Symptoms of cow milk allergy in infants

Is Cow’s Milk Allergy Similar to Lactose Intolerance?

Cow’s milk allergy is often confused with lactose intolerance as they both share similar signs and symptoms. Cow’s milk allergy occurs when the immune system has an allergic reaction to the protein found in cow’s milk. Lactose intolerance occurs when the digestive system is incapable of digesting lactose (sugar) in the milk fully.

Does My Baby have Cow's Milk Allergy?

It is not always easy to tell when a baby has cow’s milk allergy. Infants who are breastfed have a lower risk of developing a milk allergy than those who are formula-fed. Some babies may display an allergic reaction soon after the cow’s milk is introduced, while others may show signs hours or even days later. Symptoms displayed may also vary between individuals, including:

• Wheezing
• Shortness of breath
• Coughing
• Stomach discomfort
• Vomiting
• Diarrhoea
• Blood in stools
• Hives
• Swelling
• Loss of appetite
• Irritability (Colicky behaviour, poor sleeping patterns)

If you suspect your baby has cow’s milk allergy, it is important to see a paediatrician immediately to test and diagnose their condition.

How do I Care for My Baby with Cow’s Milk Allergy?

If you are breastfeeding:
It is important that you remove cow’s milk and dairy products from your own diet as milk protein can be passed through your breast milk during feeding. You can do this for a trial period to see if your baby’s symptoms improve. Be extra mindful and always check food labels for presence of milk or milk-based ingredients. Your paediatrician may involve a dietitian to advice on diet changes and how to replace nutrients that may be missed when excluding cow’s milk from your baby’s diet.

If you are formula-feeding:
Your paediatrician may advise you to switch your baby to a hypoallergenic or an extensively hydrolyzed formula as these are usually least likely to trigger an allergic reaction. Do not embark on a dairy-free diet for your baby unless under the advice of your doctor.

Can My Baby be Allergic to Other Foods too?

Since protein in goat’s and sheep’s milk are similar, there may be a cross-reactivity to these products if your baby has cow’s milk allergy. Hence, it is not recommended to substitute cow’s milk with similar products as your baby could also be allergic to these products. You may wish to consult your paediatrician before introducing possible allergy-inducing such as eggs, nuts, soy, wheat, shellfish and fish to your child.

It can be troubling for parents to find out that their child is allergic to cow’s milk — a nutritional staple for many children. But there are ways to successfully cope with this allergy. If breast milk, which is the best milk for your child, is not a viable option, there are other good alternatives available to ensure that your growing child receives all the necessary nutrition.

Dr. Chiang Wen Chin and Dr. Lee Bee Wah, both consultant paediatricians at Mount Elizabeth Medical Centre, share what parents need to know in order to effectively manage their child’s milk allergy.

This video is supported by an unrestricted education grant from Abbott, the leader in paediatric nutrition*.

1. Definition and Common Symptoms of Cow Milk Allergy

   CMA, the second most common food allergy in young children, is an abnormal immune reaction to cow’s milk protein. If your child has CMA, he could fall into either of two types of CMA: Immunoglobulin E (IgE) mediated CMA and non-Immunoglobulin E (non-lgE) mediated CMA.

   In some children, CMA manifests itself quite immediately, sometimes within minutes of ingesting cow’s milk, in the form of cough, redness, itchiness or even becoming breathless and turning blue. Such an immediate reaction is symptomatic of lgE mediated CMA. In non-lgE mediated CMA, the adverse reaction to cow’s milk may only occur several hours after cow’s milk is consumed, and the symptoms are typically vomiting, diarrhoea or blood in the stool.

2. Proper Management of CMA is Crucial

   If your child has a milk allergy, it is critical for you to know how to best manage the allergy. Many studies have shown that food allergy, including CMA, is associated with decreased quality of life for not only the child but for the caregivers as well.

   Your child’s medical specialist would be the best person to educate you and your child on how to assess the severity of the reaction, and clear any misconceptions you may have about milk allergy. Do not let milk allergy affect your child’s quality of life and day-to-day performance.

3. Good Alternatives to Cow’s Milk Formula

   Naturally, if your baby has CMA, it would be wise to avoid milk that contains cow’s milk protein. If breastfeeding is not a viable option, then your child will require a specialised formula.

   If your child suffers from lgE mediated allergy, a tasty, economical substitute is a soy-based formula. Otherwise, an extensively hydrolysed formula should be used. In cases of CMA, an amino acid formula may be recommended for your child.

4. Goat’s Milk Formula is not a Recommended Option

   If you believe that feeding your child goat’s milk is a better alternative to feeding him milk with cow’s milk protein, you may be surprised to learn that goat’s milk protein and cow’s milk protein are very closely related. This means that if your child is allergic to cow’s milk, there is a high probability that he may be allergic to goat’s milk too. In fact, up to 80% of children with CMA cannot tolerate goat’s milk.

5. Children May Take a Longer Time to Outgrow CMA

   Although some studies in the past decades have shown that 80% of babies outgrow CMA by the time they reach four or five years old, more recent research indicates that CMA may linger on till much later, with almost 60% and 40% of children still having CMA when they are 8 and 12 years of age respectively.

6. Pay more attention to your child’s food intake and growth

   If your child has CMA or any other food allergies, it is advisable for your child to undergo an individualised nutritional assessment with a dietician or paediatrician to ensure that his diet is adequate. It is also important to make it a practice to plot your child’s height and weight on a growth chart, to ensure that he is growing healthily.

   The timely introduction of cow’s milk or dairy in the form of baked foods and eventually the introduction of cow’s milk in the form of formula milk, fresh milk, cheeses and yogurts should be done under the supervision of a healthcare professional. During this process, parents will be advised to look out for any reactions due to CMA so that tolerance level can be assessed.




About Dr Lee Bee Wah

Dr Lee Bee Wah is a Consultant Paediatrician with special interest in allergy and immunology at The Child and Allergy Clinic, at Mount Elizabeth Medical Centre. Dr Lee is currently an Adjunct Professor (Department of Paediatrics) at the National University of Singapore, and a Visiting Senior Consultant Paediatrician (Children’s Medical Centre) at the National University Hospital.

About Dr Chiang Wen Chin

Dr. Chiang Wen Chin is a paediatrician with special interest in allergy and immunology at Chiang Children's Allergy and Asthma Clinic, at Mount Elizabeth Medical Centre. Dr. Chiang is currently a committee member of the American Academy of Asthma, Allergy and Immunology, the Allergy and Clinical Immunology Society of Singapore and Singapore Paediatric Society.

When does milk allergy show up in infants?

Babies with a milk allergy often show their first symptoms days to weeks after they first get cow milk-based formula. Breastfed infants have a lower risk of having a milk allergy than formula-fed babies. People of any age can have a milk allergy, but it's more common in young children.

What does baby poop look like with milk allergy?

How does poop change with a milk allergy? The most common sign that a baby is allergic to milk is blood in their stool. A baby's poop may also become more runny and frequent, similar to diarrhea. It may also contain mucus.

How do I know if my baby is not tolerating cow's milk?

The symptoms of lactose intolerance in babies and children are:.
liquid, sometimes green, frothy stools..
being irritable..
stomach aches..
bloating..
passing a lot of gas..
not putting on weight..
nappy rash..

What does cows milk allergy poop look like?

Your baby's stools may be loose and watery. They may also appear bulky or frothy. They can even be acidic, which means you may notice diaper rash from your baby's skin becoming irritated.