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11364 NUTR Weaning Bklt - UK

6 How is CMA managed?

6 How is CMA managed? CMA is initially managed by the complete avoidance of all cow’s milk, dairy and foods containing milk as an ingredient. This will eliminate the cow’s milk proteins from your baby’s diet that are triggering the allergic reactions. Cow’s milk is a source of a variety of nutrients that are essential for your baby’s health and growth. It is very important that the removal of cow’s milk from your baby’s diet is managed carefully, with close medical help and support. If your baby has not yet started on solid foods, elimination of dairy from their diet may be done in two ways, depending on whether they are breast fed or formula fed. Breast-fed babies. Breast milk provides the best nutrition for your baby so if you are breastfeeding and want to continue, the diagnosis of CMA should not interfere with this. Some babies react to the small amount of milk protein that is passed through your breastmilk, whilst others can tolerate this without any problems. Experts recommend that breastfeeding mothers avoid cow's milk and supplement their diet with calcium and vitamin D while there is a possibility that their child’s symptoms are due to CMA. Talk to your doctor about whether you need to continue removing all milk and dairy foods from your diet after this time. A dietitian can help you with this, and can give advice on the obvious and hidden sources of cow’s milk and how to replace the nutrients you may miss when excluding cow’s milk-containing foods from your diet. Formula-fed babies. If you are bottle-feeding, either exclusively or in addition to breastfeeding, it is important that you replace your baby’s standard cow’s milk-based formula with a suitable nutritionally complete, hypoallergenic formula, such as the Nutramigen with LGG ® or Nutramigen PURAMINO formulas your healthcare professional has recommended for your baby. Whether breast or formula feeding, you will need to ensure that your baby is not given any other sources of cow’s milk protein, e.g. in oral medications and remedies, or in early foods, e.g. rusks and baby cereal products, so checking the ingredients list on products for ‘milk’ is important. Milk alternatives 6 • Goat’s and sheep’s milk, and milk from any other animals, are not recommended for infants with CMA, as the protein in these milks is very similar to the protein in cow’s milk • Rice drinks are only suitable for children over 4.5 years of age • Experts recommend that soya formulas should not be given to infants before 6 months of age, and it should not be the first choice for older infants unless advised by a doctor or dietitian www.nutramigen.co.uk

The role of the dietitian 7 Cow’s milk allergy Following a cow’s milk-free diet can be challenging, especially when you start to introduce solids, so you may wish to ask your doctor to refer you to a paediatric dietitian. 5,7 A dietitian can give you practical advice on managing your child’s diet. They will provide advice to help you make sure your child’s diet is completely free from cow’s milk, including information about the hidden sources of cow’s milk in foods. They will also advise on what foods to give your child to ensure they are not missing out on essential vitamins and minerals because of their special diet. Your dietitian will also advise you if there are other foods that your infant should avoid, particularly if they have more than one food allergy. The dietitian will help you tailor the diet to suit your child’s own individual needs and check that it is varied and nutritionally adequate to maintain healthy growth and development.