Cow’s Milk Protein Allergy (CMPA) and Your Baby

First, what is a CMPA?

CMPA is short for cow’s milk protein allergy. This is when the body reacts to the specific protein in cow’s milk. The immune system responds abnormally to cow’s milk and can result in unpleasant and potentially life-threatening allergic reactions. Unfortunately, CMPA is one of the most common food allergies in babies. Many children outgrow it by age 1 to 3. However, a small percentage will not.

It’s difficult to find reliable stats, but about 3 – 7 babies out of 100 will develop CMPA. This is just a reflection about the tricky nuances of data collection! Oh science!

What are the signs/symptoms of CMPA?

These are the most common physical signs that a baby may have a CMPA:

• rashes, eczema, hives, swelling of face and lips
• stomach and gut problems like nausea, vomiting, diarrhea, stomach pain, blood or mucus in stools
• airway problems like a runny nose, wheezing; troubled breathing, drooling, gagging
• baby is not gaining weight as expected

How is CMPA diagnosed?

It’s important to get a firm diagnosis of CMPA by working with your healthcare practitioner. We realize resources will vary from community to community but this is a big part of your child’s health history. It’s also an opportunity for providers to rule out other diseases.

Your provider may use a variety of ways to help with diagnosis such as an elimination diet followed by a challenge, skin prick test, patch test or a blood test. However, the elimination diet followed by a challenge is the “gold standard”.

Difference Between CMPA and Lactose Intolerance

Before we dive in, it’s important to note: breastmilk is FULL of lactose, It’s the principal sugar in  human milk…this means, infants were *meant* to tolerate it.

There is some definite confusion among parents around identifying if a baby has lactose intolerance vs CMPA, but the two are very different. If you need support diagnosing this, it’s best to work with your health care practitioner.

When we think about a dairy allergy, we’re talking about the PROTEIN in milk.
When we think about a lactose intolerance, we’re talking about the SUGAR in milk.

In all honesty, lactose intolerance among infants is very rare. Like…super-duper rare. If a baby presents with congenital lactose intolerance they typically present with severe diarrhea, vomiting, dehydration and poor growth. We also see these symptoms in babies with a rare disorder known as galactosemia. In these cases, a medical team would be helping and a soy based formula would be offered. Typically, parents cannot breastfeed baby. Breastmilk contains lactose regardless of whether the nursing parent consumes it. Congenital lactose intolerance and galactosemia would most likely be evident shortly after birth.

In our research, we’ve also learned that some pre-term babies may have a temporary lactose intolerance simply because their body isn’t producing lactase enzymes just yet (this is the enzyme needed to breakdown lactose, the sugar in milk)! But don’t worry, if you’re hoping to nurse you can continue to offer your human milk and babe’s enzymes will start to kick in. If you’re a formula feeding family, your babe may benefit from a low lactose or lactose free formula, and eventually you can look at transitioning off.

What about your older child?

From the data we’ve reviewed, it appears as though lactose intolerance is very rare in children under 5 years of age! Phew! If you suspect your child is intolerant to lactose, work with a Registered Dietitian to help. Your child can likely still tolerate many forms of dairy that contain lower levels of lactose or lactose free products.

What To Do if CMPA is Suspected?

Okay, you’ve noticed signs and symptoms that your baby may have a CMPA and you’ve visited your healthcare provider for an assessment. Now what? This information might be particularly helpful if you haven’t quite started solids yet!

PLEASE NOTE: don’t go at this alone. Restricting any diet unnecessarily is never the goal; discuss with your Dietitian or health care provider! Also…this does not replace medical advice you’ve received. 

Step 1:

Nursing or Breastfed Baby: nursing parent needs to remove all dairy (including trace amounts) from their diet and may benefit from a calcium/vitamin D supplements.

Formula Fed Baby: switch to an extensively hydrolyzed casein formula. In some cases, your healthcare provider may even suggest an amino acid based formula.

Step 2:

Stick with the new plan for 72 hours. If cow’s milk was the culprit, then symptoms should start to ease up at this time, although full resolution may not be seen for up to two weeks. 

Step 3:

If symptoms have started to resolve, continue with the dairy-free/extensively hydrolyzed plan. If symptoms have not started to resolve, consult your baby’s pediatrician! 

Step 4: 

If symptoms resolve, double confirmation that cow’s milk was the culprit is an important part of the picture. The nursing parent should resume a dairy containing diet or the formula fed child should resume standard formula. If symptoms reappear, then it’s confirmed! Again, this challenge is an important piece and can be overlooked.

Step 5:

If symptoms reappear with the dairy challenge then go back to dairy-free plan!

Extensively hydrolyzed formula is expensive and sticking with a dairy-free diet can be challenging so it’s important not to impose these restrictions on a family, if they’re not necessary!

How Long Does it Take for Milk Proteins to Clear Breastmilk?

Have you heard that it can take 2-6 weeks for cow’s milk to be removed from a nursing parent’s system after cutting it out?

Thankfully this just isn’t true!

Just imagine how heartbreaking and guilt-inducing it would be if a breastfeeding mama accidentally ate some dairy! To think that she might be subjecting her child to symptoms for the next couple of weeks simply because she thought the pesto she ate was dairy-free when it actually wasn’t. 

In fact, dairy protein fragments are cleared from mother’s milk 6 HOURS after ingesting them. How cool is that?

This is sooo important to know because some women will decide to wean from the breast out of caution for their child (not because they wanted to wean) when it wasn’t actually necessary!