Cow's milk allergies are the most common allergy among young children. For parents of infants, they can be particularly frustrating, whether you're breastfeeding or formula feeding. Milk allergies and intolerances to milk proteins can cause painful symptoms in newborns and infants.
To get a parent perspective on feeding an infant with a dairy allergy, I asked for advice from Bernadette Geyer of Nursing Mom Recipes. Her daughter was allergic to both milk and soy as an infant, and she maintained a dairy-free, soy-free diet during nursing.
Recognizing Dairy Allergies in Infants
Common symptoms of dairy allergies include hives, eczema, angioedema, asthma and, rarely, anaphylaxis. Dairy allergies are more commonly associated with gastrointestinal symptoms (like diarrhea and vomiting) than are some other allergies.
Milk Protein Intolerances
Another condition that's different from dairy allergies -- but one with similar implications for feeding -- is milk protein intolerance. In this condition, the digestive tract is unable to digest casein or whey, the two major proteins in milk. The major symptoms of milk protein intolerance are gastrointestinal -- bloating, diarrhea (which may be bloody), vomiting and nausea. GERD (gastroesophageal reflux disorder) is also associated with milk protein intolerance. These symptoms may occur very soon after a feeding or may happen hours later.
Getting a Diagnosis
Some symptoms -- hives, breathing difficulty, and the like -- are unmistakable and will no doubt send any parent to the pediatrician immediately. Others -- bloating that may manifest more as colic or distress, or a rash that comes and goes -- may be more subtle. In Geyer's case, "we started noticing blood in our daughter's stool when she was two-and-a-half months old."
Be alert to any symptoms that may be associated with dietary issues, especially if the same symptoms tend to recur regularly after feedings. And use your doctor's call-in line to ask about any concerns you have, even if they may seem slight. Your doctor will ask you to come in if symptoms seem to require more follow-up.
Treatment Options for Dairy Allergies
Whether your baby has a dairy allergy or a milk protein intolerance, she'll need to avoid milk. The two options for avoiding dairy in your infant's diet are nursing on a maternal elimination diet that's completely free from milk products and derivatives, and feeding your child a dairy-free formula. Both options present unique challenges.
Dairy-Free Formulas: Know Your Options
Soy formula may seem like the obvious alternative to milk-based formulas for a baby with a milk allergy, but for many families who may consider formula feeding (either as the primary source of nutrition or as a supplement), soy formula won't work. (Soy is, like dairy, a common allergen.) Hypoallergenic formulas -- formulas made of proteins that have been hydrolyzed, or broken down into their component amino acids for easier digestion -- are the preferred option for babies with food allergies.
However, hypoallergenic formulas are almost always derived from cow's milk, and in some cases, allergic infants don't tolerate them. This was the case for Geyer's daughter: "The hypoallergenic formula was milk-based, and our daughter was apparently lactose intolerant since the hypoallergenic formula made her extremely gassy and irritable, and her sleeping was terrible because of the gas. After about a week, she refused any hypo-allergenic formula."
Eating Dairy-Free With a Newborn
It's hard enough to change your diet radically when you want to, or when you're at a point in your life when your main focus can be your diet. When you're adjusting to life with a newborn, of course, that's not the case; especially in the early going, you're likely to find yourself pressed for time and favoring foods that require minimal or no preparation.
There are two major concerns you'll have to balance on a dairy-free elimination diet: getting sufficient calories and nutrition for lactation, and reading labels carefully to avoid dairy and dairy-based ingredients. You may be surprised at the number of nonintuitive foods that contain dairy products: "Canned soups were extremely tricky," says Geyer.
In lieu of most heavily processed foods, Geyer relied on nutritious grab-and-go foods like "applesauce, fruit cups, oatmeal, and hard-boiled eggs." Another strategy you may be able to use (one that served me well when my own daughter was young) is to freeze double portions of meals when you do have time to cook.
Finally, if you're concerned about getting adequate nutrition or calories on your restricted diet, your pediatrician or lactation consultant may be able to offer you good advice or connect you with a nutritionist or dietitian specializing in nursing mothers.
Sources:
Crittenden, Ross G. and Louise E. Bennett. "Cow's Milk Allergy: A Complex Disorder." Journal of the American College of Nutrition. 2005. 24(9): 582S-591S. 18 May 2008. Hassall, Eric. "Talk is Cheap, Often Effective: Symptoms in Infants Often Respond to Non-Pharmacologic Measures." Journal of Pediatrics. Mar. 2008. 152(3): 301-3. Sicherer, Scott H. "Food for Thought on Prevention and Treatment of Atopic Diseases Through Diet." Journal of Pediatrics. Oct. 2007. 151(4): 331-33.
