1. Prepare yourself for a milk elimination diet—take time to get ready! Starting an elimination diet half-way will not benefit your child. It is an all or nothing effort.
Prepare to start a milk elimination diet. For parents, caregivers, or someone with a child requiring a special diet, learning milk and dairy products could cause significant harm to a child is stressful. This stress can be multiplied ten-fold if this is the first family member that needs an elimination diet. There is so much to learn about cross-contamination, alternative products, and providing food that meets the nutrition demands of a growing child.
Make sure you take time to mentally prepare yourself for some of the challenges such as readying your family (see next point) and knowing what to do in the event of accidental exposure. If your child is still on infant formula, then the first few months may be ideal since he/she is just beginning to eat fruits, vegetables, grains, and proteins.
As your baby gets older and can start self-feeding, be prepared to spend extra time at the grocery store as label reading becomes more critical (see point number 3).
As a parent, be sure to engage in regular self-care by talking to a counselor, pastor, friend, or family member when the stress becomes overwhelming. Find a support group so you can remind yourself that you and your family are not alone.
2. Prepare your family for an elimination diet
A well-prepared family is often less likely to challenge the news that another family member needs to start avoiding milk and all dairy products. Older generations often question the need for elimination diets because the frequency of food allergies in the past was lower. While their questions can be downright frustrating, try to remember their perspective; this is just as new to them as it is to you.
If your baby needs to drink an amino acid-based infant formula or if you are trying your toddler (with your doctor’s or dietitian’s advice) on a milk elimination diet, your family needs to be prepared. Children who are able to consume milk and dairy need to understand that their sibling has to eat and drink different “special” foods. They need to be a “big boy” or a “big girl” and help keep their sibling safe by not offering to share and keeping their cups and food out of their sibling’s reach.
Placing all children in the home on a milk elimination diet, regardless of whether they need it to accommodate one child’s special diet, is not a good idea. Children who must avoid cow milk and dairy very often require supplements or a specialty formula to ensure their diet is nutritionally complete. In addition to the very high cost of supplementing all children, it places an unnecessary burden on the child/children without any food allergies.
Grandparents, aunts, uncles, cousins, siblings and close friends all mean well but it is critical that they understand that there are no cheat days and, yes, just one cookie could in fact hurt. Help these extended family members find safe treats to provide as an alternative since so many of us like to show our love through food.
3. Read every label every time.
I treated a family in the past because they were concerned their child had developed additional food allergies beyond milk. The child was on a milk elimination diet for many months, and the family was managing it quite well without too many issues or worries. The child was growing well and tolerating the amino acid-based formula nicely.
During my nutrition assessment and diet review, we discovered that a healthy “go-to” food was most likely the culprit for this child’s symptoms. The manufacturer changed the ingredients, and the family was unaware that this “go-to” food now contained whey protein (a component of milk). The best way to identify product ingredients is by reading the actual packaging label that corresponds to the product contained within that packaging, or you can call the product manufacturer. Product websites do often have ingredient information; however, these sites are not always kept up to date and may misguide your label-reading judgment.
Please remember that some product manufacturers view their ingredients as commodity items. They know what ingredients can be changed or substituted and may do so when prices increase, or supply is interrupted. Many food manufacturers try to produce their products ensuring a consistent level of profit without changing final prices. As commodity prices change, their manufacturing process may vary, and they do not always warn consumers about any changes in how they manufacture or in the ingredients they use.
Read every food label every time.
Fortunately, there are apps for smartphones that help track ingredients in products with a quick scan of a bar code or QR code. Technology can be a huge benefit to someone who is buying groceries to accommodate varied diets types within a family.
4. Avoid cross-contact at home – Milk Elimination Diet-
Cross contact or cross-contamination, for example, occurs when one food without milk touches food or a surface with milk. Some children are so sensitive to milk proteins that this type of accidental exposure can result in anaphylaxis.
One way to help avoid cross-contamination is by designating one shelf in the refrigerator as the “milk-free shelf.”
Here are things parents need to know before starting an elimination diet if your child is at risk of severe reactions, like anaphylaxis:
(See point number 2: Creating a milk-free home is not a good idea if you have other children)
- Designate a specific shelf in the pantry or perhaps an entire cabinet for milk-free dry ingredients.
- Making a whole cabinet a milk-free zone provides a space to include pots, pans, toaster, cups, cutting boards, knives, etc.
Tip: if you have duplicates you can designate the extras as “milk-free equipment.”
- If utensils have been washed thoroughly in warm, soapy water, then you don’t need to have a second set.
- Once you prepare a milk-free meal, cover it and place it aside while preparing other food that contains milk.
- After the meal is over, remember to wipe down all kitchen surfaces, including the kitchen table. It is better to do this when one meal concludes.
5. Teach your child to be her own advocate, and know the why of a milk elimination diet.
Knowledge is power, and children are always learning. Explain to your child how to ask if it is okay for her to eat certain foods. Teach your child to ask an adult if a food contains milk.
Show him/her to not take food offered to them by other children (even siblings) without an adult’s approval.
Teach children to be their own advocates and to respectfully ask questions. Asking questions will keep them safe when you are not with them. I hope this makes you comfortable with them eating without you by their side monitoring what they eat.
Children have a fantastic ability to adapt and view their allergy as just part of life. The adults in their lives more often have a much harder time with the diet.
6. Use supplements
I am a “food first” kind of mom and dietitian. However, in certain situations, supplements are necessary to avoid placing children at risk for nutritional deficiencies. If children with cow milk allergy do not consume adequate amounts of protein, calcium, vitamin D, etc. they risk poor growth.
Work with a registered dietitian to determine your child’s nutrition needs. A registered dietitian can determine how food and supplements can work together to meet those demands. Remember to see a dietitian regularly since the needs of young children can change quite quickly as they grow.
Alternative “milks” such as rice, soy, oat, hemp, and coconut are not always an acceptable replacement for cow milk, especially for children under the age of 2 (and they should never be fed to an infant as an infant formula). They are not balanced enough for a child as a sole source of nutrition. Do not rely on these beverages the same way you would on cow milk and dairy products.
Our guest blog today comes from Alexia Beauregard. Alexia Beauregard is a Registered Dietitian. The inspiration for this blog is based on her extensive experience working with the families of patients diagnosed with EoE. Please be sure to talk to members of your child’s healthcare team before applying this information.
Last updated February 2020.