This post is by contributor Naomi Cook. Read about our regular contributors here.
A pharmacy shop assistant once said to me “When you’re breastfeeding, think like a cow, eat like a cow. Eat green…”
I smiled politely and sniggered as I walked away, how ridiculous I thought, babies need exposure to all kinds of food through the mother’s breast milk! There is, of course truth in my smug reaction. However, my second baby has challenged those confident claims and has revealed that things are not quite as simple as that, as she was diagnosed with acid reflux and cow’s milk protein intolerance in her early weeks.
What is it?
Cow’s milk protein intolerance (CMPI) or allergy 5 is, according to my pediatrician, becoming an epidemic. This wasn’t stated in a scientific journal, nor meant to be taken literally, but said to me in passing during one of our appointments as she, sighing, reflected on the number of babies she’d had come through her office being diagnosed with the condition.
“About 1 in 50 babies have the problem – most grow out of cow’s milk allergy by the age of 4 years and cow’s milk allergy in adults is rare.” 5
CMPI should not be confused with lactose intolerance; the latter refers to the inability to digest lactose whereas CMPI refers to a immunological reaction where there is damage to the digestive tract 7, including the oesophagus 4 incurred by proteins passing through the mother’s milk, to the baby, after she has consumed dairy produce 1, 8.
Symptoms
CMPI “…is easily missed and needs to be considered as a cause of infant distress” 8
Symptoms are not necessarily clearly defined and diagnosis may be suspected from a cluster of symptoms, potentially including; general unhappiness, unsettled behaviour, 3, 5, 7, 8 poor feeds and poor sleeps (though I’m sure many ‘normal’ babies go through stages of exhibiting all these symptoms). Vomiting and reflux are also symptoms 3, 4, 7 that all may not be well, especially if the baby shows signs of painful acid reflux that isn’t completely resolved with medication 3, 6. Consistency and frequency of bowel motions can also reveal signs of the CMPI, diarrhea may occur, stools may be mucousy and blood stained 3, 4, 7.
Diagnosis
Noninvasive diagnosis of CMPI can occur if the mother undergoes an elimination diet and sees an improvement in the potential symptoms outlined above 7. Diet changes not only include the elimination of obvious dairy products like milk and cheese, but also of egg and all products containing dairy derivatives. In addition soy is usually avoided because the soybean protein is also a common allergen 5, 6, 7. The mother will generally find that she may be unable to consume a number of processed food stuffs (you’ll be amazed that how much hidden dairy and soy there are in most products!). It may take up to two weeks for the proteins to exit the mother’s system and another further two weeks to exit the baby’s, although there may be improvement within a week 3, 8. Many babies will out grow the intolerance by four years of age 2, 3 and somewhere in the second half of their first year it may be possible to trial these things into the mother and baby’s diet 3.
The Mother…and me
What about the mother? After seeing their baby suffer many mothers will gladly undertake these dietary changes, grateful that something can be done! But there are health issues at stake; firstly, since dairy tends to form the backbone of calcium intake, calcium deficiency must be avoided and secondly, there should be strict attention to other areas of diet such as protein, iron, vitamin and even fat intake to ensure her diet contains all necessary elements 2,8. Mothers who suspect their babies are suffering from this condition should see a medical professional for assessment and advice. It is not recommended that anyone attempt an elimination diet without medical supervision.
In my experience the elimination diet has been a challenge due to the fact I am also vegetarian, I have become a vegan whose diet is further limited by the fact soy is also out of the picture! At the beginning it required a lot of thought to ensure that I was getting adequate nutrients but I am thankful for the fact that there are plenty of health food shops in the city where I can buy all kinds of things that I can eat… the “tahini treat” (cookie) has become a real buddy, along with new dietary staples, nut milks, coconut milk, cream and fat! I have made some fantastic cakes and muffins with these ingredients. When I start feeling sorry for myself at the whiff of a freshly cooked pizza or milky latte, I just look at my transformed daughter who was so unhappy for her first 7 weeks then feel grateful that her problem was something so simple that it could be solved by my diet alone.
Have you ever been advised to “eat like a cow!” when breastfeeding? Do you have examples of any foods that you have eaten which have caused a reaction in your baby?
DISCLAIMER: The information contained in this article should NEVER be used as a substitute for the advice of a licensed physician. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please see a physician if you think you or your child are unwell.
References
Useful Reading
Naomi blogs at http://childhood101.com/.
{ 18 comments… read them below or add one }
No allergies, thankfully, although I do remember my daughter having an adverse reaction to my milk after I consumed a big bowl of my mother-in-law’s French onion soup. We were up all night with a very windy and unhappy little bub. Also, I found brassicas – cabbage, cauliflower, brussels sprouts, broccoli – always needed to be eaten in moderation with both children.
Have you given any thought or research to raw milk? There”s a lot to milk that is burned away in the pasteurization process that aids in digestion. Not sure about the proteins in specific but i wouldn’t be surprised if raw milk was an option.
An excuse to stay away from brussel sprouts then! ; ) I wonder if it’s because these veggies are particularly good at producing methane, must add a certain ‘tang’ to the milk. R.E raw milk, unfortunately it still contains the potentially allergic proteins, pasturisation does reduce some of the nutritional value whilst killing bacteria, but in both milks the problematic proteins remain. Lactose Free milk and also the alleged ‘low allergy’ A2 milk also both contain proteins that can irritate susceptible individuals.
I think articles like these are great for the moms dealing with these issues but I also worry that a lot of women self-diagnose — despite the warning that they shouldn’t!
An elimination diet may take up to 14 days for the offending food to get out of the mom’s system and you would technically have to reintroduce the food just to make sure that the issue didn’t change for other reasons.
A lot of moms don’t realize that crying increases around 3 weeks and then peaks at 6-8 weeks and dramatically reduces by 12 weeks.
That doesn’t mean there isn’t also a medical issue (like reflux or food intolerance or allergy) sometimes that is causing the crying, especially if there are other symptoms…but there are a lot of moms who could save themselves a lot of sacrifice and grief if they could hold on for a few weeks more!
My first child was very colicky. I thought I was going to go insane, wearing, rocking, feeding her constantly. But by about 8 weeks, the crying finally started to diminish.
She did keep crying & arching her back immediately following feedings, though, at which point I finally got a doctor to believe me about acid reflux, she had two doses of Zantac and…24 hours and even that stopped.
Hi Candace, thanks for reading and for your comments.
A word on self diagnosis; yes it can be dangerous but I guess we should remember too that 21st century medicine is different to that hierarchical medicine of the past where medical knowledge was ‘esoteric’ belonging entirely to the doctor. Articles on health should empower women “consumers” of health care (yes, no longer cited as “patients”!) to go their doctor armed with some ideas. A good doctor should welcome educated questions.
Secondly, the crying baby and “colic” ahhh yes, this contentious issue! I intend to write on this later in the year. How much crying is “normal”? Says “who”? What is “colic”? And so on…I know of a couple who were so bent on believing that “crying” is normal their baby went for 8 weeks without having it’s acid reflux diagnosed.
Am looking forward to hearing your thoughts when I write that one. Thanks again!
You’re preaching to the choir on Internet research and doctors trusting parents instincts… I have a whole post on colic myself.
But part of modern culture is also a search for the quick fix…
I worry that a mom may haphazardly eliminate and then the colic disappears…when it would have naturally done so anyway. Meanwhile she continues and is hungry for a year or more!
Hi Candace
I’m the mother that self diagnosed my child’s cows milk protein intolerance. It wasn’t quite as drastic as you’ve indicated.
It was simply removing all milk products from my diet, eggs and wheat and then I added them back one by one. I watched her closesly and documented it. Something my Dr could not have done (infact my Dr said it was normal for a baby to cry but I knew better as a second time mum).
Anyway once I found the source, I went to see the allergy clinic in Sydney and it was confirmed. By the time it was confirmed, my daughter was happy (a new baby). Had I waited to see a specialist, it would have taken 12 weeks. I love the internet and all the people who share their stories. Without them, my daughter would have unncessarily suffered as would I and the rest of my family.
The entire process took 1 month by no means a year! And furthermore, I wasn’t hungry because I could eat as much as I wanted of the other foods.
You misunderstand. I am not saying tracking down an allergy takes a year. I’m saying that a mom may mis-selfdiagnose and avoid a long list of protein-rich and healthy foods for the duration of breastfeeding–which should be a year or more.
I am also not saying allergies and intolerances are non-existent–I’m saying they are far less common than one might assume based on reading blogs and forums…and that moms desperate to end colic may jump the gun and make breastfeeding more challenging than it needs to be.
This is why it is important to reintroduce the suspect food to verify…because otherwise it could be that something else eliminated the colic.
Thanks Naomi for this interesting post. My second daughter has recently been diagnosed with cow’s milk protein (& soy) intolerance at 12 weeks old and I can really identify! I am a GP and while I strongly suspected she had this condition, I still took her to a paediatrician to have it investigated and confirmed.
I’m not a vegetarian and have reflected to myself on several occasions how much tougher this would be if I were. I find dietary calcium a challenge, & have started myself on supplements to be sure I’m getting enough.
As you say though, it’s amazing the changes you can make without a second thought because it’s for your child. My husband is having no chocolate for a year out of solidarity, bless him.
Going through this has made me reflect a lot on the bizarre-ness of our typical Western diet… how strange it is that people are appalled by the thought of a woman still breastfeeding a walking, talking toddler, and yet taking milk out of a cow’s breast and giving it to that toddler… and drinking it as adults too… is somehow totally normal! When you think of it this way, it’s amazing that more babies aren’t cow’s milk protein intolerant.
All the best with your dairy-free journey and I hope your little girl continues to be healthy and happy.
Hi Maggie, thanks so much for that post,
You know, I have a hunch that the 1/50 estimate of CMPI incidence may be way off the mark, that may be how many kids are actually diagnosed…But perhaps there are many more with less severe symptoms (not prompting medical attention)…Would love to look into it. Downregulation of lactase/lactase nonpersistence occurs in later childhood and adulthood naturally, so it appears we really aren’t meant to consume huge amounts of dairy anyway! This has made me look into other dietary sources of calcium, (I also can’t tolerate the supplements), thankfully, as mother nature would have it, calcium from non-dairy sources is more easily absorbed when dietary protein intake is decreased.
I take Spa Tone (natural iron supplement) and Floradix (iron and B vits). Floradix also do a calcium and magnesium supplement, kinder to the gut than the brick calcium tablets. Have you come across these?
And to chocolate, Loving Earth do a great vegan chocolate range and a delicious vegan chocolate spread made with coconut oil and raw cacao, fixes those cravings in a jiffy!
Thanks again, hope your daughter is improving now, poor little thing! Keep in touch…
P.S I would love to know how much you come across this condition at work? Do many mums show up with babies with CMPI symptoms? How about GERD? Thanks again!
Thanks Naomi for your tips – will have to look out for that Loving Earth chocolate
I’m currently taking a standard prenatal / breastfeeding multi, and a calcium tablet which thankfully I seem to have no troubles with – but the liquid supps are a good alternative too.
GERD is very common and I see it often at work – in fact so many babies have reflux that I think it’s almost physiological. The effects of it are wide-ranging, though, from the “happy chuckers” (my first daughter was one of those) who really need no treatment, through to the distressed, screaming, back-arching bubs (this was my second daughter) – and then there are the “silent” refluxers who are often missed because they don’t visibly vomit.
CMPI is less common, however awareness and knowledge is rapidly growing in medical circles. Unfortunately however, GPs tend to lag behind specialists in their awareness of emerging conditions because their job is to know “a little bit about a lot of things”. My daughter’s CMPI symptoms were classic, with the mucousy, bloodstained diarrhoea, however when I went to see my own GP for the paediatric referral, he shrugged and said it was probably haemorrhoids (!). So you can see how babies with more subtle symptoms might be dismissed altogether by some doctors.
Even though I have a Diploma in Child Health and a special interest in this area, I find the “unsettled baby” one of the most challenging presentations to deal with in General Practice. Parents are often stressed, sleep-deprived and at the end of their tether. The baby is sometimes crying and upset during the consultation, and often accompanied by a restless toddler, and sometimes other family members who want to give their two cents’ worth as well (sometimes helpful, sometimes not). People have often already Googled and self-diagnosed. You want to examine the baby to make sure s/he’s healthy, You want to reassure the family. At the back of your mind is always – “is Mum okay, is she coping, could she have postnatal depression?”. There is so much information to sift through, and all of this in a 15 minute timeslot!
Another issue is the fact that many of the possible causes (reflux / colic / dietary intolerance) will improve with time, even if nothing is done. Most GPs know this, and so have a tendency to dismiss the parents and hope they’ll just survive somehow until things improve. I think this is unfortunate, because often identifying and treating the cause can mean that the parents (and of course the baby!) can enjoy these early months rather than just survive them.
As for my daughter, she has dramatically improved. The diarrhoea settled within days, then gradually over a couple of weeks her reflux symptoms settled (without medication) and she’s now a “happy chucker” like big sister was. I can only assume the CMPI was causing her to have both colitis and oesophagitis. I’m relieved to now have a happy baby and I always try to be philosophical about these things – having been through this will hopefully increase my awareness of the condition & make me a better doctor.
Okay, finished babbling on and on now!
Hemorrhoids! Similarly a gp I know was quite amused as I described the condition, he didn’t even know that proteins pass into the breast milk. It is hard for gps to stay up to date for sure, so many constant developments in all areas not to mention changing item numbers and so on. I suppose it’s a matter of knowing your strengths and when to refer.
Funny similarities between our girls, my first was a profuse vomiter, (no problems except I smelt of vomit all the time) and my second a silent acid refluxer. Omeprazole helped a lot but not with the mucousy stools and sleep issues. There were amazing changes within the first week of elimination, the resistant nappy rash disappeared overnight at day 5, at day 7 there was a marked reduction of mucous in the stool. Then four weeks later, she was a new baby. I’d say it took the whole four weeks for the total turnaround.
Just had to comment as this is a subject very close to me – we discovered my son’s severe dairy allergy when he was 4 months. He’s now 3 and still allergic, but just want to say that while it’s challenging as the kid’s get older, it can be done – for us, it means we don’t eat a lot of processed foods (which is a good move, anyway). I get so frustrated with people who comment that he can’t possibly be getting enough calcium (he takes supplements on the recommendation of his pediatrician and eats other dietary sources of calcium) – I always want to point out that much of the world doesn’t consume cow’s milk! Cow’s milk really is for baby cows.
You make a really good point, look at the size of cows! Our skeletons are so much smaller; yet cow’s milk is portrayed as being not just important, but a necessity in our diet. As Maggie was saying too, this condition can make you quite philosophical with regards to what is seen as the ‘norm’ to eat, and deviating from that so odd for onlookers. It’s definitley opened my mind with regards to nutrition. Would like ideas from you for tasty toddler food though! Dairy really does make most foods quite palatable and such a useful (and nutritious) quick fix for hurried meals!
You misunderstand. I am not saying tracking down an allergy takes a year. I’m saying that a mom may mis-selfdiagnose and avoid a long list of protein-rich and healthy foods for the duration of breastfeeding–which should be a year or more.
I am also not saying allergies and intolerances are non-existent–I’m saying they are far less common than one might assume based on reading blogs and forums…and that moms desperate to end colic may jump the gun and make breastfeeding more challenging than it needs to be.
This is why it is important to reintroduce the suspect food to verify…because otherwise it could be that something else eliminated the colic.
my son was diagnosed with cow’s milk protein intolerance at 3 weeks old i initaly took him to one hospital (which i wont say) and it was because he was bleedy from his bum and had diarrhea for 7+ days they told me it was just a little tear and to put vasaline on it as it would heel up this was on a friday by sunday he wasnt feeding and when he did was bringing it back up went limp just wasnt himself so took him to the RCH in melb with 10mins of seeing triage they had us straight i poor little guys went though the works xrays, lumper puncher you name it i think he had it within 24hours they had diagnosed him and was told his reaction was quite server as his tummy and rectum swelled causing it to bleed out his now on Neocate formual ( if you now much about it this would love to know), Anyways my little man is now 13weeks old and gaining weight is off to see the allergist soon as the head ped at RCH said he was a rare case i not sure if it was because of the recation he got to it , Im now though starting him on soilds and it’s hard if you or anyone has some tips for me i would love to hear them as farax ect has traces of milk/dairy though it and i cant take the chance. thank you
Hi Katie, why don’t you email me at the team email address and we can have a ‘chat’ via email. Put “For Naomi” in the subject x