CMPA: Survival Tips

Cow’s milk protein allergy is rare in breastfed babies, affecting only around 0.5%. Most cases of reflux, ‘colic’ symptoms, and loose stools are not caused by CMPA. Symptoms may include:

• projectile vomiting
• Stools which are loose, frothy, mucousy or bloody
• Abdominal pain
• Failure to thrive/weight loss/ slow weight gain
• Hives, exzema, or other skin problems
• Wheezing or breathing difficulties

If you think your baby might have CMPA, speak to your Health Visitor, Midwife, or GP. You may also find it helpful to read through the resorces listed at the bottom of this page.

Noah, a few days before he was diagnosed with CMPA

Despite CMPA being rare, it is still the most common allergy in children under 3 years old and is massively over-diagnosed in babies, which often leads to mothers stopping breastfeeding and using a hydrolysed formula instead. In the past decade, despite there being no evidence that cases of CMPA have actually increased, the number of diagnoses has, and the amount of money the NHS is spending on hydrolysed formulas has increased by 700%. Formula companies profit directly when babies are diagnosed with CMPA, and it is believed that their influence over mothers and healthcare professionals is resulting in more babies being wrongly diagnosed with the condition. A report on this was published in the British Medical Journal here.

However, lots of babies are diagnosed with CMPA, and lots of women choose to cut out dairy without a diagnosis. Some of the proteins from the food we eat enter our blood and can therefore enter our milk. This means that if your diet includes products made from cow’s milk, then your breastmilk can contain small amounts of cow’s milk proteins. You do not have to stop breastfeeding if your baby is diagnosed with CMPA, but you will have to exclude dairy from your diet. For women like me, who exist predominately on a diet of cheese, chocolate and buckets full of milky tea/coffee, a diagnosis of CMPA can leave us wondering how on earth we’re going to survive! So here are some tips to help you get through it:

What is dairy?

The older generation might tell you that ‘diary’ means milk and eggs. That’s not true. ‘Dairy’ is cow’s milk and any products or ingredients derived from cow’s milk. This includes:

  • Cow’s milk, UTH milk
  • Cheese
  • Yogurts, fromage frais
  • Cream, sour cream, Creme fraiche
  • Butter, butter fat, butter milk
  • Ice Cream
  • Most margarines
  • Lactose
  • Lactose free, milk, spread and cheese (these products still contain cow’s milk protein. It’s just the sugar, lactose, which has been removed. Lactose is also the main sugar in human milk, whether or not you consume dairy)
  • Ghee
  • Curd
  • Casein, caseinates, hydrolysed caseinates, sodium caseinates
  • Lactoglobulin
  • Milk powder, cheese powder, skimmed milk powder
  • Milk solids
  • Non-fat milk solids
  • Whey, hydrolysed whey, whey powder, whey sugar

If a packaged food manufactured in the UK or EU contains an ingredient derived from milk, it must have this clearly indicated on the label. The offending ingredient will usually be written in bold and will either be followed by ‘(milk)’ or will have ‘milk’ listed in the allergens panel on the label. Lots of foods state ‘may contain cow’ s milk’ on the label. This does not mean that this product definitely contains cow’s milk, and is often just added to protect the manufacturers from being sued, but it can mean that this product is made on a production line which also handles cows milk and so small traces of the proteins may be in that food. Most women breastfeeding a baby with CMPA can safely eat ‘may contains’, but some who’s babies have a particularly severe allergy can not, so it is best to check with your GP or Dietician if you are not sure.

Eggs are not a dairy product

Check the labels on EVERYTHING

Cow’s milk crops up in a lot of unexpected places! When my son was first diagnosed I thought ‘that’s ok, I don’t have that much cows milk in my diet anyway’. I didn’t think it would be such a huge adjustment. But have you ever read the back of a packet of crisps? Sliced ham? Chicken goujons? Honestly, it’s everywhere! So make sure you check the ingredients list on absolutely everything. This can be really frustrating to begin with and it can make you feel like there is NOTHING youre allowed to eat! But I promise it gets easier once you get used to it.

What on earth can I eat?!

Product alternatives

Anything you make with dairy can be made without dairy. There are alternatives for everything! The lists bellow are not exhaustive. These are just the products that I have used personally and my opinion on them, but there are plenty of others!

Milk:

  • Soya is great for everything. Some women lose weight when they go dairy free. If this is something which concerns you then using ‘alpro growing up milk’ is a good option as this contains more fat than regular soya milk as it is designed for toddlers
  • Oat milk has a really mild taste. Oatly make lots of different types of milk, such as whole, semi and skinny, and ‘Oatly barista’ for coffee
  • Almond milk has a subtle nutty taste. Great in mashed potato, cheesy dishes and drinks
  • Coconut milk is delicious in curries
  • Cashew milk can be pricey but it’s my favourite for coffee

Butter/margarine:

  • Flora freedom is my favourite, it tastes no different to normal Margarine to me
  • Vitalite is also very popular and usually cheaper
  • ‘Pure’ do a sunflower oil spread and an olive oil spread, the olive oil one is very tasty
  • The stork baking block (the one wrapped in foil, but not the one in the tub!) is dairy free* and great for baking

Cheese

  • Violife do a lot of different types. I love the slices on Crackers. The original block is OK but it doesn’t melt great. Tbh I didn’t find a dairy free cheese which I liked when melted, but it’s all down to personal taste
  • Most supermarkets now do a huge range of dairy free cheese’s, everything from cheese spread to wensleydale with cranberries. Sainsburry’s started this trend off and their brand became affectionately nicknamed ‘Gary’ (an explanation of that here).

Yogurts

  • Soya yogurts are very popular, they do have an aftertaste though which I’m not overly keen on
  • Koko coconut Yogurts are delicious

Ice cream

  • Most supermarkets do lots of different dairy free ice creams now, I like tescos strawberry cornettos
  • Swedish glacé ice cream made my life worth living whilst I was dairy free

Chocolate

  • Moo free chocolate is nice and not too expensive, it also comes in lots of different flavours
  • Vego chocolate is amazing
  • Most dark chocolate and mint chocolate is dairy free (always check the label)
Dairy free hot chocolate fudge cake and ice cream, made with a Betty Crocker cake mix and Swedish glacé ice cream

Keeping the price down

Buying everything from the ‘free from’ section can get really expensive. Thankfully, just like there are lots of things which contain dairy unexpectedly, there are also lots of things you would expect to contain dairy which don’t! Such as:

  • Oreos, party rings, fruit shortcake biscuits, hobnobs, tesco’s chocolate digestives (and some others)
  • Mr kipling apple and blackcurrent pies (NOT the regular apple ones)
  • Most garlic breads
  • Morrison’s pizza bases from the pizza counter, they’re just as nice without cheese!
  • Some packaged party cakes and cupcakes
  • Tesco’s chocolate churros
  • Betty crocker’s cake mixes and a lot of the tubs of frosting

*Disclaimer: the dairy free items listed on this page were correct at the time or writing, but manufacturers often change ingredients. Always check the label!

Have a look around when you go shopping, you might find some safe foods which surprise you! Going dairy free can be a huge adjustment for some people, but after a few weeks, once you’ve learned what you can and can’t eat, you won’t miss it at all!

Dairy free recipes

For most recipes, all you need to do is replace the dairy products with the same amount of a non-dairy alternative. However, I found a few delicious dairy free recipes which I still use today, even though my son has grown out of his allergies! Here are a couple of my favourites:

Butternut squash ‘mac and cheese’

Recipe for the sauce here. I adapted it by adding blended walnuts and a bit of almond milk if it ends up too thick, chucking some peas in, and grating some violife cheese on top.

Cheese-less pizza

Pizza is just as delicious without cheese!

For this pizza I used a store bought pizza base (check the label!), smothered it in hummus, added courgette, Peppers, tomatoes, red onions, grated carrot and some tiny bits of broccoli, then drizzled a bit of olive oil on top.

For more recipes, infiltrate vegan groups on Facebook and see the awesome blog Dilan and Me!

Eating out

All restraunts and takeaways are required by law to tell you if your food contains one of the 14 most common allergens (including cow’s milk). They must be able to provide you with allergen information if you ask for it. If they can’t, you can report them to the Food Standards Agency. Some restraunts are better than others for this. From my experience, Nando’s is fantastic. They have a big allergy booklet for you to look through at your table listing every allergen in every dish, and will amend most dishes to make them dairy free if you ask them to!

Most coffee shops now have a dairy and often soya free alternative milk for your drink (thank you, vegans!), but we can’t expect our friends/family/work places to stock up on cashew milk for when we pop over for a cuppa, and we don’t want to have to carry a bottle of alternative milk with us everywhere we go. Breastmilk storage bottles are the perfect solution for this! Just the right size to hold enough milk for a few cups of tea!

This is my breastmilk (see more about blue milk here!) but I also used these bottles to carry my cashew milk to work with me

Looking after your health

Dairy took up a larger proportion of my diet than I had anticipated, and to begin with I lost a lot of weight as a result of cutting it out. This doesn’t happen to everybody of course, and some would be grateful for dropping a few pounds, but for me this was a problem. I was also concerned about my calcium intake. I knew that my body would prioritise my baby and take what calcium he needed from my stores, so without any dairy in my diet I had to be careful I was eating enough of the right stuff! Calcium supplements can be taken, but it is pretty easy to get enough calcium through your diet by including things like:

  • Leafy Green veg such as Kale and spinach
  • Fortified alternative milks
  • Fortified cereal
  • Bread (all bread in the UK is fortified with calcium)
  • Dried fruit
  • Sesame seeds and almonds

If you are losing too much weight, try upping your intake of healthy fats such as:

  • Avocado
  • Nuts and nut butters
  • Adding extra oil to foods
  • Making smoothies with avocados or peanut butter
  • Oily fish (but limit this to two portions per week whilst breastfeeding)

If you are concerned about your weight loss, speak to your GP to rule out any underlying causes

Will it ever end?

90% of children grow out of a cow’s milk allergy by the age of 3, and some grow out of it much sooner than this. With support from your GP or Dietician, you will eventually begin to reintroduce dairy to your own and your child’s diet by following the milk ladder. Each child is individual, so it is important to follow your healthcare proffessional’s advice on when to begin the milk ladder. Usually, the first attempt is made 6-12 months after initial diagnosis. My son was hospitalised with his CMPA symptoms as a newborn, so I was expecting to be dairy free for a very long time, but I successfully reintroduced dairy to my diet when my son was about 13 months old, and he reached the top of the milk ladder at around 15 months. I found that I had completely gone off cheese, and reintroducing cow’s milk turned out to be almost as big an adjustment as removing it in the first place! If you are really missing dairy, rest assured that there will more than likely be a light at the end of the tunnel!

Resorces for information and support

The GP Infant Feeding Network info on CMPA

The Breastfeeding Network factsheet on CMPA

Facebook support group for mothers breastfeeding babies with CMPA

NHS info on CMPA

NHS info on reflux

Boobie Babies on Facebook


The information on this page should not be used in place of medical advice. Information found online should always be discussed with your own IBCLC, Dr or Midwife to ensure it is appropriate for you and your baby’s situation. Contact your Dr, Midwife or Health Visitor with any concerns about your own or your baby’s health and welfare.

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