Feeding difficulties and Cow's Milk Allergy

Cow's milk allergy (CMA) is the leading cause of food allergy in children under 3 years of age. It is thought to peak in the first year of life, with true CMA affecting 2-3% of the infant population.

CMA can be IgE or Non-IgE mediated or a mixture of both. IgE mediated allergy will present as an immediate reaction to the milk protein and your child may develop hives or breathing difficulties for example. A non-IgE mediated reaction is a delayed reaction and may present with symptoms such as reflux or eczema.

Non IgE mediated CMA symptoms vary widely. The most common symptoms may include vomiting, poor weight gain, excessive crying throughout the day, reflux, mucus or blood in the stools, eczema, diarrhoea, constipation and respiratory difficulties.

Some infants with CMA have feeding difficulties. These may include

 ·       Feeding for comfort/cluster feeding throughout the day- which in some cases may exacerbate symptoms of reflux

·       Vomiting and regurgitation during and/or after feeds

·       Poor growth

·       Bottle or breast refusal or aversion.  This is because babies may learn that when they drink their milk they feel sick, bloated, or in pain, and therefore form a negative association around feeding.

·       Coughing and choking on milk (secondary to reflux)

·       Generally being a difficult feeder, such as taking very short feeds or needing to be fed while very sleepy or with lots of distractions such as walking round being rocked and sung to.

Breastfeeding and CMA

·       CMA and maternal oversupply can present quite similarly with regards feeding symptoms. But the treatment is VERY different. It is important to work with a trained breastfeeding professional to help guide a diagnosis as well as an appropriate medical professional if CMA is suspected.

·       Symptoms of CMA in a breastfed baby may include reflux, and silent reflux, vomiting, coughing and choking (due to reflux), difficulties settling or falling asleep on the breast, irritability as the feed progresses or after a feed, poor growth and breast aversion.

·       You may notice that your breastfed baby will not feed for comfort, that breast feeds are short. During feeds, your baby may become irritable, come off the breast and won’t settle. The number of feeds per day may reduce and your milk supply may be affected.

·       Growth spurts and cluster feeding can be particularly difficult times for an infant with CMPA.

·       First line treatment is maternal dairy exclusion for 6 weeks followed by reintroduction of dairy to confirm.

·       Direct treatment for the baby may include strategies such laid back or koala nursing position, keeping baby upright after feeds, baby wearing.

·       Other helpful strategies may include reducing cluster and comfort feeding if it is exacerbating reflux and using a dummy. Please note that these should only be recommended by a breastfeeding professional and will require specific guidance in order not to impact milk supply and baby growth.

CMA and formula feeding

·       Responsive bottle feeding and following your infants lead can really help stopping overfeeding and exacerbating reflux.

·       This may lead to little and often feeds which help with the stomach not being too full at any one time

·       Pacing feeds can help slow down the rate of the feed giving the stomach more time to digest the milk as it gets delivered gradually

·       Feeding in a more upright position or in left elevated sidelying position can help

·       A hydrolysed formula will likely be prescribed. Some babies’ feeding will improve once treatment commences. For others feeding may get worse before it gets better, due to the different taste of the milk.

·       Strategies such as gradually introducing the milk by mixing it with standard formula initially can help. Some parents add flavouring to the milks, however this should only be done under the guidance of your Paediatrician or Dietitian.

Unfortunately, not all babies improve with medical treatment alone. Others will need feeding therapy from a speech and language therapist who specialises in feeding and swallowing difficulties. Typical treatment involves strategies which normalise the feeding process. For example, by watching your baby’s cues, letting them take control of the feeding process and helping them regain a drive to feed.

Weaning

Babies with CMA are often weaned before 6 months under the advice of a Paediatrician. For some babies this can really help, for others this can create additional difficulties, as they are not developmentally ready. It is a well-established fact that babies feed best when they are physically capable to feed, have some hunger, and are fed responsively. For more information on weaning your baby with CMA read here.

If your baby is experiencing difficulties with feeding due to CMA and you need further support please do get in touch. Stacey@feedeatspeak.co.uk