As I approach the due date for my first baby, thoughts and worries are running through my mind, including one many pregnant women might not think about: will my baby have a cow's milk allergy? That may seem like a very strange thing to be worried about. But I, along with 7.5% of babies, had a cow's milk allergy. Getting a diagnosis is often difficult, as my mum knows and I've seen first-hand.
Cow's milk allergy: spotting the signs
Cow's milk allergy can be difficult to identify as the symptoms are often general and non-specific and may or may not be immediate. I've seen children react within minutes of having milk and others react hours or even days later, making it difficult to pinpoint the exact cause.
Symptoms to look out for include:
• Skin symptoms e.g. a rash, eczema or swelling
• Gastrointestinal symptoms e.g. nausea, vomiting, diarrhoea, colic or reflux
• Respiratory symptoms e.g. a runny nose, wheezing or chronic coughing
These may seem like very general symptoms but if they're ongoing and you're concerned and think your baby is reacting to cow's milk, then it's a good idea to speak to your GP. It's important to get an accurate and prompt diagnosis to address babies' symptoms and to avoid unnecessary dietary restriction. With the right treatment and advice, babies can stay well-nourished so they grow and thrive.
Diagnosis and management: top tips
There are two ways to diagnose cow's milk allergy. If your baby has immediate reactions to milk, testing will be done by a specialist either by blood test or by a 'skin prick' test. If your baby has a delayed reaction, an exclusion diet will be recommended. Cow's milk is completely taken out of the diet for approximately two weeks to see if the symptoms disappear. Cow's milk is then reintroduced (under supervision) to see if the symptoms return and if they do, you have a confirmed diagnosis.
In theory the treatment is straightforward: avoid cow's milk. In practice it's a little more complex. We can all think of foods to avoid: milk, yoghurts, cheese and chocolate. What about the biscuits, cakes, sauces or pre-packed foods made with cow's milk though? A dietitian can really help here with advice on foods to avoid, suitable substitutes and recipe ideas to keep the diet balanced.
If you're a breastfeeding mum, you can continue to breastfeed. If you need to exclude dairy from your diet, a dietitian can point out calcium-rich dairy alternatives. If you're bottle feeding, your healthcare professional may recommend a specialist formula, such as an extensively hydrolysed or amino acid formula.
When it comes to weaning, if you make everything from scratch you can be sure it's milk-free; but what about if you're out for the day and want to grab a couple of jars of food? It's doable - just remember to check the ingredients list for milk and related items carefully. Food labelling has improved over the years with the most common allergens, including milk, now clearly highlighted.
The future can be bright with good planning
The good news is that by the age of one, nearly half of children will have outgrown their allergy. For those who haven't, there are a few extra things to think about:
• Does the nursery or school know about the allergy?
• Are there chocolates for a birthday at school?
• Do friends want to share and swap lunchbox contents?
• What about the birthday party at the weekend?
• What about eating out?
They key is to plan ahead; for example, take milk-free snacks into school for those occasions, take some dairy-free snacks to the party and explain the situation to children, teachers and other parents.
It gets easier as children start to understand their allergy and manage their own diets and there are lots of possible substitutions, like soya-based products and other alternative milks. Supermarkets have a growing range of 'free from' foods which can make dietary changes even easier.
So where does that leave me? I won't continue to worry about whether or not my baby will have a milk allergy. If he or she does, with the correct diagnosis and support it's a perfectly manageable condition. So it's time to focus on getting to know each other and making the most of this very special time.