CMPA Frequently Asked Questions

As the mother of a child who cried constantly for the first few months of their lives I know how difficult that can be. As the mother of a child who had to either be feeding or asleep to be happy, I know how awful that can become. As the mother of a child who was sick so often we would leave puddles where ever we went, we would both get through multiple outfit changes throughout the day and we never ever owned enough muslins, I know how draining that is. As the mother of a child who didn’t gain weight at the rate he should’ve, I know how scary that feels. I am the mother of a child with Cow’s Milk Protein Allergy and I know firsthand how incredibly daunting that diagnosis is. But a diagnosis is an answer, it’s a chance to make changes and see improvements, and honestly, that diagnosis changed our lives. If any of this is sounding familiar to you, or your baby is presenting other symptoms that you can’t seem to explain or get under control it’s very possible that a CMPA diagnosis could change your lives too.

I’ve shared more about our diagnosis and personal experience with CMPA and soya allergy in a guest post over at Mamanatal. This post is mainly about facts and common misconceptions as well as frequently asked questions. Scroll down to the bottom for a video going through some frequently asked questions. It’s important to point out this is information I have picked up through my experience with allergies and shouldn’t be used in place of appropriate medical guidance. It should be useful to everyone dealing with CMPA but is written from the perspective of a breastfeeding mother so is more focused around that.

If you’re looking for dairy free cake (aren’t we all?) head straight to my Breastfeeding with CMPA Dairy Free Treats List (also soya free)

Cow’s Milk Protein Allergy (CMPA) is an immune system response to one or both of the two proteins found in cow’s milk. It is the most common infant food allergy in the world, presenting in between 3-7% of infants. It shouldn’t be confused with lactose intolerance (the inability to digest the sugar found in all milks, including human breast milk) which is incredibly rare in infants. What makes the diagnosis of CMPA difficult is that often these symptoms vary dramatically; they can be seen as “normal” to a degree, or are often linked to other problems or health issues. For example colic symptoms, such as difficulty settling or excessive crying, vomiting or reflux, mucous filled nappies, eczema or rashes on the skin are all common symptoms. Symptoms can also include constipation or diarrhoea, a runny nose, conjunctivitis or slow weight gain. Your baby may suffer from one or many of these symptoms in varying degrees and that can often make it very difficult to pinpoint a cause. The allergy is divided into two categories– IgE mediated and non-IgE mediated response, based on how the body reacts to the allergen. Generally IgE responses are immediate, such as hives or swelling, and non-IgE are delayed reactions, like eczema, diarrhoea or constipation. It is also possible to also develop anaphylaxis to cow’s milk protein.

SO WHAT SHOULD WE DO IF WE SUSPECT OUR CHILD HAS CMPA?

If your baby is showing symptoms of CMPA I would recommend visiting your GP or Health Visitor and asking for a referral to a dietician. It may be useful if you can show them a food diary and any pictures of reactions/symptoms you have. Your health care providers should help you confirm diagnosis, usually by excluding the allergen and then reintroducing, and subsequently create a personalised care plan. The Milk Allergy in Primary care (MAP) algorithm shows what should take place and in what order.

CAN WE HAVE A TEST DONE TO CONFIRM?

Unfortunately testing for Cow’s Milk Protein Allergy is not straightforward. You may be offered ‘skin prick’ or blood tests but these can only determine an IgE mediated response. If your child has non-IgE mediated CMPA this will give a negative result. There are also many other causes of false negatives or false positives, especially in young children. These tests can be useful when guiding reintroduction but there aren’t incredibly helpful for confirming a diagnosis. The gold standard for confirming CMPA is to eliminate dairy for a period of time and keep track of symptoms. If it is CMPA you should see some improvements. You can then confirm diagnosis by reintroducing milk into your/their diet to see if symptoms come back. Read more about how to confirm CMPA in a breastfed baby.

CAN I STILL BREASTFEED?

A common misconception of CMPA is that you can’t continue to breastfeed and instead must move your child on to a suitable formula. This is totally incorrect. What you will need to do if you want to continue feeding is to remove the allergen from your diet immediately. This seems impossible in the beginning because milk seems to be hidden in so many things, like wine, ham, pineapple juice and even pickled onions! Eventually though you do get the hang of reading labels and there are so many delicious alternatives out there you’ll be fine. It can take up to 3 weeks for your system to be completely dairy free and another 3 for your little one’s system to also be clear, but you should start seeing improvements before then. If you aren’t breastfeeding or want to move on from it there are a number of suitable formulas out there which your GP should be able to prescribe.

DOES THIS MEAN MY CHILD MAY HAVE OTHER FOOD ALLERGIES?

Multiple food allergies are possible but rare, and the chances of your child having more than one aren’t increased by having CMPA, with one exception. The proteins in soya are very similar to the proteins in cow’s milk and sometimes the body attacks them both in the same way. Around 30-50% of those with CMPA will also react to soya protein so it may be necessary to cut this out also. If symptoms still persist after 6 weeks of a dairy free diet you might want to explore the possibility of further allergies with support from your health care providers. Keeping a food and symptom dairy may help you establish a pattern.

WHAT MILK ALTERNATIVES CAN I USE?

There are many alternative milks available and these can be used in food/cooking once your little one is 6 months old. Make sure to choose a fortified version to help with your child’s daily calcium intake. These alternative milks shouldn’t be used as a main drink for young babies as they don’t contain enough nutrients and calories. NICE guidelines advise that CMPA children stay on breastmilk or formula until 2 years old. Rice milk shouldn’t be a main drink for children under 5. For a great chart comparing the main alternative milks available check out this great post.

WHAT ABOUT GOAT’S MILK?

It’s predicted that up to 90% of CMPA children will react to all animal milks as the proteins are so similar, so I would recommend avoiding goats milk, cheese, etc.


HOW CAN I MAKE SURE MY CHILD GETS ENOUGH CALCIUM?

Your GP may be able to prescribe calcium supplements for you if you’re breastfeeding. If your child is breastfeeding they will be getting everything they need from you. There are also lots of vegan sources of calcium out there like green leafy vegetables, almonds and apricots so try to offer these often.


WHAT ABOUT FOODS LABELLED “MAY CONTAIN MILK”?

It’s really important to note that a ‘may contain’ label (or any type of similar wording)  isn’t legally required. Brands cannot use the warning if there is no risk of cross contamination, but they are not obliged to include it on packaging if there is a risk. Due to how most pre packaged food is produced – on mass in large warehouses which produce all kinds of other foods, it’s likely that ALL packaged food items will be at a small risk of containing traces of allergens. However this risk is very small. Avoiding may contains (which would need to include all packaged foods, all foods from bakeries and any food produced in a restaurant which also handles dairy products) would put a huge limit on your diet and would most likely be unnecessary. It comes down to chance. It’s very possible to eat a ‘may contain’ 99 times and have no reaction, then react on the 100th. It’s equally possible to react to something once and then eat it 99 more times with no issue. Overall I think avoiding ‘may contains’ is not something you need to do, and avoiding only the ones labelled as such is basically pointless.

The one exception here is chocolate. As chocolate is a viscous product the machines for making it cannot be cleaned and therefore it is at more risk of containing milk traces. This doesn’t mean you have to avoid may contain chocolates, but it’s important to be aware there is a slightly elevated risk. There are several companies who produce chocolate in a dairy free factory, like Plamil and Moo Free.

WILL MY CHILD OUT GROW IT?

Hopefully! Around 50% of children will outgrow CMPA by 12 months, 60-75% by 2 years and 85-90% by 3. Depending on the severity of your child’s allergy you may be asked to “challenge” their allergy periodically using something called a milk ladder. You typically start at the bottom of the ladder with baked milk as this is when the protein is most broken down and work your way up to raw milk. Some children are able to tolerate up to a certain step on the ladder before reacting, and recent research shows that regularly exposing them to even a very small amount of the allergen can speed up the rate they outgrow the allergy.

USEFUL LINKS 

For a full list of symptoms and some excellent links to helpful information you can visit the CMPA Support webpage.

For more support to continue breastfeeding a baby with CMPA check out the Breastfeeding with CMPA and Other Food Allergies – Support Group UK – please note this is a private group for breastfeeding mums only. Look out for a message from our admin team after you request to join. 

For a treats list of dairy and soya free foods as well as recipes and more resources take a look at our Dairy Free page

To read NICE guidelines for CMPA click here and you can find the MAP algorithm for suspected CMPA mentioned earlier here