Grumpy or an allergy?
Finally I have put pen to paper (or should I say fingertips to keyboard!) to write my first blog...sorry to those who asked for it months ago and only now am I getting round to it! When people know I am a Dietitian people often ask for advice or support on whether their child has an allergy. I thought I would pose some questions for you to ask yourself to prepare for your visit to the GP / Health Visitor who should ideally be your first port of call for support and advice. - why do you think your child / infant has an allergy? A health care professional will ask for a clear history of when the problems started. A good professional will start from birth and ask about any concerns you may have during this time. Write down what you feel your concerns are. Has your baby changed in personality? Were they content and sleeping well but now irritable and grouchy? - is your baby growing well? some babies experiencing food allergy will experience faltering growth where they do not follow their centile lines, whilst some will gain lots of weight as they feed to soothe the pain. Some infants will continue to grow along the same centile even if they have an allergy so do not rely on weight as a reason not to visit your GP - have your babies bowel habits changed? were they the typical yellow mustard baby poo but now have become green and runny or stringy / with mucous or even constipated / passing blood? an unexpected change in bowels should be discussed with your Health visitor or GP -are the concerns at a particular time of the day or with every feed? Colic usually happens early evening and can be particularly distressing but allergy symptoms usually happen with every feed
-is you baby pulling their knees up with every feed? arching their back during feeding and pulling away from the breast / bottle? if so discuss with your health visitor and ask for their advice on whether it could be a cows milk protein allergy. Babies can be allergic to breast milk if they have cows milk protein allergy as small particles are passed through in the breastmilk.
-is your infant vomiting after each feed or are they posseting? posseting is usual for babies but is only small in volume and does not usually cause faltering growth, reflux should be discussed with your health visitor as whilst some can get better with age some requires medication to help if you are worried that your baby/child has a cows milk allergy seek help. Do not keep swapping infant formula's or start following restrictive diets as these can cause problems in themselves- including further alterations to bowel habits and weight loss. If your GP / HV is concerned that your baby/child may have a cows milk protein allergy then the first step for breastfeeding mums would be to remove all dairy from mums diet. It is important that mums then substitute the dairy with a non dairy alternative such as oat, soya or nut milk (talk to your HV or GP if you have further history of allergy in your family before deciding which milk to swap to). Mums may benefit from a calcium and vitamin D supplement to ensure their requirements are met.
If baby is bottle fed then the first line advice would be to trial an extensively hydrolysed infant formula (EHF)- this is a formula prescribed by your GP which has been partially broken down and therefore less allergenic. These formula do not taste as sweet as standard formula therefore it may be a challenge to get your infant to take the bottle, however stick with it as from experience those that persevere do succeed. If after a trial of the EHF symptoms do not resolve then baby may be prescribed an elemental formula - this is a formula prescribed by your GP / Hospital
which has been completely broken down into its smallest pieces so baby just has to absorb it and not actually digest any of the protein etc. In most cases you will be asked to re-challenge your child after a specified period of time to provide confirmation of the diagnosis of cows milk protein allergy. How you challenge will be explained by your health care professional at the appropriate time. At the appropriate time you will also be guided through the careful reintroduction of cows milk protein using the milk ladder. Anyone with a baby with a cows milk protein allergy should ask if they can be referred to their local NHS paediatric dietitian for advice and support throughout formula and weaning stages. For more information search www.allergyuk.org and iMAP guidelines.