Weaning a CMA infant - Cows Milk Allergy

The majority of children who are allergic to cow's milk will grow out of their allergy by the age of 3 - 5 years. Your child's doctor or dietitian will help you manage their allergy as your child gets older*.

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by Carina Venter
Senior Allergy Dietitian, Isle of Wight
Why is weaning so important?

Weaning is an important time for families as it provides the ideal opportunity to introduce the infant to a variety of new tastes and textures. These early experiences have a strong effect on later eating habits as infants who miss important flavour and texture milestones may become faddy or difficult feeders in childhood and this may persist into adulthood. This means that obtaining a varied and balanced nutritional intake will be more difficult.

Why do parents of cows’ milk allergic infants find weaning so difficult?

Introduction of solid foods can be daunting for most, but for parents dealing with a cows’ milk allergic infant, this is potentially an even more challenging experience. Traditionally, mothers start weaning with baby rice, fruit and vegetables, followed shortly by fromage frais and yogurt. Finger foods such as bread sticks or toast fingers served with soft cheese are also popular weaning foods. Many of these foods , as well as other favourites such as broccoli in a cheese sauce cannot be given to cows’ milk allergic infants and should be avoided.

The most difficult question that remains however is at what point other foods that commonly cause allergies, such as egg, fish, soya, wheat, peanuts and tree nuts, can be safely introduced. Parents are understandably cautious when it comes to feeding their baby these foods.

Weaning is further complicated by additional restrictions on the use of soya milk (shouldn’t be used until 6 months of age) and rice milk (shouldn’t be used until 4.5 years) based products for all infants in the UK.

*Skripak et al., 2007, J. Allergy Clin. Immunol., 120 (2007), pp. 1172-1177

How can a dietitian help?

A dietitian can help to make weaning a less stressful event and will be able to advise parents on how to wean their infant confidently.

The dietitian can advise parents on:

When to wean
Each infant should be managed individually and developmental signs of readiness for solid food in the infant and parental opinions should be taken into consideration when advising on the ideal age to begin weaning.

Signs of developmental readiness:

Can sit up unsupported

Shows interest in other people’s eating

Chewing fists

Waking during the night when previously had slept through

Crying between feeds

Suitable textures
The texture “ladder” that infants should climb includes runny/pureed, mashed, lumpy, chewy and crunchy foods. From around six months, infants can also start to eat finger foods in addition to the other textures that they are managing. Finger foods are good for practising hand-eye co-ordination. Sometimes you’ll see the different stages of food referred to as Stage 1, 2, 3 and 4 weaning foods, particularly those found in the supermarket, but it is worth checking that the texture inside the container reflects what is written on the labels – lumpy foods should have lumps in!
Suitable flavours
Infants should be offered a variety of fruit and vegetables to start with and foods the infant is not allergic to, should not be unnecessarily avoided or delayed due to nutritional reasons and development of taste preferences.
What to do with the other foods commonly causing allergic reactions on infancy?
Some parents may ask if their cows’ milk allergic infant should be tested for other possible food allergies prior to introducing new foods. Unfortunately there is no clear guidance for health care professionals about whether to test or not, and practices may vary across the UK and indeed across the world.

It is however known that up to 50% of infants with CMA can also develop allergies to other foods.

The following is therefore recommended:

Introduce only one new food at a time and start with single ingredients

Your dietitian can provide you with a list of foods to introduce and start with small amounts, ideally cooked, of each food first and increase the amount of food if no reaction occurs.

Try to introduce new foods earlier during the day, so that you can observe any possible reactions and get advice if necessary.

Discuss clear steps with your doctor to follow in case of an allergic reaction to a food, particularly what to do if your child’s breathing is affected.

Next in this section CMA past the first birthday

When to wean

Suitable textures

Suitable flavours

What to do with the other foods commonly causing allergic reactions on infancy?

What is CMA?

Could My Baby Have CMA?

What can I do?