As you may have gathered from my previous posts, cow’s milk is a common culprit for both colic and reflux symptoms in babies. I’m not going to go into details as there is an excellent website called Is It Cow’s Milk which explains it very well so pop over there and have a good read.
Done….? Now what…..?
There is a lot you can do if you suspect cow’s milk may be an issue. Cow’s milk allergy was one of the main culprits for our eldest as you can read in the previous post titled “The Ribena Baby”. We bumbled our way through managing it, which led to numerous mistakes and hours working our what to eat. It would have been a lot easier with someone to guide us through so I’d like to share some of what we learned along the way. Every baby is different so not all of what I write may be helpful to you but I hope that at least some of it makes your journey a little less bumpy and more direct than ours was! The only piece of advice not to be dismissed is that you MUST involve your doctor before you start eliminating cow’s milk. Don’t go messing with your babies nutritional intake on your own!
I’m going to split this topic into two posts, one for formula-fed babies and one for breast-fed babies, simply because there’s a lot of information.
Formula fed babies
1) Before you do anything make sure you complete a 3 day feed and symptom diary. Include crying, sleep quality and quantity, nappy contents, rashes, vomiting, etc. The more detailed the better as this will form your baseline so that you later have concrete evidence of whether going cows milk free has been effective or not.
2) Go see your doctor, symptom diary in hand. Take a print out of the “Map of Medicine: Infantile Colic” if you feel it may be helpful in discussing your baby’s symptoms. Be open to discussing all causes of colic and all management options as your doctor will hopefully have more experience than you in dealing with unsettled babies.
3) If you and your doctor decided that a trial of being cow’s milk free would be beneficial they will prescribe a trial of an extensively hydrolysed or amino acid based formula. Is It Cow’s Milk describes what these are very well so pop over again for another look. The extensively hydrolysed formulas, which are made from cow’s milk with the proteins broken down, are usually sufficient to treat cow’s milk allergy. They still contain lactose, which is preferable as without lactose your baby’s gut may stop producing lactase enzyme which can lead to a secondary lactose intolerance. Some babies will still react to the broken down milk proteins in extensively hydrolysed formulas in which case your doctor should prescribe an amino acid based formula, which are not derived from cow’s milk at all. Our daughter was breastfed but we introduced a formula during weaning and she needed an amino acid based formula called Neocate LCP, having reacted to an extensively hydrolysed formula called Pepti. All babies are different and you may need to try a few formulas before settling on the one that suits your baby. Be aware that although soya based formulas used to be the first choice for babies with cow’s milk allergy it is no longer to be used in babies under 6 months so if your doctors suggests it you should politely and respectfully say no and explain why.
4) Hypoallergenic formula taste foul! If your baby is very young they may accept it quite happily but do not be surprised if your baby refuses it initially. If this happens mix it with your baby’s normal formula initially starting with 1/4 hypoallergenic milk and 3/4 normal formula and then increase the volume ratio of the hypoallergenic formula gradually until your baby is accepting just the hypoallergenic formula.
We needed to start with 1/8 hypoallergenic formula and 7/8 expressed breastmilk and increased by 1/8 hypoallergenic formula every three days to get our daughter to accept the formula. It took nearly a month and a lot of expressing but it was worth it so persevere if you think it’s going to help.
5) Make sure you continue with your symptom diary. If your baby is reacting to cow’s milk then you should notice a difference in your baby’s symptoms within 24-48 hours of being cow’s milk free. It takes around 2 weeks to clear the system entirely of cow’s milk however so you won’t see the full effects until then.
6) After the hypoallergenic formula trial head back to your doctor with your symptom diary. If it has made a significant difference your doctor will likely continue to prescribe a hypoallergenic formula. The majority of children grow out of the cow’s milk allergy but cow’s milk should only be reintroduced with the guidance and supervision of a healthcare professional. You should ask for a paediatric dietician referral to guide you on what to feed your baby when you wean them and also to guide you in how to reintroduce cow’s milk at a later date. Your doctor may refer your baby to an allergy clinic especially if they suspect your baby has other allergies or there is a history of allergies in your family.