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.
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.
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.
- Lactose Intolerance and the Breastfed Baby: Australian Breastfeeding Association.
- Cow’s Milk (Dairy) Allergy: Australasian Society of Clinical Immunology and Allergy
- Approach to Milk Protein Allergy in Infants: Brill, H. (2008) Canadian Family Physician 54 (9) pp1258-1265
- Gastro oesophageal Reflux and Cow’s Milk Allergy in Infants: A prospective study: Lacono G, Carroccio A, Cavataio F, Montalto G, Kazmierska I, Lorello D, Soresi M & Notarbartolo A (1996) Journal of Allergy and Clinical Immunology 97:3 pp822-827
- Cow’s Milk Allergy: Parenting and Child Health
- Protein Intolerance: A. Nocerino & S. Guandalini. (updated 2010). eMedicine
- Management of Reflux & Vomiting in Babies: Australian Doctor, Sydney Children’s Hospital
- Guidelines for the Diagnosis and Management of Cow’s Milk Protein Allergy in Infants: Vandenplas Y, Brueton M, Dupont C et al (2007) Archives for Disorders of Childhood 92: 902-908
- Dairy and Other Food Sensitivities In Breastfed Babies: Kellymom.com
- Cow’s Milk Allergy: International Association of Infant Food Manufacturers
- Milk Allergy and Intolerance: Food Standards Agency, UK