Some common
questions and
answers

When your baby starts taking an extensively hydrolysed formula (eHF), you might see changes in their poo pattern as well as the consistency. The consistency and colour may change due to the type of proteins that are used in the eHF, which are designed to be more easily digestible.

It very much depends on the type of reaction your baby has and symptom resolution can vary from child to child. It can take up to 4 weeks on an extensively hydrolysed formula to see a significant improvement in symptoms and some symptoms may take longer to resolve completely.  Please ensure you discuss your child's progress on their eHF, and any concerns you might have, with their GP, allergy doctor or dietitian.

If your baby starts taking an amino acid-based formula (AAF), you might see changes in their poo pattern, colour and poo consistency. 

AAFs require minimal digestion. So if your baby has been experiencing digestive problems, such as persistent diarrhoea with blood in poo or vomiting due to cow's milk allergy, switching to an AAF should see an improvement in these symptoms.

It very much depends on the type of reaction your baby has and the speed of symptom resolution can vary greatly from child to child.  Some symptoms may resolve within days and for others it may take up to 4 weeks on an AAF to see a significant improvement in symptoms. Some symptoms may take even longer than that to resolve completely.  Please ensure you discuss your child's progress on their eHF, and any concerns you might have, with their GP, allergy doctor or dietitian.

What is considered normal?

When it comes to bowel movements "normal" can vary enormously between babies and depends on factors like the age of your baby, if your baby is bottle or breastfed, and if they are taking solids. As babies start eating solid foods, their bowel movements often change both in frequency and consistency. This can vary depending on the type of foods consumed. The general guidance for what is considered “normal” is as follows:

Frequency:

• Newborn babies have several bowel movements in a day, sometimes even after every feed. But as babies grow, the frequency of their bowel movements often decreases.

Colour and consistency:

• Breastfed babies typically have a loose, mustard-yellow or seedy poo, which is considered normal. Formula-fed babies may have slightly firmer brown or tan poo, but they should still be soft and easily passed. Poo consistency can vary among babies, and changes in consistency within the normal range is generally not a cause for concern.
• Look out for any noticeable changes in your baby’s poo pattern (frequency and consistency). In the case of diarrhoea, keep a record of the number of bowel movements per day along with the poo consistency. Also, it’s good practice to pay attention to your baby’s behaviour during bowel movements. Excessive straining, crying, or signs of discomfort might be an indicator of constipation.

Breastmilk is best for your baby. When breastfeeding is not possible your healthcare professional will advise on the most suitable alternative allergy formula (called a hypoallergenic formula) for your baby. When using these formulas there are a few things to consider. Hypoallergenic formulas for babies with allergies can be extensively hydrolysed formulas (eHF) or amino acid-based formulas (AAF). These formulas smell and taste very different to standard infant formula or breastmilk.

Some little ones will transition across to these new formulas easily, however for others the change in taste or smell may put them off, so they may need a little more time.

Here are some tips to ease the transition to the new formula:

• if breastfeeding, try to have someone else feed your baby for the first few feeds
• if your baby has not had an anaphylactic reaction or other immediate severe reaction to cow’s milk/dairy and you are starting a new hypoallergenic formula, you can also gradually change them over (using titration). We recommend however that you always discuss this with your baby’s health care professional first. This is when you mix a small amount, ~25ml (1oz), of their new formula with their current formula or expressed breastmilk, building up until the transition is complete i.e., they are taking 100% hypoallergenic formula.
• if your baby has had an anaphylactic reaction or a severe reaction to cow's milk/dairy then you should stop all forms of cow’s milk/dairy and in this case, titration of formula is NOT suitable for your baby
• if foods have been introduced to your baby’s diet, you can mix the formula with the foods before offering it as a drink – this will help them become more familiar with the new taste.
• your baby may refuse initially as the taste is very different, so we advise you to have patience as it may take time before your baby accepts this new feed.

We recommend that you always discuss this with your baby’s healthcare professional first.

The timeframe for resolution/symptom improvement can vary depending on the severity and type of symptoms that your baby is experiencing. You may start to see an improvement within 2 -4 weeks of making this change, however, we recommend you discuss this with your doctor/GP/dietitian who will be able to provide you with personalised advise on what to expect.

If you are exclusively breast feeding and have not seen an improvement in you baby's symptoms 2-4 weeks after removing dairy, it is unlikely that your baby has a cow's milk protein allergy. It is best to reach out to your GP/allergy specialist to discuss this and what next steps might be.

If your baby has been prescribed a hypoallergenic formula and you have not seen their symptoms improve or resolve after 2 -4 weeks it is important you go back to your GP/allergy specialist or dietitian to discuss your baby's options. They may need to move to another formula. Equally some of these symptoms could be secondary and require separate management.

Hypoallergenic formulas tend to have a thinner consistency and may appear less milky than standard formulas.  This is because some of the components within the hypoallergenic formula have already been broken down and so are smaller, causing the formula to be thinner in nature.  It’s important to note that this is normal and you should not be tempted to add more powder to your baby’s feeds than is recommended.  It is also important that you do not try to thicken the formula if this has not been advised by a healthcare professional.  If you are concerned about the consistency of the formula or are worried that your baby is having difficulty with it, please speak to you baby’s doctor.

Please be aware that it is not advisable to add anything to your baby’s feed unless advised by your baby’s healthcare professional.

Your baby’s healthcare professional (HCP) may advise that your baby tries a different hypoallergenic formula. There can be several reasons why the removal of cow’s milk/dairy from their diet does not work. For example, if your baby does not like the taste and therefore does not consume enough of the formula. So, it is important to discuss the situation with the HCP and agree on a plan of action together.

If the symptoms have not resolved fully on the eHF after the specified time period given by your baby’s healthcare professional (HCP) then the HCP may recommend that your baby tries another formula, which might be an AAF. This will very much depend on the symptoms your baby presented with and the situation they are in on review.

You should always wait until your baby has been seen by a healthcare professional (HCP). What happens next will depend on several factors including your baby’s age, initial symptoms, current food intake as well as their growth and development.

This will depend on your baby’s initial presentation of symptoms and the follow-up reviews by the healthcare professionals (HCPs). However, most babies outgrow their allergy to cow’s milk/dairy by the age of three to five years. Your baby’s HCP will commonly re-test the cow’s milk/dairy allergy around 1 year of age to see if your baby has outgrown his/her allergy. Depending on how your baby responds they may be able to take cow’s milk/dairy foods in their diet again and this may be built up over time but should always be guided by a healthcare professional.

This very much depends on how the symptoms are presented in the first place. However, it is known that around 80% of children will outgrow their allergy to cow’s milk/dairy by the age of three to five years. However, this depends on many different factors, including what symptoms your baby presented with, if your baby’s reaction was immediate and severe (e.g., anaphylaxis) following the consumption of cow’s milk/dairy or if it was delayed (delayed reactions appear between 2-72 hours). If your baby had an immediate severe reaction e.g., an anaphylactic reaction, then it usually takes longer for them to outgrow their allergy, and in this case, they will be tested (often called challenged) in the hospital setting by the healthcare professional (HCP). The exact timing is very difficult to predict, but in some (severe) cases it lasts 5-10 years, or longer. If however, your baby had a delayed reaction, for example with digestive symptoms (also called non-IgE-mediated CMPA), then outgrowth may occur much earlier; in some cases within 1 year - and in this case, they will be tested (challenged) in your home.

During the home challenge, the HCP will probably use the milk ladder to introduce the allergen (cow’s milk/dairy) in a stepwise manner. They will advise you on when the time is most appropriate for your baby to be challenged. Also, the time it takes for your baby to progress up the rungs of the ladder i.e., tolerating more forms of dairy/milk, will depend on how they respond to each new food introduced.

Sometimes babies have accidental challenges when they consume an allergenic food by accident. How they react will indicate if they remain allergic or not. If this should happen, it’s a good idea to gather some information for the HCP e.g., the type of food eaten, if there was a reaction, details of the reaction, how long it took to see the reaction, the time of day, who was present etc., providing this important information to your HCP will help them guide the most appropriate actions and the next steps.

It is not believed that there cow's milk protein allergy is hereditary.

There are a number of great resources that mums and dads can access to better understand Cow's Milk Protein Allergy and also to get more support in the journey with Cow's Milk Protein Allergy some of these organisations and resources include:

1. Allergy UK https://www.allergyuk.org/about-allergy/allergy-in-childhood/cows-milk-allergy/ Allergy UK has a range of resources specifically designed to support parents of babies and infants with cow's milk protein allergy. They also run a free dietitians support line where parents can get get specialist advice on food allergies.
2. NHS England https://www.nhs.uk/conditions/baby/weaning-and-feeding/food-allergies-in-babies-and-young-children/ Food allergies in babies and infants is not uncommon. Here the NHS provides additional information and context on what to do and how to manage these potential symptoms.
3. Anaphylaxis UK https://www.anaphylaxis.org.uk/ If your baby or infant has a severe cow's milk protein or food allergy it can be scary. Anaphylaxis UK provide a range of resources and support designed to raise awareness and provide information to those who face severe food allergies as well as their family and caregivers.