Milk and Milk Allergies

by T. Berry Brazelton, M.D., author of Feeding: The Brazelton Way

Breast milk is ideal for babies. Replicating it has become the goal of formula manufacturers. In an effort to improve on breast milk, iron has been added to "fortified formulas." Some babies cannot tolerate this added iron, and it may contribute to colicky stomach pains. (Babies get by with the iron from their own red blood cell stores until they are 4 to 6 months old. Then they may need more iron than is usually present in breast milk. Breast milk contains small but variable amounts of iron. But babies on breast milk may be more likely to absorb iron more easily than babies on formula.)

Rarely, a baby may react to breast milk. This is usually due to some food in the mother's diet. The problem is likely to disappear when the mother can identify and eliminate the culprit.

A few babies are unable to digest lactose, the sugar in cow's milk. This is referred to as lactose intolerance—it's not an allergy. Some babies with lactose intolerance will be able to digest this milk sugar later on, after their intestines have had time to mature or to heal from an infection that has temporarily caused it. Lactose intolerance should not cause a rash or trouble breathing, since it is not an allergic reaction. Usually, the main symptom is diarrhea, along with stomach pain.

A small minority of babies are allergic to cow's milk protein and cannot tolerate the cow's milk in formulas. This is called milk protein allergy. Repeated spitting up, stomach pains, diarrhea, rashes, and even trouble breathing are signs that the baby is allergic to milk protein and needs a substitute. Your child's pediatrician can help you select one.

If the switch does calm down your baby's symptoms, you'll know not to give her milk or milk products until much later—the second or third year. Then, watch for any allergic response to recur. Meanwhile, your pediatrician should make sure that the substitute formula covers her protein, calcium, fat, and vitamin requirements throughout her infant years. Some infants who are allergic to milk will also be allergic to soy-based formula. There are substitutes for soy milk if your baby is allergic to it.

An infant with a milk protein allergy may be more likely to develop other food allergies, so go slow; during the first year, avoid foods that are most likely to cause allergies: eggs (especially egg whites), nuts, soy, oranges and other citrus fruits, chocolate, shellfish, and corn and wheat products.

Signs of Milk Protein Allergy

• Frequent spitting up, vomiting
• Signs of abdominal pain (or colic), such as frequent crying, especially after feedings, irritability, difficulty soothing
• Diarrhea, bloody stools—there are, of course, other causes for this that your doctor will also want to check for
• Scaly skin rash (atopic dermatitis) usually appears later, by 6 months of age
• Hives (urticaria)—big, raised, red bumps over the skin
• Trouble breathing, swelling (especially of mouth and throat), lethargy—these can be signs of a serious allergic reaction that requires emergency attention from a doctor

What to Do If You Suspect a Milk Allergy

• If your child is having trouble breathing, call for emergency help.
• Talk to your doctor about the signs of milk allergy you are concerned about. She or he will want to sort out a milk protein allergy from lactose intolerance, since the treatments are different.
• Ask your doctor about stopping cow's milk formula and trying a soy-based formula instead. However, some infants allergic to milk proteins will also be allergic to soy-based formula. A lactose-intolerant baby can be switched to a lactose-free formula.
• If you want to be sure that cow's milk was indeed the problem, talk to your doctor about slowly starting her back on very small amounts of cow's milk again-after she's recovered from her earlier troubles. If the same symptoms recur, you'll know that the cow's milk was the culprit. But don't try this if your baby had any serious allergic reaction symptoms, such as eczema, trouble breathing, swelling, or lethargy.
• As they get older, some babies will be able to digest cow's milk products comfortably. But check with your doctor before reintroducing cow's milk products.

Excerpted from Feeding: The Brazelton Way © 2004 by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Perseus.

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