Cows milk protein allergy….. CMPA… I had never heard of it until one day when Mr Small was about 5 months old and suddenly I had to become an expert overnight.
Apologies for too much information but it all started with one nappy with streaks of blood in Mr Small’s poo…. I did the classic ‘mum google’ and decided it was probably because he’d been a little bit constipated and was just due to straining. However I still mentioned it to the GP when I was there a couple of weeks later and she thought it was worth a referral to the next local paediatric clinic.
We duly attended the next clinic and was greeted by a cast of thousands… a senior consultant from St Mary’s hospital, a trainee consultant, a junior doctor, a local gp and a midwife (there may even have been a couple more people). I was asked to go right back to the beginning of any medical history.
Half an hour later having covered:
- the offending nappy
- a propensity to eczema
- an ongoing battle with nappy rash
- a blotchy red skin reaction round the mouth when we tried Aptimil ready-made formula (although not HIPP organic)
- a propensity to be quite sicky after pretty much every feed – not a burning/convulsing reflux or projectile but enough to have had a fairly extensive period of administering baby gaviscon, and more than just a bit of spitting up
- a very colicky start to life
The pretty conclusive conclusion from the consultant was a possible cows milk protein allergy (or CMPA), which apparently can be very common.
THE TREATMENT – CUT OUT ALL DAIRY FROM MR SMALL’S DIET (and go cold turkey on the infant gaviscon)
… which included my diet as I was still breastfeeding (woohoo Christmas number 2 with no cheese-board….!!!)
At this point in time I was combination feeding (2 bottles of formula and 3 breastfeeds a day) and was also on the cusp of weaning so it was a lot to think about…
The first step here is to try a hydrolysed formula – this is where the cows milk proteins have already been partially broken down so should be easy to digest
This sounds simple but this stuff smells and tastes AWFUL! Apparently very young babies don’t usually have a problem taking it but from around 6 months it can be tricky to introduce and Mr Small was having none of it…. And I didn’t really blame him!
We’d been prescribed Similac Alimentum and it was over Christmas time so I was feeling a bit desperate when he wouldn’t take it at all. The NCT group came to the rescue and one of the girls said that a friend had had the same experience and that Aptimil Pepti is hydrolysed and not as vile tasting as some of the others. Willing to try anything I splashed £17 on one 400g tin to try… I introduced it gradually, swapping one more scoop over at a time and within 3 days Mr Small was happily having a whole feed so this was now sorted.
The bonus of being on hydrolysed formula is that you can usually get it on prescription as it’s a medical requirement, so that was a silver lining.
As I was still breastfeeding, Mr Small going dairy free meant me going completely dairy free too – which was not so fun over Christmas but definitely worth doing. The main thing was finding what alternatives you actually like, for me this was:
- Milk – Almond milk or oat milk in cereal, soya milk in coffee
- Cheese – sadly this just went out the window… I couldn’t get on with a the dairy free cheese alternatives they tasted pretty vile…
- Butter – Bertolli olive oil spread or Vitalite
- Cakes and treats – Mrs Crimbles biscuits and treats were a big hit and most mince pies were OK – check the label! Dairy free chocolate was unfortunately not so good…
- Icecream – Swedish glace
Ones to watch – for me the surprising things that contained dairy were lots of loaves of bread and things cooked in butter in restaurants – always check the label or ask the question
.. also it’s actually much easier to stick to an exclusion diet when you are a) doing it for your baby and b) other people completely understand why you are doing it so they don’t try and tempt you!
This was surprisingly the easiest part of CMPA for me despite being quite apprehensive about the whole weaning journey. To begin with it doesn’t differ from weaning any baby as you introduce veggies and fruits first and we bypassed baby rice (many of which contain milk powder) for various reasons, CMPA included. Once we were into 3 meals a day and avoiding dairy, Mr Small’s meal plan looked something like this:
- Breakfast – Weetabix or porridge made with his formula or oat milk
- Lunch/dinner – anything that you would normally make but with a milk/cheese/or butter substitute…. I figured he wouldn’t mind the dairy-free cheese as he wouldn’t know what real cheese tasted like!
- Pudding/snacks – fruit, rice cakes, melty puffs/nibbles, toast with dairy-free spread, coconut yoghurt
AFTER 2 MONTHS DAIRY FREE, I HAD NOTICED:
- a significant decrease in vomiting after milk
- less eczema and nappy rash (although not entirely perfect)
- no suspicious nappies (however this really was a one-off)
- the blotchy mouth reaction didn’t happen with any milk substitute products but did seem to occur at random with some foods (but never the same one twice or consistently) and then disappeared within an hour or so
At this point the dietician advised me to gradually reintroduce cows milk formula as a challenge to see whether Mr Small would be able to cope with it without a reaction.
We did this challenge with HIPP Organic and we were very lucky…. Mr Small tolerated it fine and we were then discharged after a follow up session. I don’t know to this day if it really was CMPA and his little system somehow rebooted or gradually grew out of it, or whether it was more reflux based and settled down once he was having more solid food.
I know we were very fortunate, and that some mums can battle with CMPA for years. I also realise it must be even harder when children have very violent reactions to foods that challenge them or when they are older and can’t have what their friends have. In the end were only completely dairy free for 2 months before our dietician advised me to start challenging with cows milk formula, but it is doable and there are support groups out there are are full of advice and meal/ingredient suggestions.
If you are starting your CMPA journey, good luck, you will be fine. As always, do get in touch if you have any questions or would like a link to any of the support groups.