Does my child have a milk allergy? with Emma Shafqat – Food For Kids Podcast episode 19

Joanne Roach (00:13)

Hello and welcome to the Food for Kids podcast. I'm Joanne from the Foodies. Today's episode is all about children having a milk allergy and it's an interview with Emma Shafqat of Dietitian with a Difference. She's been on this show once before in episode 4 talking about fussy eating. We talk about the two main types of milk allergy as well as lactose intolerance, what the differences are between them, what to look for in your child if think they might have one and what to do about it. Emma's really knowledgeable not only as someone who worked with this issue in the NHS but also because her child Olivia had a milk allergy herself. It's quite a long interview but really interesting. But because I like to keep these episodes bite-sized, I'll keep this intro short and go straight to the interview.

Joanne (00:57)

So Emma, could you first of all, tell me what a cow's milk allergy actually is? what does that look like if you've got one?

Emma (01:03)

So a cow's milk allergy would be when a child reacts to the protein that is in the cow's milk. There's sort two types of cow's milk allergy. You either have your non-IgE allergy, which is when it's a delayed reaction. So you'd normally expect your reaction to be within sort of two to 48 hours. Or you have what we call an IgE allergy, which is more of an immediate reaction. But in terms of symptoms, I will list some of the symptoms for the different types. So with an IgE allergy, which is your immediate allergy, like I said, it tends to be things like your itchy skin, they might have hives on their face, so sort of raised lumps might be in different parts of their body They can get like acute eczema, they can get vomiting, diarrhea, coughing as well is another symptom. You can get wheezing, shortness of breath, sneezing, congestion. There's lots and lots of different symptoms which is what makes cow's milk allergy so difficult sometimes to diagnose

If your child does have an immediate IgE allergy and they immediately react to something, then it is important that you go speak to your GP because then what they might do is refer you for an allergy test. So they will refer you for either a skin prick test or a blood test. That only works for your IgE allergies not for your non-IgE allergies

Joanne (02:18)

So those are things where you can really spot my child had something that had cow's milk in it and then straight away afterwards or within a couple of hours. I keep seeing this pattern?

Emma (02:27)

Yeh and I would definitely see someone because again, that can have more serious consequences as well and it can lead to things like anaphylaxis as well. With a delayed reaction, which is your non-IgE allergy, those symptoms can be slightly different but can be similar as well.

Joanne (02:33)

Okay.

Emma (02:42)

But the main difference is that I would expect them to occur within sort two to 48 hours later. So not immediately. And that's your main signpost, I'd say. But again, so things like itchy skin, they might have rashes. I know Olivia vomited lots, like arching back, really bad reflux can sometimes be a symptom. Sometimes blood or mucus in the stool as well. Colic, like food refusal. I know Olivia by the end really had that would just literally refuse to drink the bottle completely. Again, they can have like wheezing and another sign sometimes is like faltering growth as well. Not always, but sometimes linked with the food refusal but not in every child. But again, this list isn't exhaustive and some children present it differently So it's so important if you are worried, you do go back to your health visitor or your GP and discuss these symptoms and the problems that you are having, because you do need a full detailed medical history and background on your family to understand exactly what's going on and that it's not linked to any other issue that might be going on.

Joanne (03:44)

Okay, so obviously young children once they're not breastfed anymore they're they're having cow's milk. regularly either in formula or in full fat milk these are symptoms that just could be happening all the time right a child could just generally unwell in these ways, all the time, and you wouldn't necessarily think it's just after a feed.

So would you say that's the first port of call is if your child's having some of the symptoms you listed to kind of start looking at what they're eating and maybe think about cow's milk first.

Emma (04:11)

Potentially yes. It's the most common allergy, but I think often with cow's milk allergy is normally picked up before weaning. So it's often picked up when you're breastfeeding or you're bottle feeding, because obviously, that's kind of the first thing your child is really exposed to, because the cow's milk protein, particularly if they're being bottle fed, for example. But again, like you said, it can be hard to diagnose.

And I know with for example, in my case, Olivia, I didn't really pick up till she was about three months old. So it just gradually took time and I didn't associate any of the symptoms because neither me nor my husband have got cow's milk allergy. It didn't even cross my mind that she would have one. And we were just told by the health visitor she's just got reflux or she's just colicky and she's a premature baby. And I must say like things like the rash, I never even noticed because actually I never fed her naked. And it wasn't until we were actually in hospital when they took all her clothes off and then fed her then. I suddenly realized that after a little while she was starting to come up in like these little rashes. And I was like, oh, I've never even noticed that. So that's something to do. Try feeding your child with no clothes as well, just to see if there's any kind of reaction cause yeah, I really didn't notice that one, but we had, mainly most of the things were vomiting really by the end she was just literally refusing the bottle.

And I remember I went to the doctors and I just said, look, she's tiny. She's losing weight now. She won't drink. I remember passing her around my NCT friends as well going “someone else should try feeding her. Cause I can't get her to take this bottle”. They were like “Gosh, it's really hard work with this”. It got to the point where I was like “I can't get her to drink this bottle. I'm giving up”. So I went to the GP and we were lucky. We saw an amazing GP and he referred us straight to the hospital where we were then prescribed, hydrolyzed formula for her to try, which made a massive difference to her.

Joanne (05:57)

It's just the worst thing isn't it when your child won't eat, especially when they're tiny and especially if it's your first child?

Emma (06:02)

Yeah, I wouldn't want to go through that again, which is kind of why I try and help other moms out there because it's not a nice experience. And you know, I'm a dietician but I still didn't really recognize it or think about it to start with. So, you know, don't beat yourself up. Everyone talks about colic and babies and reflux and it just being normal.

And also there's part of you that feels like, don't want to keep pestering people. keep going back to the doctors being one of those neurotic mums, you know, like, but I'd say just go with your instinct. Because in the end, actually, I probably should have got a lot earlier, but I kept thinking “It's nothing. It'll be fine. She'll grow out of it.”

Joanne (06:36)

I think that spectre of the “I don't want to be the neurotic mom” is a really big thing isn't it because society tells us we're hysterical all the time. And especially if it's your first baby, and you're also exhausted. Yeah. You, you often don't have the confidence to advocate for yourself or your child because you're thinking they must see these people every day and I bet every parent feels like this and most of them are wrong but actually, sometimes you just know there's something not right and if you actually speak to doctors most of time they'd say they'd rather see you and send you away because you shouldn't be there, than you not come.

Emma (07:07)

Yeah, definitely.

Joanne (07:07)

And excuse my ignorance, but can you explain the difference between the non-IgE reaction, which is the more overall delayed reaction and lactose intolerance?

Emma (07:17)

So a lactose intolerance is basically your baby's reacting to the sugar that's in the milk. So lactose is a sugar that's in the milk and we need lactase, which is the enzyme to break it down. Lactose intolerance is actually really, really uncommon in babies, partly because obviously babies were breastfed and it's got lactose in it. So you tend not to see it so much.

And obviously normally in later life as well, people can be lactose intolerant, often linked more to like gastro bugs So that can often lead to lactose intolerance Sometimes that can show up as lactose disease or other autoimmune diseases as well. but it is very rare in little babies to see lactose intolerance. I'm not saying it never happens, but it is rare and it's probably more likely to be a cow's milk allergy, an non-IgE cow's milk allergy than an lactose intolerance

It could be loads of other things going on in your baby not to do with cow's milk allergy at all, which is why we always advocate that if you do cut the cow's milk out and you are put, for example, on a formula or you're breastfeeding and you've cut the milk out and you try to do a reintroduction just to see whether you get that reaction again.

Joanne (08:21)

Okay.

Emma (08:25)

So that you can rule it out. Because with a non-IgE allergy, we don't have any way of testing. The only way to see whether a child actually has a cow's milk allergy is by reintroducing milk back in again. And there's a set way of doing that as well, that you can follow to do reintroduction. But that is our only way because the skin prick test, the blood tests aren't gonna show you anything.

Joanne (08:48)

So if you're thinking that this might be happening to your child, the first port of call is to go to your GP and talk about it, tell them what you've noticed?

Emma (08:58)

Yeah, or if you're still in contact with a health visitor, it depends. Some people don't see the health visitor for very long and I know I didn't see the health visitor very much. So I went straight to the GP, but I think if you've got a health visitor involved they're quite knowledgeable as well.

Joanne (09:13)

Okay, so if you found out that your child has a cow's milk allergy what do you advise families to do, do they ever get to drink milk again and how do you deal with it?

Emma (09:22)

So basically, normally, if your child is diagnosed with cow's milk allergy if you are formula feeding, they should prescribe you some hydrolyzed formula. They'll start with a particular type, like something which is partly hydrolyzed, so slightly broken down. And you would start on that.

That made all the difference to us. But a lot of children, they won't. And you might have to go on to what we call an amino acid type of feed, which is even more broken down, and most children will be fine on that. The downside of those formulas is that they do not taste good. They're quite bitter and their poo will end up very green. So don't worry. That's totally normal.

And then if you're breastfeeding, then you would be advised to cut milk out of your diet. I think the thing that's really important though is if you're breastfeeding is obviously you've still got really high calcium requirements. So I definitely would advise moms to be on a like a pregnancy breastfeeding type supplement to make sure they get enough calcium and then choose the calcium rich foods and fortified alternatives like your oat milks and your soy milk and things like that as well.

So that's your first thing is to cut that milk out.

Then after normally six months post-reaction, we would then look, obviously depending on how old your child is, because obviously if you're weaning again, you would wean as normal, but by cutting out all milk from their diet. So you have to be really careful on looking at labels of everything. So everything that should have milk in should be in bold on the labels. So be really good at looking at labels because there's lots of things that have milk in that you didn't think had milk in.

And you will make mistakes and you will feed your child something with milk in because I did it multiple times and that's how you know your child's definitely still reacting to milk.

And then normally what happens is after a period of time and things have settled we will do a milk reintroduction with them when we try reintroducing a little bit of milk back into their diet again through either their formula or breastfed just to confirm that it is actually a milk reaction and that is what's causing the problem It's not a nice process and I must say it wasn't something I was particularly keen on doing.  So I get parents and mums worries and concerns about the reintroduction process

Then after that, so once you've done all your weaning, and you followed your cow's milk free weaning. Again, look out for all the fortified products. There's so many good products out there now, with veganism and stuff. It's not so challenging as I think it used to be in the past. There's lots of options available.

And then around 12 months or post six months reaction, basically the last reaction your baby had, you would then look at introducing something called the milk ladder.

Right now the milk ladder is only for children who are non IgE allergy. So only the ones that have a delayed allergy. Because for an IgE allergy, you would probably be under an allergy specialist and they might do a hospital reintroduction. So it will be different. It's only non IgE allergies, only your delayed ones that you would look at doing the milk ladder in at home. You'd be under the supervision of a dietitian, so you would never just try and do it on your own. You would always have some kind of professional to help to give you advice and support.

It's a six step process, you start with biscuits at the bottom, these are what we call very well cooked. So the protein has been baked at really high temperature. So therefore, your body is less likely to think it's something foreign and less likely to react to it, then basically, you work your way up the ladder. And the top of the ladder is basically cow's milk or the formula.

The ladder is very precise, it gives you the exact amounts, there's recipes, and it's something called the IMAP milk ladder that we all follow. And the reason we do this is to introduce at a very slow stage level. So we don't want to rush, just giving them, formula straight away.

Because for example, for that being Olivia, I just couldn't get past like about step three. I couldn't get like white sauces in her. She would vomit, she'd scream, you know, she was really uncomfortable. But she was fine with like biscuits, well cooked things, muffins, anything like that further down the ladder, she was absolutely fine with and it took us to about three and a half to get right to the top of the ladder. So I would say don't despair, even if you don't get there the first time around, keep going. And what you do is you wait like three to six months and then you try again. But if, for example, you were fine with the cookies and you were fine with muffins, Then just keep going and keep wherever that level you got to.

So say you got to step three, which is like pancakes, you keep all of that food in because it keeps exposing them and then when you wait that three to six months again you then start from level three again.

Joanne (13:58)

Okay, so that's why it's like a ladder because basically you go up a stage and then, if the next step is to the next rung is too high for you, you can still stay on the rung you are you're not going back down to the ground again.

Emma (14:08)

No, and we always advise you to stay at that level, you stop, you wait, and then you try again. % of children grow out of a milk allergy before school age. So you expect them with a non-IgE allergy to grow out of them. I mean, obviously there's a small percentage that don't, but most children will grow out of a cow's milk allergy.

Joanne (14:27)

So just out of interest, what are the six rungs that you mentioned?

Emma (14:30)

So you've got your cookies and biscuits at bottom, you've got your muffins, you've got pancakes, you've got your cheese, your yoghurt, and then finally your pasteurized milk or your formula milk.

Joanne (14:44)

Okay, so you can see that, it's getting more and more in its original form as you go further up the ladder.

And then when you get to the top of the ladder, are you then discharged from the dietitian and you just go about your life or do you have to keep an eye on it ?

Emma (14:56)

So then if you've reached the top of the ladder, then that's it. They can have milk in their diet and you don't have to use the alternatives anymore. And you might find your child doesn't like milk anymore. but they can have everything with cows milk and so you don't have to worry.

Joanne (15:10)

It's really nice to know kind of what the beginning, the middle and the end of this process is, because I think sometimes it's so terrifying the idea that your child might have an allergy. You don't know what their life's going to be like. And with this particular one, it's nice to know that there is a process. And for most children, there is an end to it.

Emma (15:25)

Yeah, definitely.

Joanne Roach (15:30)

So I found that really interesting and also very encouraging that the vast majority of children do grow out of a milk allergy. Emma's got great information on her Instagram feed and website about milk allergies and the milk ladder and she does weekly Q &A sessions on her stories so that's a great place to go if you want to ask her any questions. Well that's July wrapped up already and I'll be back in the next episode with a rundown of foods that are in season in August. I hope to see you then and in the meantime, happy eating!

Chapters

00:00 Introduction

00:57 What does a milk allergy look like?

03:26 What to do if you think your child might have a milk allergy

07:07 What's the difference between a milk allergy and lactose intolerance?

09:13 What happens if your child is diagnosed with milk allergy?

11:56 What is the milk ladder?

15:30 Summary and outro