PAEDIATRIC
WEANING AN INFANT WITH COW’S MILK PROTEIN ALLERGY - Part 2 Cow’s milk protein allergy (CMPA) is the most common food allergy in babies and young children and the management of CMPA is an ever-evolving landscape. In Part 2 of this article, Paula takes a look at complementary feeding and the introduction of allergenic foods, highlighting micronutrient inadequacy and its management. There are no official UK guidelines for weaning an infant with CMPA. Weaning should commence when a baby is showing all the signs of developmental readiness, which is usually around six months (but not before 17 weeks) of age. Signs of developmental readiness include: • the baby can maintain a sitting position and can hold its head steady; • the baby can pick up food and navigate it to its mouth; • the baby can swallow food (look for loss of the tongue thrust reflex). Introducing solids to a baby who has cow’s milk allergy (CMA) should be the same as for a non-allergic baby, except avoiding all sources of cow’s milk and dairy products. The Food Allergy Specialist Group (FASG) of the BDA recommends starting with green vegetables and root vegetables, potatoes
and rice, as well as iron-rich foods such as chicken, meat and pulses, from six months of age (as iron stores start to run low from six months of age for full-term babies). INTRODUCTION OF ALLERGENIC FOODS
Common allergenic foods (such as egg, soya, wheat, peanuts* and other nuts*, sesame seeds*, mustard seeds*, celery, fish and shellfish), should not be avoided once a baby is six months old, as long as the baby is not allergic to these foods. Current advice is to introduce all common allergenic foods that a baby is not already allergic to, and which are part of a family’s usual diet, between 6-12 months of age (FASG BDA). *as ground nuts, nut butters, or seed butters for babies and young children. A sensible and practical approach is to introduce each allergenic food one at a time earlier on in the day, so that the
Table 1: Products available on prescription**
Extensively hydrolysed formulas
Amino acid formulas Soya formula
Brand
Manufacturer
Aptamil Pepti 1 & 2
Nutricia
Nutramigen 1 & 2 with LGG
Mead Johnson (part of RB)
Aptamil Pepti Junior
Nutricia
Similac Alimentum
Abbott
Pregestimil Lipil
Mead Johnson (part of RB)
SMA Althera
Nestlé Health Science
Nutramigen Puramino
Mead Johnson (part of RB)
Neocate range
Nutricia
SMA Alfamino
Nestlé Health Science
SMA Wysoy
Nestlé Health Science
Paula Hallam RD, PG Cert (Paed Diet) Specialist Paediatric Dietitian Paula is a Specialist Paediatric Dietitian and owner of Tiny Tots Nutrition Ltd. She helps families of babies and children with many nutritional concerns, such as fussy eating, iron deficiency anaemia, constipation, growth faltering and food allergies. She also facilitates weaning workshops for new mums.
REFERENCES Please visit: https://www. nhdmag.com/ references.html
**For more on appropriate formulas and prescriptions, see Part 1 of Paula’s article in the October issue of NHD. www.NHDmag.com November 2019 - Issue 149
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