A Dairy-free Diet for Cow’s Milk Protein Allergy

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A dairy free diet involves avoiding all forms of dairy foods such as milk, butter, cheese, cream, yoghurt, fromage frais, margarine, custards, ice cream and other foods made from milk. This also includes goat’s milk, sheep’s milk and even buffalo milk (think buffalo mozzarella) and any other milk products from animals.

 

 

 

Why might your baby need a dairy free diet?

Your healthcare professional may have suggested that your baby needs a dairy free diet if they have symptoms of a cow’s milk protein allergy or intolerance.

A cow’s milk protein allergy is when the body’s own immune system decides it doesn’t recognise the protein in milk and thinks it is a threat. It produces an allergic response that makes your little one unwell.

Symptoms can include eczema, red skin, hives, swelling of the lips, tongue or mouth or body, difficulty breathing, an itchy runny nose, tummy troubles such as vomiting, constipation or diarrhoea, reflux, tummy pain, poor growth, asthma and in extreme cases, anaphylaxis.

Symptoms of an allergic reaction can be immediate or delayed. Immediate means that they come on within two hours after eating and this is sometimes called an IgE allergy. Delayed allergy symptoms can occur anything from two hours to several days later! This is sometimes referred to as non-IgE allergy.

A cow’s milk protein intolerance doesn’t actually exist. It’s a term that healthcare professionals used to use to describe the delayed onset or non-IgE allergy but is often still used today.

It’s worth noting that lactose intolerance is not an allergy to dairy foods and is a completely different condition to those babies who have a cow’s milk protein allergy. With lactose intolerance, your baby doesn’t need to avoid all dairy products. See my ‘Managing Your Baby’s Lactose Intolerance’ post for further information.

 

How are they diagnosed?

Immediate onset allergies can be diagnosed by skin prick tests where a small amount of the suspected allergen food is put on your baby’s skin. The surface of the skin is then scratched and the size of the ‘wheel’ it creates is measured. Alternatively, a blood sample can be taken and sent off for further analysis.

Delayed onset allergies however, can only be diagnosed by following an elimination diet. Essentially this means excluding the suspected allergen food and then reintroducing it to confirm or reject the diagnosis. This must be done under the supervision of a dietitian and if your baby’s symptoms are severe then the reintroduction will be carried out in a hospital.

Alternative tests such as IgG, Vega testing, iridology, hair analysis, kinesiology or cytotoxic testing are widely available at a cost, but none of these methods have any scientific evidence for their use and can’t diagnose an allergy or intolerance.

 

Should I try giving my baby a dairy free diet without a confirmed diagnosis?

Dairy foods are one of the top five food groups and contribute to a significant amount of your baby’s nutrition. Formula fed babies for example get 100% of their nutrition from dairy foods as most infant formula is based on cow’s milk. Once weaning starts, this gradually reduces as food intake goes up, but dairy still plays a significant role in nourishing your little one right through their childhood.

You have to be careful as if you cut out this food group and don’t replace the nutrients dairy provides, your baby could be deficient in energy (calories), protein and fat which will affect their growth and development. They will also be low in calcium, affecting their bone health, iodine, vitamin A and a B vitamin called riboflavin.

Always seek the advice of a healthcare professional before you try a diet that avoids a whole food group as babies can become deficient in nutrients quite quickly which can affect their health and growth. It’s likely that if an allergy is suspected, your doctor or health visitor will refer you to an NHS dietitian for guidance as dietitians are the only nutrition professionals regulated by law that can advise you on how to manage a free-from diet without risks to your baby’s health. You can also self-refer to a dietitian in a private practice – look for one who is experienced in paediatrics and allergies.

 

Weaning and milk allergy

At the start of weaning, you don’t need to do anything differently. The usual vegetables and fruits are perfect for weaning a baby with a milk allergy. As time goes on (and provided your baby is over 6 months), progress to adding in starchy carbohydrate foods such as bread, rice, pasta, cereals and grains and proteins such as eggs, meat, fish, beans, lentils and other pulses, so that your baby has a varied diet consisting of three meals a day by 6½  to 7 months of age.

You will need to avoid milk, butter, cheese, yoghurt, fromage frais, cream and foods that contain milk such as custard or ice cream. If you know your baby has a food allergy before you start solids, avoid that food or food group and introduce the foods listed below, one at a time alongside the fruits, vegetables and other foods your baby already eats. It’s sensible to start with a small amount and increase gradually over the next few days. If there is no reaction, include this food as part of your baby’s diet and move on to the next food.  

 

Top allergenic foods include:

MILK EGG WHEAT GLUTEN SOYA
FISH SHELLFISH PEANUTS TREE NUTS SEEDS

It’s very important not to delay the introduction of these foods. Research tells us that there is a critical window for desensitising your baby to high-risk foods and that these foods must be given between 6 and 12 months to reduce future risk. In fact, there are guidelines to suggest this should be as early as four months in babies with severe eczema, but the decision to do this needs to be made by an allergy doctor.

As weaning progresses and your baby starts to drop milk feeds, you need to be in close contact with your dietitian as babies who follow a dairy-free diet need to take more breastmilk or formula than others in order to meet their nutritional requirements.

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