Introducing Dairy After CMPA Diagnoses

Today I wanted to discuss Cow's Milk Protein Allergy (CMPA) and the process of milk reintroduction through a milk ladder. In case you missed my previous post, my little boy was diagnosed with a CMPA allergy at about 2 months old. We were exclusively breastfeeding so I started on a strict dairy-free and soy-free diet. The reason for also avoiding soy is that there is a higher risk of soy protein allergy in babies with CMPA.

What is CMPA?

CMPA affects about 7% of children under 1 year of age. CMPA occurs when the body's immune system sees the proteins in cow's milk, casein and whey, as a threat. There are two main types of CMPA:

IgE-mediated CMPA: Reaction typically occurs within minutes.

Non-IgE-mediated CMPA: Delayed reaction occuring anywhere from 2-72 hours after ingestion.

Potential Symptoms

IgE mediated	Non-IgE mediated
Skin: rash, hives, itchy, swelling of the lips/face/eyes, flushing, eczema	Skin: flushing, itchy, eczema that doesn't improve with treatments
Hoarse cry, difficulty breathing, wheezing, coughing, sneezing, congestion	Colic
vomiting, diarrhea	Abnormal fatigue, refusal to feed, weight loss or stagnated weight gain
floppy, unresponsive, limp, pale	Diarrhea, blood and/or mucous in stool, excessive gas, abdominal discomfort, redness around anus, reflux, coughing

*This list is not complete - if you are concerned your child has CMPA, see your doctor to discuss your child's symptoms.

When to Start Introducing Cow's Milk Proteins

My little boy has just turned 1 year old and it's time to try introducing cow's milk proteins to his diet. The sweet spot is between 9 and 18 months. This timeline depends on how long your child has been dairy-free (recommended to wait until they have been dairy-free for at least 6 months)I will admit I have been a bit apprehensive to start this process which is why I decided to wait until the 1 year mark where research suggests about 50% of children will have outgrown the allergy. I am hoping that is our case. I really, really, really miss cheese. He has been exposed to soy products since he started solids. I have not yet tried full-on tofu or edamame, but he has had foods with soy protein in them with success.

Milk Ladder

The milk ladder is a step-wise approach to gradually introduce milk products into your babies diet to build tolerance. The following figure takes you through the process.

If you are breastfeeding, it is recommended that you maintain a dairy-free diet during this process to remove the guesswork if there are any reactions. We only want the milk proteins coming from one source so we can gauge what and how much of the food resulted in a reaction.

Tips:

Make sure your baby is healthy before starting. You don't want other factors confusing the process. If your baby gets sick, pause where you are in the ladder and let them get better before going to the next step.

Keep a reaction journal. If you notice any symptoms as discussed above, write them down along with the date, time and food you served.

Communicate with your healthcare team. Make sure your GP is aware you are starting this process and I highly encourage that you get in touch with a dietitian to help you through the process.

Be flexible. Whether it is a refusal of certain foods, reactions, flu bugs, holidays, etc., things will disrupt your plans and will not likely go perfectly smoothly. This is where being in touch with a registered dietitian can be super helpful. They can provide suggestions and help you manage these times of chaos to keep your child on track.

How long will this take?

That's a good question. As you can see in the above figure, you want to spend a few months on each step. Some children might fly through the steps while others might see some reactions and have to backtrack. It can take a few years to reach the top of the milk ladder!

I will be starting off at step 1 this week with my little guy and I can't wait to take you on this ride with me. Stay tuned here on my blog and Instagram for updates.

If you have any questions or would like to book in, head over to my contact page and send me a note. I would love to hear from you.

Talk soon!