If you are breastfeeding a child with CMPA and you are considering moving on from breastfeeding, it’s really important that you understand the facts and guidelines about getting your child the right nutrition.
According to current NICE guidelines children with CMPA should remain on breast milk or dairy free formulauntil two years of age.
The guidelines specifically state that alternative milks (such as oat, hemp, coconut etc) are NOT suitable for young children, and should only be used as a main drink for children aged TWO AND ABOVE.
Any alternative milks can be used in food/cooking from 6 months, with the exception of rice milk which should not be given to children before the age of 4.5.
The reason for these guidelines is that alternative milks do not adequately meet the nutritional needs of young children. Very few of them contain iodine (M&S oat is currently the only one available I believe) which is essential for healthy brain development, and none of them contain enough protein or fat – also very important for growing children.
For a more detailed comparison of alternative milks and information on the vitamins take a look at my dairy free milk comparison chart. Read the NICE guidelines for confirmed CMPA here.
Ending Your Breastfeeding Journey
It’s firstly very important to remember that breastfeeding is very beneficial to a child’s health at any age, despite what some health care professionals will tell you. If you want to stop breastfeeding because of external pressures, or because you’ve been told something like “breast milk has no nutritional value” over a certain age – then please know that the benefits of breastfeeding will continue regardless of your child’s age, and that the World Health Organisation actually recommend that ALL children are breast fed “up to the age of 2 and beyond”. Breast milk changes and adapts as your child grows, as their feeding habitats develop and as their needs vary. It’s very very clever stuff and will absolutely be giving your child everything he or she needs at whatever age they are.
Make Sure It’s Your Choice
The most important thing is that you are deciding to stop because you want to, and not because you have been told you have to or you feel like you should. Here are a few of the common reasons I often see causing mums to want to stop breastfeeding their CMPA baby, and my thoughts on each.
If you want to stop breastfeeding because your baby is still suffering from symptoms
If you’ve eliminated dairy and your little one still seems to be struggling with symptoms or reacting it can be really stressful, and sometimes it feels like formula would be a better option. Many people worry about their breast milk causing harm to their little one if they are still consuming unknown allergens, but this isn’t the case. Formula does seem like a quicker route to take to get them reaction free when you’re possibly dealing with multiple allergies, but remember the following things:
- You will eventually have to get to the bottom of your little one’s allergies, whether you do that now or when you start weaning
- Formulas contain lots and lots of ingredients, many of which your little one could be allergic to (like coconut for example). There is no guarantee that formula will give you a reaction free baby
- Formula, or not breastfeeding, comes with a certain amount of risks, such as an increased rate of diabetes, ear infections and respiratory problems
- Breast milk will work to heal the gut and do all the other amazing things that it does even if your baby is reacting to something in it. If damage to the gut occurs whilst you’re figuring out what’s going on, your breast milk will actually aid the gut to recover quickly
If you’re struggling with your little one’s symptoms and need some extra support, take a look at What to do When Dairy Free Doesn’t Work.
If you want to stop breastfeeding because you are returning to work
Take a little time to read this CMPA FAQ page. Depending on your baby’s age it is very likely that they will cope well with you returning to work, and you will be able to continue breastfeeding successfully. If you’re a part of my Breastfeeding With CMPA Support Group please access the returning to work thread on the pinned post for much more information on this.
If you want to stop breastfeeding because you are finding it tough
Breastfeeding can be really, really tough. Breastfeeding a baby with food allergies can be even harder. You may be dealing with a very unhappy or poorly baby, and you may be struggling to give up some of the foods you love most. Some mums really struggle with the pressure to not mess up, and some begin to feel isolated and like they can’t go out or socialise with friends.
Firstly, these feelings are so, so normal and you need to give yourself a break. It is okay to feel this way, it is okay to find it tough, we all have at at least one point. Secondly, take a step back, relax and remember why you’re doing this. Yes it can be tough, but it isn’t forever. There are lots of things that don’t suck about giving up dairy, and there are lots of yummy dairy free treats to keep you going strong. The end result of this will be a happy and healthy little one and when you look back on this a few years from now it will be a distant memory. If you’re feeling overwhelmed about CMPA then take some time to scroll through all of the breastfeeding with CMPA resources here, and get the truth about some common myths surrounding it.
If it’s breastfeeding in general getting you down then consider how you could improve things for yourself without giving up entirely. You could think about trying to reduce feed frequency, or perhaps try to night wean. It may just be that you’re exhausted and desperately need a break, so take one if you can. Older babies will be fine without feeding for several hours if you need a day to yourself, and they’ll more than likely not even think about milk while you’re gone.
The best breastfeeding advice I was ever given was never give up on a bad day. You can do this, you are doing it, and it will get so much easier soon. Grab some dairy free doughnuts, try and enjoy a little peace or time to yourself, recharge yourself and fill your cup. You might feel much more positive about it all tomorrow.
If you want to stop breastfeeding due to being pregnant
Again it’s actually possible that your child will cope well with this, and many mothers go on to feed throughout pregnancy and then tandem feed. There is another thread on this in the Breastfeeding With CMPA Support Group.
If you want to stop breastfeeding because you need to begin a course of medication
If you need to start taking a specific medication and you’ve been told that you cannot breastfeed on it, I would strongly urge you to contact Wendy who runs the BfN Drugs in Breast Milk Service. There are actually very few medications which are not compatible with breastfeeding, but there are lots of doctors who seem to give out misleading and incorrect info. Wendy is the woman in the know here, and you can trust her information above anyone else’s. Check out the BfN Drugs Factsheets, or contact her directly (either on Facebook or by emailing firstname.lastname@example.org) if you have a specific question that isn’t covered there.
The bottom line is that if you want to stop breastfeeding then that is a choice and is, of course, entirely up to you. The point I want to make here is that you should never feel like you ‘have to’ stop feeding, or that you ‘should’ for any reason. Making the right decision for your child and for yourself is what is important, so if moving on from breastfeeding is what you want to do then read on for your options.
If your child is over the age of 2
If your child is over the age of 2 years old, and has either self weaned or you have decided to finish your breastfeeding relationship then you can select the best suitable alternative milk from the chart, and continue to offer plenty of vegan sources of calcium, good fats and healthy protein options. Monitor their diet and be sure to discuss any concerns with your dietitian or GP.
If your child is under the age of 2
If your child is under the age of 2 then you have several options:
Move on to a suitable dairy free formula
If you’re definitely sure you are going to move on from breastfeeding before your child reaches two years old and they have Cows Milk Protein Allergy then you will need to use a dairy free formula. This can be a little tricky for a few reasons, but as discussed above it is really important for your young child.
If you are looking to find a suitable dairy free formula you first need to know that there are three types – soya based formula, hydrolysed formulas and amino acid based formulas. Soya formula is available to buy in supermarkets, the others will require a prescription.
Soya formulas are obviously not suitable for those children who have a soya allergy, and we know that some where between 30-50% of CMPA children will. There are some drawbacks to soya formula, and some concerns over phytoestrogens so it’s something to look into a little further. The NHS and NICE both list soya formula as being suitable for children over 6 months under the guidance of a health care professional, so it’s something to discuss with your dietitian or GP. Alpro Growing Up soya based drink is also an option, as it is designed for children aged 1-3 and does contain additional iodine. You can see how it compares to cows milk and to the other alternative milks in the comparison table.
The hydrolysed formulas (such as Aptamil Pepti or Nutramigen 1) contain heavily broken down milk proteins, meaning the body is less likely to recognise them as an allergen. Many CMPA babies can tolerate this kind of formula, however if your baby has been reacting to milk protein through your breast milk then it’s very likely that they won’t. Lots of health care professionals may ask you to try this type of formula first, but be aware that your baby may react to it.
The third type of dairy free formula is amino acid based, and this is completely free from milk protein so safe for those with a more severe allergy or very low tolerance. Examples include Nutramigen Pureamino or Neocate. These formulas are more expensive for the NHS to prescribe, so you may face more resistance.
Problems With Moving on to Dairy Free Formula
The first problem people often come across when moving on to dairy free formula is poorly informed health care professionals, who insist that they cannot prescribe formula for babies over 1, usually due to budget cuts. The NICE guidance is designed to offer evidence based recommendations for health care professionals to promote and protect good health. If you are struggling to get support from your current health care professional and have been told that an alternative milk is suitable as a drink for a child under 2, then I would urge you to print out the specific guidance and take it with you to your appointment to ask why they aren’t following it properly. There are also specific products out there that you can ask for, like Neocate Advance or Active which are designed for CMPA children over the age of 1.
The second issue commonly found when older babies are moved on to a dairy free formula is that they just don’t seem to like it very much. I haven’t ever tasted it, but I can confirm that the smell isn’t particularly pleasant. Since they have been used to the sweet taste of breast milk it will probably be quite a big adjustment.
Continue to Breastfeed
This is the option most breastfeeding mums tend to go for in my experience, and my Breastfeeding With CMPA Support Group is full of many mums who are breastfeeding slightly older babies now. By the time your children are hitting 12 months or so, breastfeeding is probably much easier than it was when they were smaller. Many of us have tricky starts and face different challenges whilst establishing feeding, and I always think that once babies are older and everything is going okay is when we reap the rewards of our hard work. Personally I can’t imagine having to faff around with formula when I was so used to just wapping out a boob.
Usually as children get older their feeds do reduce, although I know lots of you are still feeding boob monsters. Babies who are down to 1 or 2 feeds a day will still be getting absolutely everything they need as your breast milk will adapt accordingly. If the frequency of feeding is getting you down you could consider trying to feed less rather than stop feeding entirely; either by night weaning or gentle distracting/redirecting to reduce day time feeds.
Use Donor Milk
Another option to consider if you need to move on from breastfeeding is the use of donor milk. There are mums out there who may be free from your child’s allergens and may be open to donating milk to you. Breast milk has the same healing properties regardless of who made it, but bare in mind that it won’t be so personally tailored to your little one, especially if the kind person donating has a nursling of a very different age. Milk sharing is definitely a good option though if you want to continue providing some kind of breast milk for your child, and it’s actually far more common than you may realise. Take a look at the Human Milk 4 Human Babies Facebook page for more information, and to request (or donate) breast milk.
Ignore The Guidelines
As with anything it is absolutely down to you if you decide to finish breastfeeding and use an alternative milk as a main drink for your young child. Do remember that even non allergic children should only have breast milk or formula before 1. Hopefully this post has given you a greater understanding of what the guidelines for children with CMPA are and why they are in place, and it’s totally up to you what you do with that knowledge. Some people have dietitians who are adamant that their child receives a diet varied enough in nutrients to make up for where alternative milks are lacking. Personally I am fairly experienced with ‘The Beige Stage’ that most toddlers experience, and would not be happy to rely on diet alone to fulfil a growing child’s nutritional needs, but it is something you must weigh up for yourself.
As always don’t just take my word for it (or your dietitian’s…). Read the stuff I’ve linked to, research it a little yourself, and just try to make an informed decision. Do whatever is right for your child, for you and for your family, but make sure you know all of the facts before you decide.