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Cow’s milk protein allergy ! (CMPA)

CMPA is quite common and may present as persistent vomiting, diarrhoea / constipation, poor weight gain, dry skin / rash and excessive crying. Treatment is by eliminating CMP from diet but only under specialist supervision.

There are two types, IgE mediated and Non IgE mediated. Basically, the latter is usually presents later and is milder but there is no test for it. If baby is breast fed, then treatment is eliminating dairy from mum’s diet (I know, it’s sad, but luckily only for few months).

If formula fed, then there are several hydrolysed formulas available like Aptamil Pepti, Similac Alimentum, Nutramigen. They are broken down proteins, so taste and smell horrible (Honestly, they have not been able to improve the taste of any of these). Fortunately, babies haven’t developed lots of taste buds, so are usually able to drink these (sometimes takes a lot of perseverance!). Parents can close their noses while making them!

The effect of dairy elimination from maternal diet or change to Hydrolysed formula is not apparent immediately, as CMP takes 2-4 weeks to be eliminated from baby’s body. But slowly symptoms start to resolve like reflux, skin, vomiting, irritability, blood in stool etc.

The good news is that most children grow out of Non IgE mediated CMPA (the much more common one) between the age of 1 to 2 years. We recommend challenging them with milk formulas beginning from 6 month onwards by use of a milk ladder:

http://cowsmilkallergyguidelines.co.uk/downloads-and-resources/downloadable-map-milk-ladder/

Reflux (Gastroesophageal Reflux Disease)

Many babies cry a lot specially after the feeds. This could be Gastroesophageal  reflux.

Gastroesophageal reflux (GOR), the passage of gastric contents into the oesophagus, occurs commonly in newborn infants, especially those born prematurely. Physiologic GER typically is a developmental process that resolves with maturation. GER generally resolves on its own by one year of age. In infants who remain asymptomatic, no further evaluation or intervention is typically required.

In contrast, GOR disease (GORD), is clinically significant GER that causes problems. In infants they include frequent vomiting, aspiration pneumonia, irritability, failure to thrive, and exacerbation of respiratory symptoms, including chronic lung disease and most commonly excessive crying.

I see many babies who have been suffering as the reflux is undiagnosed or untreated. Diagnosis is usually clinical indicated by poor feeding, possetting/vomiting a lot, crying, arching of the back, unsettled babies. Treatment is by burping them after each feed for 15-20 min, sleeping them at an angle by raising the head end of mattress, feed thickeners like Gaviscon Infant/Carolbel and some medications which can be prescribed by doctors.

Babies who are breastfed, can be tried on feed thickeners like Gaviscon Infant or Carobel. They do tend to constipate the child, so dose may have to be adjusted.

There are some pre thickened formulas available now like Aptamil Anti Reflux (AR), Cow & Gate AR, SMA Staydown etc. They can be tried if the baby is formula fed and see if that helps. If the simple measures are not working then professional advice should be sought.