Regardless of your parenting prowess; navigating the weaning journey with an infant with Cow's Milk Protein Allergy (CMPA) can be a daunting process.
As you transition your little one from breast milk or formula to solid foods, it's crucial to ensure they receive all the necessary nutrients for healthy growth and development and choosing suitable plant-based alternatives is a key part of this process.
Introducing our CMPA weaning guide -let us do the thinking for you and take away some of the everyday stresses - our gift to you!
Disclaimer: this guide is for uncomplicated CMPA - if you have a strong family history of atopy (food allergy, asthma, eczema, hayfever) or suspect multiple allergies please discuss weaning with your healthcare professional.
Understanding CMPA
CMPA is an immune response to proteins found in cow's milk. Symptoms can range from digestive issues to skin reactions and respiratory problems. For children with CMPA, avoiding cow's milk and all products containing its proteins is essential.
The Weaning Process
Weaning typically starts around six months of age, when solid foods are introduced alongside breast milk or formula. For children with CMPA, it's important to select safe, nutritious alternatives to cow's milk, but weaning is otherwise the same as with non allergy children. Weaning can be spoon fed, or baby led, or a combination of both with the aim of trying to encourage variety and a balanced intake.
Introducing Other Common Allergens Into The Diet
Allergy UK lists the most common food allergens as:
Celery
Cereals containing gluten (wheat, barley, rye, oats)
Eggs
Fish
Seafood: Crustaceans (e.g. prawns, crab, lobster), Molluscs (e.g. mussels and oysters)
Milk
Mustard
Peanuts
Sesame
Soybeans
Sulphur dioxide and sulphites (at a concentration > ten parts per million)
Tree nuts (e.g. almonds, hazelnuts, walnuts, brazil nuts, cashews, pecans, pistachios and macadamia nuts).
We know from research studies that abstaining or delaying the introduction of common allergens until >1yr life may actually increase risk of developing an allergy to these.
If your child has CMPA but no known sensitivities to other allergens before weaning then it is advisable to introduce these one at a time in the diet alongside other weaning foods from 6 months of age.
Introducing Solid Foods
When introducing solid foods, ensure they are free from cow's milk proteins.
Fruits and Vegetables | Weaning generally starts with offering fruit and vegetables, usually as purees or well cooked pieces as finger foods. Start with offering single fruits or veggies then you can jazz things up with combinations. These are naturally free from cow's milk proteins and rich in vitamins and minerals. If you need to thin the texture then you can use expressed breast milk or your baby's allergy formula for extra nutrition rather than water. |
Grains | Rice, oats, quinoa, millet & couscous are excellent naturally low salt and sugar choices. Flour can be used to make baby pancakes or healthy mini savoury muffins. Avoid pre-packaged foods that may contain hidden dairy ingredients. |
Fortified Cereals | These make easy convenient breakfast options -choose cereals fortified with iron and other essential nutrients. Check labels to ensure they are dairy-free. Good examples include weetabix/Oatabix, readybrek, baby rice. |
Protein Sources | Lentils, beans, tofu (if soy is tolerated), and peas are good first protein sources. Smooth nut butters are a good source of protein and good fats and a good way of including peanut and tree nuts in the diet - just stir a teaspoon into dairy-free yoghurt or baby porridge or add in baking. Offer fish, seafood, red meat and chicken/turkey as other protein options. |
Dairy alternatives | There are a plethora of dairy-free options available now including soya/coconut/almond based yoghurts, cheese & cream alternatives (e.g. cream cheese, creme fraiche, hard cheese). These help boost calcium intake and offer variety in the diet. Ensure any fats you are using are dairy free (i.e. replace butter with plant-based butter/margarine or use oil for cooking) |
Plant-Based Milk Alternatives Plant based milks can be a useful addition to the weaning diet and used in cooking. When choosing plant-based milk alternatives, look for options fortified with calcium, vitamin D, and other essential nutrients such as iodine, but avoid ‘organic’ milks as these wont be fortified. After the age of 1, If baby is growing well and eating a nutritious and varied diet then you can slowly transition from using allergy formula to a fortified plant-based milk as their main drink, the average age of this transition is around 18 months of age.
Soy Milk | High in protein and often fortified with calcium and vitamins. Choose unsweetened, fortified versions. |
Oat Milk | Naturally creamy and often fortified with calcium and vitamins. It’s a good source of fibre but lower in protein |
Almond Milk | Low in calories and often fortified, but it’s also low in protein. Ensure it’s unsweetened. |
Coconut Milk | Rich and creamy with a distinct flavour. It’s low in protein but often fortified with vitamins and minerals. |
Pea Protein Milk | High in protein and typically fortified, making it a great nutritional alternative. |
Nutritional Considerations
Ensuring your child gets adequate nutrition is crucial. Here are some key nutrients to focus on:
Calcium:Â Important for bone health. Besides fortified plant-based milks, leafy green vegetables, fortified cereals, and tofu can be good sources.
Vitamin D: Essential for calcium absorption and bone health. Fortified plant-based milks and safe sun exposure can help meet needs.
Protein:Â Vital for growth and development. Plant-based proteins from legumes, nuts, seeds, and fortified plant milks can ensure adequate intake.
Iron:Â Necessary for healthy blood cells. Include iron-rich foods like lentils, beans, fortified cereals, and leafy greens.
Iodine: important for thyroid hormones which support growth, metabolism and overall early life health and development. Iodine is found naturally in white fish & fortified products and in smaller quantities in eggs and meat.
Tips for Success Read Labels: Always check ingredient lists for hidden dairy protein ( allergens listed in bold on the ingredients list e.g. whey powder (milk))
Variety:Â Offer a wide range of foods to ensure a balanced intake of nutrients and to help your child develop a taste for diverse flavours.
Consult a Dietitian:Â A paediatric dietitian can help plan a balanced diet and ensure all nutritional needs are met.
What next?
The majority of children will outgrow their cow's milk protein allergy - this is generally tested using specific milk ladders. We recommend seeking the support of a trained Paediatric dietitian to discuss this further.
Conclusion
Weaning a child with CMPA requires careful planning and attention to nutritional details, but with the right plant-based alternatives, it’s entirely manageable. By choosing fortified plant-based milks and a variety of solid foods, you can ensure your child receives the necessary nutrients for healthy growth and development. We recommend consulting with your healthcare professional to tailor a weaning plan that best meets your child's needs.
Book in with allergy specialist dietitian Rosie or any of the team for more support https://www.oxfordpaediatricdietitians.com/book-online
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