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Every case of CMPA will be as individual as the baby itself. You may find that your baby outgrows the allergy as young as one, or they could be 10! Less often they may never outgrow it; there is no way to know. The best we can do is manage the condition, whilst trying to make life as "normal" as we can for our child, whatever their age.
There isn't a cure for CMPA, however many children will outgrow the allergy before the age of 5.
Completely avoiding cow's milk in the diet, or allowing a certain level which your child can tolerate as they grow older is the only way to control the symptoms.
If multiple allergies are present (soya, egg, fish, wheat, gluten, nuts, etc) these will also need to be avoided to ensure symptoms remain under control.
Excluding cow's milk from the diet sounds simple, that is until you begin to check food labels and realise just how many foods contain some form of CMP! Milk is hidden in anything and everything from bread to wine.The most important part of any exclusion diet is learning to read food labels, and as manufactures often change their products ingredients, it is vital to check the label before every purchase, even if it has been eaten safely in the past.
What alternatives are there to "normal" formula, and is it ok to continue breast feeding a baby with CMPA?
If you are breast feeding it is completely ok to carry on and can indeed be very beneficial in aiding other problems that can often present alongside CMPA including Reflux. Breastmilk is far easier for a baby's gut to digest than formula milk. However, you may need to follow a complete avoidance diet yourself if CMPA Symptoms present. This should be done with the assistance of a healthcare professional as removing cow's milk drastically reduces your intake of calcium and other essential nutrients from your diet - you will likely need to use supplements temporarily and should use calcium enriched milk substitutes.
If you are formula feeding there are two types of formula suitable for CMPA - Extensively Hydrolysed (EHF) and Amino Acid (AAF.) An EHF is made by super heating (Hydrolysing) cow's milk to break down the milk proteins so that the body doesn't recognise it as an allergen; and an AAF is an amino acid derived from vegetable sources.
Your baby will be assessed based on family history and the severity of the allergy, if there is significant family history or a severe allergy an AA formula should be prescribed. In less severe allergies where there is little or no family history an EHF will usually be prescribed first (these are produced from either casein or whey so it still contains a small amount of cow's milk protein). Not all babies will be able to tolerate an EHF formula and they should then be offered an AAF.
You should NOT be offered a soya formula - they are unsuitable for infants under the age of 6 months due to levels of phytoestogens, which are too high for a babies small size. It is unlikely this would be harmful, but some studies have shown some small effects later in the child's life. There is also about a 50% chance of a soya allergy developing as the protein chains are very similar to those found in cow's milk. This is also the case with other animal milks such as sheep and goats milk, so these too should be avoided.
Lactose Free formula should also be avoided as it still contains cow's milk protein (Casein & Whey). Partially Hydrolysed Formula or "Comfort milk" also contains long chain milk protein and should also be avoided.
Where do breastfeeding mums find alternatives to everyday foods?
If you're avoiding cow's milk yourself it does not necessarily mean missing out!
There are a lot of great alternatives out there and hopefully using this site will save you time in finding them. Visit the Free From Foods page and you will find products listed in alphabetical order, with links to websites and stockists.
See our Resources page for links to all our CMPA Support Groups and useful websites such as Allergy UK and the Free From ... Community. There are also links to local "free from" bakers and cake makers, manufactures of "free from" alternatives and product stockists. Plus links to support groups on Facebook based in the USA, Canada and Australia (including our own within the CMPA Support Community).
In our Recipes section you will find recipes that have been adapted to be allergen free, as well as recipes created especially for an allergy friendly diet. There are links to recipe websites dedicated to "free from" cooking. If you have any recipes you would like to submit please send them to us via our Contact Us web-form or Facebook groups.
We also have a dedicated group, CMPA Support for Breastfeeding, where Mum's can share tips and advice and gain experience from others in similar situations.
What about weaning a CMPA baby?
Milk Free Advice, for the total avoidance of cows milk protein.
Food manufactured in the European Union is required by law to list milk in the ingredients panel if it is an ingredient in the product, so it is important to read labels with every purchase.
Easily Recognisable sources of milk:-
- Creme fraiche
- Fromage frais
- Ice Cream
- UHT milk
- Lactofree, milk, spread and cheese
- a2 Milk
Ingredients to be avoided:-
- Butter fat
- Butter milk
- Casein, caseinates, hydrolysed caseinates, sodium caseinates.
- Milk powder, cheese powder, skimmed milk powder
- Milk solids
- Non-fat milk solids
- Whey, hydrolysed whey, whey powder, whey sugar, whey syrup sweetener.
Additives that may be derived from milk:-
Food companies must also state on the label if the additives are derived from milk. If you are unsure, you can contact the manufacturer who will advise you of the source. Foods without labels and those foods which are sold loose should be avoided; you can not be sure of the ingredients and they may contain traces of milk due to contamination from other milk containing foods.
- E234 - Nisin
- E270 - Lactic Acid
- E325 - Sodium Lactate
- E326 - Potassium Lactate
- E327 - Calcium Lactate
- E472b - Lactem (Lactic acid esters of mono-and diglycerides of fatty acids)
- E481 - sodium Stearoyl-2-lactylate
- E585 - Ferrous Lactate
- E996 - Lactitol
Soya Advice for the complete avoidance of soy protein
Soya is widely used in foods so is difficult to avoid. As much as 60% of manufactured foods contain soya. Soya can be eaten as whole beans, soya flour, soy sauce or soya oil. Soya can also be used in foods as a texturiser (texturised vegetable protein), emulsifier (soya lecithin) or protein filler. Soya flour is widely used in foods including; breads, cakes, processed foods (ready meals, burgers and sausages) and baby foods. Food manufactures change their ingredients often, so it is important that you read labels with every purchase!
Terms that indicate the presence of soya:-
- Soya Milk
- Soya Cream
- Soya Ice Cream
- Soya Infant Formula
- Soya Margarine
- Soya (Soy) Sauce
- Soya Yoghurts and Desserts
- Bean curd
- Bean sprouts
- Edamame (fresh soybeans)
- Miso (fermented soybean paste)
- Soybean (curds, granules)
- Tofu/Tofutti (dofu, kori-dofu)
- Soya protein isolate
- Soya starch
- Soya shortening
- Soya protein
- Soya albumin
- Soya flavouring
- Soya flour
- Soya gum
- Soya lecithin (E322)*
- Soya nuts
- Soya oil*
Terms that MAY indicate the presence of soya: -
- Bulking agent
- Gum arabic
- Guar gum
- Mixed tocopherols
- Natural flavouring
- Vegetable gum, starch, shortening, or oil
- Vegetable broth
- Vegetable protein
- Vegetable paste
- Vitamin E
- Texturised vegetable protein (TVP)
- Hydrolysed Vegetable Protein (HVP)
- Hydrolysed Plant Proteins (HPP)
- Hydrolyzed soy protein (HSP)
- Mono- and di-glycerides of fatty acids
- MSG (monosodium glutamate)
This is a very extensive list, so finding out your level of avoidance is essential so that your diet is not more restricted than it needs to be.
There are lots of great alternatives on our Free From Foods page