since then that her weight seems to have fallen off. She has two to four very large, smelly loose stools a day and has frequent cold and ear infections. Our GP sent her stools for culturing, which produced a negative result. Other than being a really poor sleeper, and still vomiting nearly once a day, she is very happy and active. My GP thinks she may be anaemic, but that otherwise she’s fine. Should I insist that she be investigated further, or am I being neurotic?"

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.
Dr Jo Lee, Babyworld Doctor.

MILK INTOLERANCE
Q: "My daughter was one last week. She was breastfed until 10 months (obviously with solids as well from four months). From around eight months, she had some cow’s milk or formula as an occasional drink or in other foods, but breastmilk was still her main drink. When I gave up breastfeeding, she had a combination of cow’s milk or formula throughout the day. However, about three weeks ago I put her fully onto cow’s milk. I have just realised that, roughly since then, she has had looser and more frequent stools – not diarrhoea exactly, but looser as they had been quite firm. I had put this down to teething (reluctantly, because I know you can't put everything down to teething) but she has been fine in every other way, and I had her checked by the GP who agreed. Tonight, I got her some follow-on milk to see if this makes any difference, in case I am giving too much cow’s milk too soon. Could she have a slight intolerance? Should I wean her on to it in a few months gradually?"

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.
Dr Jo Lee, Babyworld Doctor.

REINTRODUCING MILK TO MILK_INTOLERANT BABY
Q: "My son is almost one. He is milk intolerant as diagnosed when he failed to thrive. At nine months he was put on soya formula and has done very well since, climbing back up from below the bottom centile (he was on the middle one when he was born). On the advice of the doctor I am re-introducing milk products back into his diet, but with little success. Yoghurts make him sick still (he doesn't like the soya ones either), cheese seems to be ok, but he has now developed bad eczema on his face. Milk in biscuits etc. has the same effect. I am persevering until my next visit to the doctor in August. Is my son missing out on any nutrition if I can't get him back on dairy products? He eats jars only, although I am having some success in mixing green vegetables in with them. He eats any fruit, most vegetables, small chicken and beef, rusks, Marmite, bread and porridge and he drinks water only plus his formula. What should I substitute for milk to give him proteins etc.? Also, over the last couple of days he has started refusing his bottles, crying lots, particularly before he goes to sleep. He usually drinks 30-35oz of soya a day. Now he is taking maybe 8oz + 2oz + 2oz plus 6-7oz at night. Is this enough – especially as he is not eating yoghurts etc. to make up for it?"

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. 
Debbie Honer, babyworld health visitor 

Gluten and wheat intolerance

GLUTEN/WHEAT INTOLERANCE SYMPTOMS
Q: "Please can you tell me what the symptoms of wheat/gluten allergy are. Based on what my toddler eats, I am sure this is the cause of his periodic vomiting."

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.
Dr Jo Lee, Babyworld Doctor

AVOIDING GLUTEN AND DAIRY PRODUCTS
Q1: "I am beginning to wean my four-month-old and understand that there are certain foodstuffs you should avoid giving your baby if close family members suffer with allergies (i.e. gluten, dairy products). My partner suffers with eczema and has had asthma in the past, and his sister is a chronic asthmatic. Is it safe to introduce these foodstuffs after six months or should I wait longer to be on the safe side?"
Q2: "At what stage can you start to introduce foods which contain gluten into a baby’s diet? The reason I am asking is because I have noticed some baby foods that are manufactured and labelled for consumption by babies from four months contain gluten and I am now confused."

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.
Debbie Honer, Babyworld Health Visitor

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