We know that breast milk is always best for infants, but if you are formula feeding it can be worrying when your baby is excessively fussy and not adapting to your formula of choice. One of the key things we want to do with this blog is help you get access to information and prepare you for what you can expect if you suspect your baby has a Cow’s Milk Protein Allergies (CMPA).
I had a horribly colicky baby and while my child did not have a CMPA there was a time I thought “maybe”… Sometimes fussiness and a colicky baby could be as a result of an underlying CMPA. The general combination of symptoms or signs that usually are present among babies with a CMPA include: vomiting, reflux, constipation, diarrhea, skin rashes/ eczema, wheezing, red or watery eyes or excessive coughing.
Often the terms “allergies” and “intolerances” are confused and are used interchangeably, however, it is important to understand the difference between the two conditions. Non-toxic adverse reaction to food can be classified in two categories:
- Immunologic reactions (allergy), meaning that the onset of an allergy would involve the immune system, and
- Non-immunologic reactions (intolerance / aversion), which is often due to an enzyme deficiency such as lactase, where the immune system is not involved in the reactions.
Having this background, does it now make sense why making use of the phrase “Allergy to lactose” is for example, an improper wording, and that an adverse reaction to lactose (diarrhea, etc.) should be named “lactose intolerance” instead?
Therefore, CMPA belongs to food allergies and in the case of a CMPA your baby could have an allergic reaction to the proteins found in most cow’s milk which are found in most formulas on the market today. There are two types of proteins in milk: casein which is the heavier protein and whey, which is the watery part when curd is removed. Your baby may be allergic to one or both of these proteins and it is always best to check with your Doctor if you suspect your baby has a CMPA before switching to another formula.
So what is the general treatment advice you can expect from Health Care Professionals?
The general process/ line of advice from Health Care Professionals would usually be as follows:
Step 1: try a partially hydrolysed formula (often named HA formulas) especially if you are still breastfeeding and need to supplement the feeds. Health Care Professionals often recommend a partially hydrolysed formula if there is a family history of allergies. So often if the mother is not breastfeeding, a tested hypoallergenic formula is the best alternative, since these formulas will protect her infant against allergies at least as well as mother’s milk would, although mother’s milk is still the best. The HA formulas on the market is Novalac HA, NAN HA and S26 HA. Many mommies have complained of the unpleasant, bitter taste of hypoallergenic formulas, however, it is important to remember that babies are willing to drink any formula that they are introduced to, especially if given when they are still young, since often their taste perception has not developed yet. When an infant does refuse to drink a hypoallergenic formula, you could introduce it into their diet slowly while mixing it with breastmilk. However, if baby is not being breastfed, then you can even add a few drops of vanilla essence to the formula, to mask the flavour.
It is very important to know that you should not use partially hydrolysed (HA) formula in cases where the infant already has a confirmed cow’s milk allergy, since these formulas are not “non-allergenic”, just allergen reduced.
Step 2: when a CMPA has already been confirmed, then an extensively hydrolysed formula should be recommended; products available on the market include Allernova Smooth, Pepticate and Similac Allimentum. Even though extensively hydrolysed formula may be tolerated by most infants, up to 10% of infants will react to these and will require an amino acid based formula.
Step 3: amino acid based formula (100% cow milk protein free) – these infants that require this level of specialised formulas would often need to be seen by an allergy specialist. Amino acid based formulas are quite pricey and therefore, these formulas are often only recommended when infants present with life threatening symptoms, are not growing as they should be or as mentioned do not tolerate extensively hydrolysed formulas.
Other options on the market: include soya protein based infant formula or other mammalian milks such as goat’s milk. These options are often considered by parents due to the cost constraints and poor taste acceptability in older infants of extensively hydrolysed formulas. However, it is very important to remember that the possibility of cross re-activity exists. This means that in the event that a baby is allergic to cow’s milk protein they may also be allergic to soya protein or goat’s milk protein. Studies have found that 95% of children allergic to cow’s milk protein react to goat’s milk too, whereas the cross re-activity for soy protein is around 14%.
However, please don’t take this information to make your own diagnosis as you will have to see your Doctor to confirm whether your little one has a Cow’s Milk Protein Allergy!
If your Doctor confirms a CMPA, what products are there on our shelves?
We went out to investigate and found three formulas in-store recommended for when your baby has been diagnosed with a CMPA. These formulas are extensively hydrolysed and they are: Novalac Allernova Smooth, Similac Alimentum and Pepticate.
The only product on the market that is 100% cow milk protein free, because it is made up of amino acids only, is Neocate by Nutricia.
This is what the brands had to say…
Allernova Smooth is made by Novalac, the market leader in France in pharmacies. We called Novalac’s customer care line and got through first try. The expert explained Allernova Smooth is an extensively hydrolysed, casein-based formula that is lactose free. From the explanation provided it seems like Allernova Smooth can be seen as a 2 in 1 formula, since it not only addresses the CMPA, but reflux as well since it also contains a specially treated corn starch which assists with reflux. So this means it is sufficient for the treatment of a moderate CMPA, but has added benefits by also assisting babies with regurgitation or reflux and for those babies that is lactose intolerant. When we investigated the label we noticed that Allernova Smooth does not contain any added sucrose – which is always an added advantage.
Similac Alimentum is made by Abbot Nutrition a division of Abbott. The Similac care line went through to either a dietician or the nurse, both of which went to voicemail. Upon calling a second time in the afternoon and unable to reach anyone, we went to investigate the matter to see what information we could find.
Basically Similac Alimentum is an extensively hydrolysed, casein-based formula which is virtually lactose free. Their literature says they are supplemented with free amino acids and that their product starts reducing colic symptoms due to protein sensitivity within 24 hours in most infants. They mention it is gluten-free, however, to our knowledge most infant formulas are…
Pepticate is made by Nutricia, a specialised healthcare division of the food company Danone. When we called, their customer care line was “not working”, however we got hold of the main number and were given the details for the person to contact. Unfortunately both times we called the number provided, it went to voice mail. So we had to research through Google…
In a nutshell Pepticate is an extensively hydrolysed whey-based formula, whereas the previous products that where discussed are casein-based. As far as we can tell neither protein is better than the other, it just depends which one your baby is allergic to. Pepticate is also naturally gluten‑free and used for the dietary management of children with CMPA or multiple food allergies.
Neocate (remember that is the one that is 100% cow milk protein free) is made by Nutricia and the big difference between this product and previous specialised formulas discussed is that it is an amino acid based formula. Amino acids are the building blocks of protein. This complete breakdown of the protein is needed for infants that are presenting with a severe CMPA. However, the downside of Neocate according to moms on the web is that it is pricey…
So now you know more about the CMPA and the suitable infant formulas available on the South African market. Feel free to ask us any burning questions you have or tell us your story.
Disclaimer: This post is based on personal experience and personal brand preference of the content author and has in no way been paid for or sponsored. BabyYumYum reserves the right to its opinions and fully supports the notion of promotion that breast is best in line with the World Health Organisation (WHO) infant feeding guidelines http://www.who.int/topics/infant_nutrition/en/ Breast milk is the best food for infants. Good maternal nutrition is essential to prepare and maintain breastfeeding. If breastfeeding is not applied, an infant formula may be used according to health professionals’ advice. Preparation and storage of any infant formula should be performed as directed on the tin in order not to pose any health hazards.