Food Allergy Living Blog Tagged Results


cow milk allergy

World Allergy Organization: Cow’s Milk Allergy Guidelines

Posted 3.24.11 | Christine Graham-Garo

A few weeks ago I had posted some highlights from the U.S. National Institute of Allergy and Infectious Disease (NIAID) guidelines on food allergies that came out in December 2010.

Today I wanted to share the World Allergy Organization’s (WAO) guidelines on cow’s milk allergy (CMA). WAO is a leading source of allergy information worldwide for medical professionals and consumers. The WAO Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines were released in April 2010. They are open to the public, which is great. Feel free to review them by following the link.

They may be best to share with your allergist, pediatric gastroenterologist, dietitian, or general pediatrician if your little one has been diagnosed with or is thought to have CMA.

Keep in mind it is a large document (~100 pages...whoa!).It really does a great job at providing recommendations on the proper diagnostic tools needed for an accurate CMA diagnosis (as 50 - 90% of food allergy diagnoses are not actually food allergies). The WAO also provides information on amino acid-based formulas (AABF), such as Neocate, and where the use of AAB products is best in the management plan of patients (e.g. Eosinophilic Esophagitis patients).

Hopefully this will help you and your child’s doctor in understanding the proper guidelines in accurately diagnosing and managing your child’s CMA. Let us know what you think of it. Is this useful information for you or your child’s doctor?

Christine


But Doctor, Is My Baby’s Rash Really JUST a Rash?

Posted 1.18.11 | Rob McCandlish, RDN

Here at Neocate, we often talk with concerned parents who tell us they’ve read other stories from parents whose children had a terrible rash that was only helped by Neocate after lots of trial and error. Frequently, these parents tell us they don’t feel their doctor is familiar with food allergies. Just yesterday a father told me that his pediatrician kept telling him that “every baby gets rashes, it’s normal; he’ll grow out of it.”

Some pediatricians and many parents are surprised to learn that about seven percent of children have food allergies. Many parents who eventually learn that their child has a food allergy, which can only be treated by changing the diet, wish their journey to a solution had been shorter and simpler. Here are some tips for what you can do if you feel your doctor isn’t recognizing your little one’s rash as a possible sign of a food allergy.

Take Careful Notes

A rash is often the first sign of a food allergy that a parent notices. While it’s true that almost all babies experience diaper rash at some point, this is not the same as a rash caused by food allergy. Diaper rash, like many rashes, is caused by something on the outside: wet or rubbing diapers, scented lotion, rough fabrics, or even fabric softener. It’s important to rule out these other causes that might contribute to eczema, atopic dermatitis, or itching.

If you’ve eliminated potential causes, it’s more likely that the rash is caused by something on the inside: a food allergen. If you document all steps you’ve taken to eliminate other culprits, the doctor is more likely to consider a food allergy as the cause of your baby’s rash. If you notice that your baby has a rash and you think it might be related to a food allergy, check to see if your baby exhibits any other signs of a food allergy. It’s unusual for a baby with food allergy to only have a rash. Make a list of your baby’s symptoms which could also be caused by a food allergy to provide to the doctor.

Many parents tell us that they went through multiple different infant formulas before finally finding relief with Neocate. Some infants don’t even tolerate breast milk because of dairy foods in the mom’s diet. Make notes of the different symptoms that did not go away with each formula you’ve tried. Many doctors assume a soy formula or hydrolyzed formula will help if the baby has a milk allergy. However, many babies with a milk allergy also have a soy allergy and can be extremely sensitive to even small amounts of milk protein.

Make an Appointment with Your Baby’s Doctor

When you discuss your baby’s rash with the pediatrician, explain that you think you have ruled out other causes, and explain the list of changes you tried that did not help. Inform the doctor that food allergy is common among infants, and explain the other symptoms your child is experiencing which could be related to food allergy. Skin creams are commonly prescribed for rashes. While these creams may help to reduce inflammation and itching caused by a food allergy, they will not help other allergy symptoms such as diarrhea, gastroesophageal reflux disease (GERD), or wheezing. Only a change in the diet will truly solve the problem.

When you see your pediatrician, you may also want to request a referral to an allergist (narrow your search by selecting the “Food Allergy” specialty). The allergy testing that these professionals perform provides the best information to help your child find a diagnosis and relief from a food allergy.

Finally, share with the doctor your knowledge of Neocate, the amino acid-based formula that makes such a difference for babies with food allergies. It’s important to follow the steps to help give your baby’s rash the best chance to heal. We know that it is so hard to see your little one feeling so uncomfortable but remember it may take some time, even after you start using Neocate.

What steps did you take to know that your baby’s rash was caused by food allergy?

- Rob

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8 Signs of a Milk Allergy

Posted 11.23.10 | Rob McCandlish, RDN

A friend told me she went to an office Halloween party as a peanut allergy. I wondered: What would you wear that says, “I am an allergy?” I still don’t know the answer to that question! Thinking about that made me wonder: Since babies don’t come with labels and can’t tell us what they experience, how do they tell us “I have an allergy?

More and more, children are diagnosed with food allergies, with cow’s milk allergy being the most common. In fact, more than 100,000 babies each year suffer from milk allergy. There are multiple clues pediatricians look for that help diagnose a cow’s milk allergy that you can look for too. Below is a list of eight questions to help parents of infants identify a potential milk allergy, designed by Dr. John Moissidis, a Board certified pediatric allergist at The Asthma Allergy Clinic in Shreveport, La.

Milk Allergy Symptoms

1. Diarrhea Diarrhea is common in babies, but if it is persistent (an average of two to four times a day for more than five to seven days) and/or if there is blood or mucous in the stool, it could signal a more serious milk allergy.

2. Vomiting Babies often spit up bits of food, but vomiting beyond the typical mealtime regurgitation should be examined by a doctor. Reflux symptoms, such as spit-up and difficulty swallowing, can also be milk allergy symptoms.

3. Skin Rash There are many causes for infant skin rashes like eczema. Milk allergy is one possible cause, especially if the rash occurs along with some of these other symptoms.

4. Extreme Fussiness Every baby cries, but crying continuously and inconsolably for long periods of time is abnormal. When there is no apparent reason, this is usually called colic. Sometimes this extreme fussiness is actually caused by the gastrointestinal pain resulting from an allergy to the proteins found in milk.

5. Low or No Weight Gain Most infants double their weight by six months and triple it by 12 months. But when babies are not getting the nutrition they need because of excessive diarrhea and vomiting, they are unable to grow like they should.

6. Gassiness All babies have gas, but when it occurs along with several of these other symptoms, it can also signal an allergy to milk proteins.

7. Respiratory Problems Colds are common for infants, but wheezing, struggling to breathe and developing excess mucus in the nose and throat is not. For some kids, these respiratory problems can be the baby’s reaction to the protein found in milk.

8. Failure to Thrive Babies with milk allergy often suffer from a lack of proper nutrition characterized by dehydration, loss of appetite and lack of energy. This overall failure to thrive is often the result of the effect the other symptoms have on the infant’s body.

My baby has one or more of these symptoms – what now?

Babies with an allergy to cow’s milk protein cannot process the complex proteins found in milk-based baby formula, and many babies also react to soy-based infant formulas. Because of this, infant milk allergy is treated by either eliminating the milk proteins from the nursing mother’s diet or by replacing the regular formula with an amino acid-based formula.

An amino acid-based formula is safe for babies with milk and soy allergies because it is made using amino acids, the building blocks of protein. Amino acids are small enough that they won’t cause an allergic reaction in the way that complete protein chains or partly broken down proteins found in other formulas will.

The next step should be to schedule an appointment with your child’s pediatrician in order to receive a more thorough evaluation and diagnosis. Bring this information with you and ask your doctor if your baby might benefit from an amino acid-based formula.

What symptoms did your baby have that led you to suspect a milk allergy?

- Rob

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Ryder's Story

Posted 6.19.12 | Sarah O'Brien

If you have been reading our blog for the past few years, you may know that I not only have been working for Neocate for over 11 years but I’ve also had firsthand experience with cow milk allergy (CMA) and Neocate.   My daughter was recommended to take Neocate when she was just seven weeks old for what doctors and I believe was a cow milk allergy.  Once we started Neocate her reflux and colic symptoms resolved within a few weeks and all went according to expectations.  So, when her brother, Ryder, came and didn’t spit up the day he was born as she did I was hopeful!  Unfortunately, his reflux symptoms started soon after he was born but seemed to be controlled with Zantac. 

At around five weeks old my poor little guy became feverish.  We were advised to take him to the emergency room which turned into four long, exhausting days in the hospital.  Multiple doctors came to see us trying to determine the cause of the fever.  We had test-after-test-after-test done with no answers and a fever that just wouldn’t resolve.   By process of elimination it was determined that he simply had a virus that he had to fight through.  However, through test results, a GI doctor believed that his virus was possibly causing his liver to malfunction.  The GI doctor told us he needed a formula that was elemental and easy to break down so the liver didn’t have to work as hard.  I couldn’t believe it; my second baby needed Neocate too.  Per the GI doctor we started Neocate immediately.  After four days, his fever finally resolved and liver levels were moving in the right direction so we headed home.

Two days after starting Neocate (with no transition period) I decided to switch him back to standard formula since I believed the virus really was the cause of the liver malfunction.  About two weeks later we had a follow-up visit with the GI doctor who told us that his liver was back to normal – phew!  However, as timing is everything, he happened to have a bowel movement at the doctor’s office.  To my BIG surprise the doctor found blood in the stool.  Back to Neocate we go!

This time I went by the book and slowly transitioned him onto the Neocate.  Again, two days into it and things were not going well.  I had a fussy baby who didn’t sleep and wouldn’t eat.  I knew in my heart that I needed to stick with the Neocate and things would get better as I tell parents like you that every day.  But, at that point my internal voice was screaming and I wanted to switch him back!  I was desperate to get my happy little boy back. 

It took every ounce of me and a lot of family/friend support to keep him on the Neocate.  After what seemed to be a year-long week, things started to turn around and after about two weeks I was so thankful for sticking with the Neocate.  He was drinking more than ever, was happy as could be and all the blood in the stool had cleared up!  He is now about to turn one and continues to do so great!  I would have never imagined that I would end up with two happy Neocate babies!

-Sarah


A Mother’s Journey – A new website to help parents

Posted 12.31.13 | Rob McCandlish, RDN


For years our team of Nutrition Specialists has helped concerned and confused parents to understand how Neocate can help children with food allergies or a cow milk allergy (CMA). Parents who are new to food allergies often struggle in the beginning and follow a long journey to answers. We wanted to help these families by providing a new resource where they are likely to look for answers.


A new website

These days many parents use the internet to research medical questions before asking their doctor, and conversations with doctors are difficult for some parents. We at Neocate created a new site to help parents have meaningful discussions with the healthcare team when their little one shows food allergy symptoms – AMothersJourney.com. We included tools to help parents such as an emotional video about one mother's journey with food allergies and a Symptom Checklist, which lists possible symptoms of CMA. We also included a Food Allergy Discussion Guide, since healthcare teams depend on information from the family in order to diagnose and manage allergies. We hope the Discussion Guide will help parents provide useful information and ask the right questions.


Who should visit the new site?

This new website was designed for families looking for answers. For instance: parents of children that may be experiencing food allergy-related symptoms who need to speak with the doctor to get more information. It can also help families with a little one newly diagnosed with a food allergy, still searching for the right formula or diet to help manage food allergy symptoms.

As a parent who has been through this journey and found the answers that your child needed, we ask that you take a look at our new site and share it with other parents who might need help. Share this link: www.amothersjourney.com


What do you think of the new site? Would a site like A Mother’s Journey have helped you when you were looking for answers?

- Rob

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Common Signs of Cow Milk Allergy (1 of 4)

Posted 10.13.15 | Nutrition Specialist


When a healthcare team recommends an amino acid-based infant formula like Neocate Infant DHA/ARA, it's often based on a suspicion of cow milk allergy (CMA). The best way for a healthcare team to confirm that an infant has CMA is to 1) remove cow milk from the diet, and 2) re-introduce cow milk in a healthcare setting under a doctor's supervision. If suspected symptoms of CMA improve when cow milk is removed from the diet then reappear when cow milk is reintroduced, CMA is likely to be officially diagnosed.

But many new parents dealing with unexpected symptoms in their little one wonder: What are some of the most common signs and symptoms of CMA among infants? This video outlines 8 of the most common signs and symptoms that a heatlhcare team is likely to keep an eye out for, or that may lead them to suspect CMA. It comes from a Board-certified pediatric allergist. However, it's certainly not a comprehensive list - some signs and symptoms are less common.

Also, not every infant with one or more of these symptoms will be diagnosed with CMA. Finally, every infant who develops an allergy to cow milk will have a slightly different experience with different signs and symptoms - no two babies with CMA are the same! Here's a bit more information on two of those symptoms.

Diarrhea

Diarrhea can be very concerning to someone caring for an infant. It's not unusual for every infant to have a loose stool every now and then, but multiple loose or liquid stools a day may be a sign of something unusual. For infants who experience diarrhea as a result of CMA may also have blood in the stool. It's important to remember that diarrhea has many causes, so the best thing to do is to check with the healthcare team if you are concerned that your little one is experiencing diarrhea. Read more about diarrhea and it's association with a cow milk allergy.

Vomiting

It's normal for every infant to spit up at some point, but some infants spit up more than others. Many infants who spit up but don't seem bothered by it are termed "happy spitters." For some infants though, spitting up may represent something more concerning such as gastroesophageal reflux disease (GERD) or vomitting. In these cases, the reflux of vomitting may be related to cow milk allergy. In those cases, taking cow milk out of the diet should help resolve the reflux or vomitting. Read more information on reflux and vomitting in infancy.

As always, consult your heatlhcare team if you are concerned that your little one is showing signs or symptoms of a cow milk allergy.

-Rob

Part 2 of 4 - Skin rashes, Extreme fussiness
Part 3 of 4 - Slow weight gan, Gas (Flatulence)
Part 4 of 4 - Respiratory symptoms, Failure to thrive


Common Signs of Cow Milk Allergy (Part 3 of 4)

Posted 10.20.15 | Nutrition Specialist


Unfortunately, a cow milk allergy (CMA) comes along with some uninvited symptoms as Rob discussed in last week’s post. In today’s post we’ll be focusing on two additional symptoms that are sometimes seen in an individual with CMA: slow weight gain and gassiness. For a more in depth list of common symptoms of a CMA, check out this video created by my colleagues, Rob and Mallory. 

Slow weight gain

You may be asking yourself ‘What factors are taken into consideration when diagnosing an infant or child with slow weight gain’? Slow weight gain is defined as gaining weight at a slower rate than other children who are at the same age and sex.

A child's weight and height generally track in a fairly consistent trend over time, with some occasional fluctuation. This pattern can be described as a percentile on a growth curve. By plotting a child's weight or height (length in the case of an infant or toddler) over time, a growth curve demonstrates their pattern of growth.

There is a range of possible reasons for why a child might gain weight slowly, and often more than one reason is contributing at a time. Individuals with a cow milk allergy often experience problems with digestion or absorption of food leading to malabsorption of nutrients. Malabsorption essentially means that the body cannot utilize the nutrients from food, potentially leading to deficiencies and possible slow weight gain. You can read more about slow weight gain here.

Slow weight gain can often lead to a diagnosis of ‘Failure to Thrive' (FTT). My colleague, Jody, will be discussing FTT during next week’s blog post. As always, don’t hesitate to contact your child’s healthcare professional if you are concerned about your child’s weight.

Gas (Flatulence)

Gas is defined as the state of having excessive stomach or intestinal air or gas. This can result in uncomfortable feelings of bloating, as well as increased belching (or burping, as it’s commonly referred to) or passing of gas from the bottom. Because of this uncomfortable feeling, an infant or child may become “fussy”, “cranky”, or “colicky”. If you feel that your child is unusually “fussy” and/or notice that your child is belching or passing gas excessively, reach out to his or her healthcare professional to discuss your concerns. Read more about this and other symptoms here.

Did you notice either of these symptoms in your little one before his/her healthcare team diagnosed CMA?

- Kendra Valle, RDN, LDN

Part 1 of 4 - Diarrhea, Vomiting
Part 2 of 4 - Skin rashes, Extreme fussiness
Part 4 of 4 - Respiratory symptoms, Failure to thrive

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What Makes Neocate Special? An Overview of Different Types of Baby Formulas

Posted 2.18.16 | Nutrition Specialist


Walking down the baby formula aisle in any grocery story can be an overwhelming experience. We all know choosing the right nutrition for your child is important. But how can you tell the difference between various types of formula if breastfeeding isn’t an option for you?

Nutrition questions and choosing the right feeding path can overwhelm even the most seasoned parent. As a family living with food allergies, you know better than most that an allergy, or multiple allergies, to food quickly multiplies the questions you encounter regarding food and nutrition.

The number of options when looking at infant formulas does not make the choice any easier. But fear not! Nutricia is here to help you. Let’s take a look at the main types of infant formulas, and how they are different. 

Cow milk-based formula: Most infant formulas available in the grocery story aisle are cow milk based. That means they are made from cow milk that is altered to resemble breast milk. However, cow milk-based formulas might not be suitable for many families dealing with food allergies. This is due to the protein found in milk. Milk protein is one of the most common food allergens, especially for infants.

Soy-based formula: When avoiding milk proteins, dairy foods, or perhaps animal proteins in general, soy-based infant formulas are often brought up as an option. This formula type is based on soy instead of cow’s milk so it is dairy-free. Unfortunately, up to 50% of children with an allergy to cow milk are also allergic to soy protein[1]. This makes soy-based infant formulas not suitable for babies with food allergies.

Protein hydrolysate formula: These types of infant formulas contain protein that has been broken down (hydrolyzed) into smaller pieces. There are infant formula options for partially broken down (partially hydrolyzed), and extensively broken down (extensively hydrolyzed) proteins. Breaking down the protein chains makes these types of formulas easier to digest and can reduce the chance of an allergic reaction for babies with food allergies. While these formulas are a bit easier for digestive systems, it’s important to remember that even the partial proteins can cause an allergic reaction in some children.

What makes Neocate Special?: Neocate is classified as amino acid-based formula. This means our formula doesn’t contain any intact protein chains and is made from the original building blocks of all proteins called amino acids. Amino acids are the most basic form of protein, the easiest form for human digestion. What makes Neocate hypoallergenic? 1) Using 100% amino acids as the source of protein, and 2) leaving out proteins and even small protein fragments that can cause an allergic reaction.

If you are a visual person like me, you may find this chart helpful in illustrating the differences in infant formulas that we just discussed.

Here’s another way to look at infant formulas and their potential for triggering an allergic reaction:

Now that you know the basic types of infant formulas, you will have the knowledge to make the right nutrition choice for your child and be prepared for the discussion with your healthcare team.

Need additional resources?

I personally find that our Parent’s Toolbox page is a great place to get started when trying to understand your child’s allergy symptoms. If you have more general questions about food allergies, then start with our overview on the Basics of Food Allergies.

We have also pulled answers to many of the general Neocate questions we hear on our FAQs page.

New to Neocate?

If you are ready to get started using Neocate, we have a variety of information available at your disposal:

Our team of Nutrition Specialists are here to help answer any questions you may have. Feel free to give us a call at 1-800-365-7354 or comment below!

- Kristin Crosby, MS, RDN

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[1] Niggemann B, et al. Pediatr Allergy Immunol. 2001; 12:78-82.

 


Cow Milk Allergy – It’s More Than Just Blood in Stool

Posted 6.14.16 | Nutrition Specialist

According to Food Allergy Research & Education, Inc (FARE), approximately 2.5% of children younger than 3 years of age are allergic to cow milk. Most of these infants and children will outgrow their cow milk allergy, while some may not.

How Do I Know if My Child is Allergic to Cow Milk?

Blood in a child’s stool can be a sign of an allergy to cow milk, and it's one that you may have heard about, or that your healthcare team may have shared with you. But what are some other signs that your child might be allergic to cow milk?

The following infographic highlights eight common signs and symptoms of a cow milk allergy (CMA), while also providing tips on what parents should look for and next steps if children are exhibiting signs of CMA.

Difference Between Lactose Intolerance and Milk Allergy

Now that we've reviewed common CMA signs and symptoms, you might be wondering, What is the difference between CMA and lactose intolerance? The following video from Dr. Adam Fox helps to explain the difference:

Dr. Adam Fox

Common Signs and symptoms of a Cow Milk Allergy

These signs or symptoms may take anywhere from minutes to hours to days until they appear.

  • Skin Rash/Itchy Skin/Hives
  • Vomiting
  • Extreme fussiness
  • Diarrhea
  • Excessive Gas
  • Wheezing, coughing or other respiratory symptoms

Now, let’s talk about each of these signs in further detail.

Skin Rash/Itchy Skin/Hives

There are many causes of rashes in infants and children. Some are viral, others are due to something in the environment, but some may be due to the food that your child is consuming if he or she has an allergy. If hives develop right after your child has consumed food, it may warrant further investigation into food allergies. The skin around the mouth may be especially itchy if your child has certain food allergies. Note where the rash is and if it seems to bother your child. Remember that old saying, “A picture is worth 1,000 words”. If a rash appears on your child, don’t forget to take a picture and show it to your doctor. If you would like to keep a diary of all the symptoms your child is exhibiting and what she consumed, make sure to check-out the Neocate Footsteps App.

Vomiting

Some babies spit-up after eating if they eat too much, too quickly or a combination of both. They may also vomit due to an illness. By keeping track of your child’s vomiting, it may help to determine if cow milk is the cause of her vomiting.

Extreme Fussiness

The definition of colic applies to healthy, well-fed infants who cry more than 3 hours a day, more than 3 days a week, for more than 3 weeks. Even though these criteria exist, colic is not well defined. The crying and fussiness that we call colic could mean that they are experiencing extreme abdominal pain, and cow milk may be the cause. Investigate extreme fussiness with your pediatrician to determine if there is a change in your child’s diet that may help.

Diarrhea

Diarrhea (and other gastrointestinal symptoms) may be due to the foods your child eats or to an illness. It is important to note when the diarrhea starts and how long it lasts. If diarrhea continues more than 2-4 times per day for more than 5-7 days, it may be a sign of a cow milk allergy. It is also important to note if there is mucus and/or blood in the stool, as these can also indicate a cow milk allergy.

Excessive Gas

Babies can be gassy as their gastrointestinal tracts get used to foods they are consuming. If your child seems excessively gassy and it has a foul odor, it may be a sign of a cow milk allergy, especially when it is in combination with some of these other symptoms.

Wheezing, coughing or other respiratory symptoms

Respiratory symptoms may be a more serious sign of a cow milk allergy and should be taken seriously if you suspect your child has more than a cold. These include wheezing and coughing. If your child starts wheezing or has other respiratory problems after consuming cow milk-containing foods, seek medical attention. More severe than other respiratory symptoms is anaphylaxis, a serious allergic reaction that requires immediate medical attention.

It is best to talk with your healthcare provider if you suspect a food allergy, and keep track of the symptoms with a food diary to help determine what the food allergen may be. The Neocate® Footsteps App can help you keep track of some of these symptoms and allows you to take pictures, if need be, of any skin rashes or other reactions.

Management of a Cow Milk Allergy

If your child is allergic to cow milk, your doctor may recommend a hypoallergenic formula like Neocate to help meet your child’s nutritional needs. Neocate products are available for children of all ages for the dietary management of a cow milk allergy. Just like you'd expect, Neocate is dairy-free! Learn more about available Neocate products.

Can You Outgrow a Milk Allergy?

Most infants and children eventually outgrow a cow milk allergy. However there is no specific age by which this will happen. Each child is unique. Over the years, research has shown that most children will outgrow a cow milk allergy within a few years. For more severe cow milk allergies, research has shown it can take longer. For example, some researchers found that 80% of chidlren they followed with CMA outgrew their allergy by 16 years of age. Read more.

These are just some of the signs and symptoms of a cow milk allergy with a couple frequently asked questions we encounter. When it comes to cow milk allergy, what other questions do you have that we can address in our future posts?

-Ellen


Meet Some Awesome Neocate Families!

Posted 7.12.16 | Nutrition Specialist

In March of this year we at Nutricia had the great privilege to meet with three wonderful families that are using various Neocate products to manage their cow milk and multiple food allergies. We were delighted to hear about their unique stories, about the ups and downs in their allergy journeys, both the tears and the laughter and ultimately about how all their experiences have made them stronger!

One topic we talked about with the families was the areas of support that they felt were the most important to them. They also told us how more information and more unique support could be made available for everyone that is dealing with a food allergy. But hear for yourself what they shared with us!

We would like to thank the families involved for their time, their energy and their wonderful stories. We will be posting more updates in the future. In the meantime, if you have a story that you would like to share about food allergy, cow milk allergy, Neocate or anything related you can get in touch with us by commenting below!

  


Can I Keep Breastfeeding My Milk-Allergic Infant?

Posted 9.19.17 | Nutrition Specialist

Successful breastfeeding can get complicated if your baby is diagnosed with an allergy to cow milk, or when other food allergies are suspected. So, what can you do when breastfeeding your milk-allergic infant comes into question?

Chances are you have given quite a lot of thought and preparation regarding your plans to feed your new infant. Breast milk is the best source of nutrition for your baby. It is the first choice when you ask the World Health Organization (WHO), the American Academy of Pediatrics (AAP), Centers for Disease Control (CDC), and healthcare professionals worldwide. However, when your baby is diagnosed or is suspected of having a milk allergy, your baby’s diet must be free of cow milk protein.

Is it possible to manage your baby’s food allergies while sticking to your plan to breastfeed? Absolutely. Let’s look at a few scenarios and possible solutions.

My infant is reacting to the foods I’m eating.

Answer: Ask your healthcare professional for their advice.

It’s possible for small amounts of protein from foods in mom’s diet to make their way into her breast milk, which can cause allergic reactions if the infant develops an allergy to those foods.

The first option your healthcare professional should suggest in this situation is for mom to follow an elimination diet and continue to breastfeed. An elimination diet means you remove suspected allergens - both whole foods and most ingredients derived from that food - from your diet. This means protein from the potential allergen don't make it into your breast milk, thus removing the allergens from your baby’s diet.

Often the healthcare team will recommend you start by eliminating just milk, or a few items like milk and soy, and foods containing certain ingredients derived from milk and soy. Here is a short video from some of the members of our Neocate team explaining the basics of an elimination diet.

It may take up to two weeks to see if the foods you've removed from your diet have made the difference for your little one. If your baby continues to have problems tolerating your breast milk or perhaps has only a minimal improvement in their symptoms, then additional foods may need to be eliminated from your diet. This may be referred to as a “total elimination diet (TED)”. Read more about one mom Rachel, and her experience with TED.

It is key that you maintain a healthy diet to maintain your own health so that you can be well and also provide the nutrition needed for your infant through breast milk.  Eliminating some foods, especially large groups of food such as dairy, may jeopardize your health, so it is important to seek medical supervision from your doctor and/or a registered dietitian when planning an elimination diet to make sure all potential gaps in your nutrition are filled.

Supplements of certain nutrients may be recommended, depending on the number of eliminated foods. Key nutrients often obtained from dairy in the diet, at a minimum calcium and vitamin D, may be recommended by your healthcare team as supplements, for example, if you’re avoiding all dairy. They may also look for alternative foods to provide these and other essential nutrients.

Some moms have even found Neocate products to be a great hypoallergenic option to supplement their own diet and meet their own nutrition needs to continue breastfeeding their babies. This might be particularly helpful when mom is asked to eliminate multiple food items from her diet, or follow a “total elimination diet”. If this is something your curious about, you could discuss Neocate Splash with your healthcare team, although any Neocate product can be used as a supplement.

I want to continue breastfeeding but am not producing enough breast milk.

Answer: Ask your healthcare professional for their advice.

Some mothers struggle to produce enough breast milk to meet the needs of their growing baby. First, you should ask for a referral to a lactation specialist - experts in breast feeding strategies. Many healthcare professionals will recommend supplementing with infant formula so the baby still gets the benefits of breast milk while also getting enough calories and nutrients to ensure proper growth of the infant while the underlying cause of the low breast milk yield is addressed.

A hypoallergenic formula like Neocate is recommended to supplement your breast milk if your little one has reacted to your breast milk. That’s because guidelines advise that babies with food allergies, or who are already struggling to tolerate breast milk due to food allergies, should be given a hypoallergenic formula like Neocate when a supplement for mom’s breast milk is needed. (The reason? The fragments of protein from mom's diet that are found in breast milk are roughly the same size as those found in formulas made from broken-down dairy protein, which means they are likely to provoke an allergic reaction.)

Supplementing breast milk with Neocate can help you continue to provide your baby the wonderful nutrition from breast milk, while also making sure your baby gets the full amount of calories and nutrients they need to continue to grow and develop from a hypoallergenic formula. Your healthcare team, such as your pediatrician or registered dietitian, will advise you on what is needed for you and your baby specifically.  The amount of formula needed should be directed by your healthcare professional and will be unique to your infant’s individual nutrition needs. 

However, this can also present some challenges. Babies often have a hard time switching between breastfeeding and bottle feeding. I hear from many mothers in this situation that the baby will often prefer one feeding over the other, and usually the baby prefers breast milk. For example, moms have told me that their baby drinks well when they are breastfeeding but they struggle with bottle feedings. Even mothers that are exclusively bottle feeding will often say that the baby prefers the bottles of breast milk over the bottles of infant formula.

Some Tips for Moms Supplementing their Breast milk:

  • Many healthcare professionals suggest manually expressing your breast milk and bottle feeding only to help in this situation.
  • It is often recommended to add prepared Neocate consistently to the bottles with expressed breast milk. This can help with bottle acceptance because the bottles are consistently the same taste and the baby is consistently being bottle fed.
  • The amount of prepared Neocate needed should be directed by your healthcare team based the nutrition needs of your baby and your breast milk production.

Let’s say, for example, that your healthcare professional determines that your baby needs an additional 10 fluid ounces of Neocate daily and your baby is drinking 5 bottles daily. In this example, your healthcare professional might recommend an additional 2 fluid ounces of prepared Neocate added to each bottle of expressed breast milk. You would prepare the Neocate at the recipe recommended by your healthcare professional, then add 2 fluid ounces to each bottle of breast milk. This ensures the baby is getting a similar blend of breast milk and Neocate at each bottle.

Again, your healthcare professional will direct you regarding what is best for both you and your little one, so ask your pediatrician or registered dietitian for what is best for you. 

I am adding prepared Neocate to breast milk, but my baby is not gaining weight.

Answer: Ask your healthcare professional for their advice.

For some infants, the calories in breast milk or formula may not be enough to support weight gain at a normal rate. When your baby can’t consume any more breast milk or formula in a day, the healthcare team may suggest other options to help your baby gain weight and keep on track with their expected weight gain, or growth curve. (You can track your baby’s intake using the Neocate Footsteps App, so you can show the healthcare team exactly what she’s taking.)

Often an increase in calories is needed. One option your healthcare professional may recommend is concentrating the Neocate before adding it to your breast milk. This can help to increase the calories and nutrients from Neocate that your baby is consuming, on top of the breast milk. The same tips discussed above can be helpful in this situation when expressing your breast milk, especially adding the Neocate to your breast milk consistently between bottles.

Again, your pediatrician or registered dietitian will advise you what is best for you and your baby, and how exactly they want you to prepare Neocate before adding it to your expressed breast milk. It's important to only change the concentration if directed by the healthcare team, and to always follow their instructions: formula that is too concentrated can lead to dehydration and other health issues. In other words, consult the healthcare team first – please do not attempt this on your own!

What other questions do you have about breastfeeding your baby with food allergies? Please share any questions or any suggestions you might have for other mothers facing this situation in the comments below.

 

-Kristin Crosby MS, RDN, LDN

Originally posted 8.9.16, Updated 9.19.17


Will My Child Outgrow Their Cow Milk Allergy?

Posted 5.24.17 | Christine Graham-Garo


When children are diagnosed with milk allergies, parents might wonder, “Will my baby grow out of it?” As much as your new hypoallergenic formula and allergen-friendly diet is helping, you can’t help but wonder when you can feed your child without anxiety. Keep in mind, it’s normal to wonder!

Good news – Many children do outgrow their allergies; however, it may depend on what the child is allergic to and the type of allergy they have. Most importantly, keep in mind that all children are different!

Children with cow milk allergy (CMA) may be more likely to outgrow their allergies than their peanut or tree nut allergy buddies. One research study showed that 80% of kids diagnosed with a CMA will outgrow their allergy by 16 years of age[1]. More specifically, other research studies have found that about 45-50% of children outgrow CMA at one year, 60-75% at two years and 85-90% at three years.[2],[3]

Fortunately, the general consensus is that around 80% of children with cow milk allergy will outgrow it by 3-5 years of age[5]. Regular follow up by your medical specialist is important to re-test tolerance of cow milk protein.[6]

Now, compare that to the studies which show that about 20% and 10%, respectively, of young patients may outgrow peanut and tree nut allergies and approximately 8% of patients who outgrow a peanut allergy will later relapse, meaning the allergy comes back. Additionally, nut-related allergies are typically more severe and more likely to be fatal, which is quite scary![3]

For example, if your little one has multiple food allergies, such as both CMA and tree nut allergies, he or she may outgrow the CMA while the tree nut allergy could still persist. Still, outgrowing an allergy to cow milk will expand their diet and improve the quality of life and available foods for your little one.

Now this may be “good news/bad news” for some families. The good news is that the chance of the cow milk allergy being outgrown is very good, even if the child has the allergy into their teenage years, they are still likely to outgrow it. The bad news is that some infants with CMA may have it into their early teenage years, and a handful may never outgrow it.

The other factor that may influence your little one’s chances of outgrowing a food allergy is the levels of allergen-specific IgE detected in their blood. This means, the lower the allergen-specific IgE detected, the greater the chance of outgrowing the allergy. Your doctor can monitor this - make sure to ask them to explain the results, show you have the level has changed over time, and explain what the possible implications are.

As mentioned before, all children are different. Your little one may have all the right “ingredients” to overcome their cow milk allergy, but there is no way to know exactly when he or she will outgrow it. Your doctor may decide to attempt a food trial by introducing some foods that your child is allergic to, in order to see if the allergy still persists. Be patient, sometimes food trials can be taxing.

Our advice to allergy parents is not to worry, there is usually a light at the end of the tunnel! It’s wonderful if a child can outgrow their cow milk allergy, but if not, they can still thrive and lead happy, healthy lives.

To the more experienced food allergy parents, can you shed any advice on food trials and outgrowing allergies? Comment below or share your thoughts with us on our Facebook page!


[1] Skripack et al, J Allergy Clin Immunol. 2007

[2] de Boissieu D, Dupont C. Time course of allergy to extensively hydrolyzed cow's milk proteins in infants. J Pediatr 2000;136:119-20.

[3] de Boissieu D, Dupont C. Allergy to extensively hydrolyzed cow's milk proteins in infants: safety and duration of amino acid-based formula. : J Pediatr. 2002;141:271-3.

[4] The natural history of peanut and tree nut allergy. Fleischer DM. Curr Allergy Asthma Rep. 2007 Jun;7(3):175-81. Review.

[5] March 2016.  Cow’s milk (dairy) allergy, Australasian Society of Clinical Immunology and Allergy, [http://www.allergy.org.au/patients/food-allergy/cows-milk-dairy-allergy] Viewed 6 May 2016

[6] Motala & Fiocchi, 2012, Cow’s milk allergy in children, World Allergy Organisation, [http://www.worldallergy.org/professional/allergic_diseases_center/cows_milk_allergy_in_children/] Viewed 15 May 2016



About Us

Food Allergy Living is a resource for parents of children with food allergies, brought to you by Nutricia, the makers of Neocate. For more in-depth information about our purpose & authors, see our About Food Allergy Living page.