Feeding your baby and managing CMPA

Symptoms of cow’s milk protein allergy (CMPA), also known as cow’s milk allergy (CMA), can be distressing, particularly at this time when you are getting to know your baby. The good news is that CMPA can be easily managed by adjusting your baby’s diet to remove cow’s milk proteins, and you will quickly notice improvements, with most symptoms disappearing within 2 to 4 weeks.

It is important that you do not experiment with a cow’s milk-free diet for your baby without recommendation and guidance from your doctor.

Breastfeeding is the best feeding option for you and your baby. Even if your baby has been diagnosed with CMPA, you should continue breastfeeding. Based on the severity of your baby’s symptoms, and whether your baby might also be allergic to any other foods, your doctor will help you to choose the most appropriate feeding option to manage your baby’s CMPA.

Importance and benefits of breastfeeding
What type of nutrition is best for my baby?

Continue to breastfeed your baby with CMPA

Diagnosis of CMPA should not affect your breastfeeding routine. In fact, breastfeeding is the best feeding option for you and your baby. Breast milk contains all the nutrients your baby needs in the first 6 months and continues to be beneficial for much longer. In addition to nutrients, your breast milk also passes the protection of your immune system to your baby (in other words, it is immunoprotective). In rare cases, when your baby’s immune system reacts to cow’s milk proteins in breast milk, your doctor might recommend you to start an elimination diet totally free from cow’s milk protein (please be aware that a dairy-free diet may not be sufficient as all traces of cow’s milk should be eliminated).

Start early: The earlier you start with breastfeeding the better. Doctors advise that starting breastfeeding within 1 hour of birth ensures your baby gets the first milk (colostrum) and protective factors it contains as early as possible.

Emotional benefit: Breastfeeding is an important way to establish and maintain a strong emotional bond with your baby.

Long-term health benefit: Breastfeeding will also aid in the development of your baby’s immune system and so protect your baby’s health long term.

Protective for your baby and you: Studies have shown that breastfeeding reduces the risks of babies developing infections, digestive tract diseases, diabetes, obesity, and even leukemias later in life. Breastfeeding is also good for you! Mothers who have continued breastfeeding have a reduced risk of developing diabetes as well as breast and ovarian cancer.

The Earlier The Better

Breastfeeding within the first hour of birth ensures the baby receives the first milk, called colostrum
For the first 6 months, exclusive breastfeeding is recommended

Protective Role For You And Your Baby

Breast milk is rich in protective factors that are good for infant health, growth and development, and decrease the risk of your baby developing diseases later in life
Mothers who breastfeed have a reduced risk of developing diabetes as well as of developing breast and ovarian cancer

Emotional Benefits

You and your baby develop and maintain a strong emotional bond.

What type of nutrition is best for my baby?

The only way to improve your baby’s symptoms is to remove cow’s milk proteins from your baby’s diet.

It is important that you do not experiment with a cow’s milk-free diet for your baby without recommendation and guidance from your doctor.

When exclusive breastfeeding is not feasible, or when it is supplemented with formula, your doctor will help you choose the suitable formula that is free from cow’s milk proteins. These formulas have been designed with your baby in mind and contain all the necessary nutrients to support growth and development.

These specialized formulas can be based on:

cow’s milk that has been treated in a certain way to ensure that proteins, whey for example, are no longer recognized by your baby’s immune system and so do not cause an allergic reaction
amino acids

The table below describes the differences between the different types of formulas.

	eHF	AAF
What is it?	eHF stands for “extensively hydrolyzed formula.” The proteins in cow’s milk that cause your baby’s allergic reactions have been extensively broken down (hydrolyzed).	AAF stands for “amino acid formula.” This formula does not contain any cow’s milk protein.
What does it consist of?	Cow’s milk proteins have been broken down to smaller parts, which means that they can no longer be recognized by your baby’s immune system. The formula also contains other nutrients to support your baby’s growth and development.	The formula consists of amino acids, which are the individual building blocks of proteins, and does not contain intact or partially broken down cow’s milk protein. The formula also contains other nutrients to support your baby’s growth and development.
Who is it for?	This is the first choice for any baby diagnosed with CMPA.	This formula is recommended for babies with severe cases of CMPA, multiple food allergies and babies whose symptoms do not improve with extensively hydrolyzed formula.

When and how to start with the introduction of solid foods

By the time your baby is 6 months old, breastfeeding (or specialty formulas) is no longer sufficient to fully support growth and development, and complementary foods should be introduced. Throughout this time, breastfeeding (or suitable formulas) continues to be the main source of nutrition for your baby.

If you start complementary feeding too early, you can increase the risk of your baby becoming ill—the reflex that supports moving of solid foods around the mouth and swallowing them usually develops between ages of 4 and 7 months, and your baby will not be ready before this. Similarly, if you start too late, your baby may not be getting all the nutritional support they need, which increases the risk of your baby developing deficiencies in key vitamins and minerals and delayed growth. As well as providing nutrition, introducing complementary foods will also provide sensory stimulation for your baby, and improve your baby’s motor skills.

BREASTFEED TO START

Breast milk contains all the nutrients your baby needs in the first 6 months of life and provides protection against infections. If for any reason you are not able to breastfeed, your doctor will help you find the suitable formula for your baby.

ONE FOOD AT A TIME

As you start introducing solid food at around 6 months old, it is best to start introducing one food at a time. This way, if you think you see an allergic reaction or notice any new symptoms, you can identify the culprit right away!

ONE MEAL AT A TIME

Start introducing solid foods one meal at a time. First start with the morning meal (breakfast/brunch), then introduce solids foods at the evening meal (dinner). As your baby grows, you can introduce the midday meal (lunch), as well as additional nutritious snacks.

COOKING AND MASHING

Although raw food is healthy, cooked foods will be easier for your baby to digest. After a few weeks, try introducing the fruits and vegetables that you have cooked with increasingly less mashing and gradually with a more coarse texture, followed by small pieces.

TRY AGAIN AND AGAIN

Even if your baby has rejected a type of food, do not give up. Refusing food is normal, and it often takes between 8 to 10 tries for a baby to accept a food type.

IMPORTANT NOTICE: Mothers should be encouraged to continue breastfeeding even when their babies have cow’s milk protein allergy. This usually requires qualified dietary counseling to completely exclude all sources of cow’s milk protein from the mothers’ diet. If a decision to use a special formula intended for infants is taken, it is important to follow the instructions on the label. Unboiled water, unboiled bottles or incorrect dilution can make babies ill. Incorrect storage, handling, preparation and feeding can eventually lead to adverse effects on the health of babies. Formula for special medical purposes intended for infants must be used under medical supervision.