A New Parent's Perspective: Cows' Milk Protein Allergy
In September 2014 my wife and I became parents for the first time when our daughter Isabella was born. For months people kept telling me how my life was going to change and that I wouldn’t ever sleep again, but I didn’t quite realise how true that would be.
We had our antenatal care and delivery at Chelsea and Westminster Hospital, and the midwives and obstetricians were utterly fantastic with us. Isabella was born a fairly robust 4kg and I remember it all as clear as day. We were delighted, and exhausted (my wife far more so than I!). When we got to our room we couldn’t quite believe this bundle of screaming flesh was our creation. That first night, I don’t think any of us slept - she screamed the entire night. So much so, that after 3 hours of unbelievably patient care by my wife and one particular midwife trying to placate her, the paediatricians were called to see her. I think by this point she had got herself into such a state that she had a borderline temperature, they took her bloods (which were all fairly normal) but insisted we stay for a further 48 hours whilst she received precautionary antibiotics.
The next 48 hours were a blur to say the least. She got her antibiotics, but didn’t really stop screaming and we started to notice that she was worse around feeding time (whether breast or bottle top-up). We had fantastic help from every member of the midwifery team, all trying to assist with the feeding - so in a sense our extra stay was really worth it for the support we received, but still she remained unsettled. We went home after 4 days, thinking that things would just be better once we were in our own home as a family.
It was indeed lovely being home, the three of us. However, the screaming continued. She was evidently ravenously hungry - she’d suckle, suckle, suckle like crazy - but would then get even more upset and writhe around, arching her back and vomiting occasionally. It was as though feeding was painful for her but the screaming continued all day and most of the night, even between feeds. She lost a bit of her birth weight (as is normal) but was a slower to put it back on than expected. We had regular visits from midwives and health visitors and despite voicing our concerns that she was so unsettled, we were reassured this was all pretty normal as objectively she was growing (albeit slowly) and progressing along well, and it was “probably colic”.
Lots of people say to me: “It must be great though, you’re a doctor and so is your wife” - true, but in this situation, like everyone else, we were just new and very sleep-deprived parents, struggling through this life-changing event and trying to work out what was normal and what wasn’t. I think between us we started to wonder if she had reflux - we’d noticed that she wouldn’t sleep in her cot (only lying on one of us) and being flat on her back seemed to agitate her a lot (to put it lightly). We tried some anti-reflux medication for a few weeks - looking back I don’t think it did much, but at the time we were so desperate for something to give her some relief that I think we were almost willing it to work. During this time we did some more thinking and began to suspect that she may be suffering from cows’ milk protein allergy (CMPA). This feeling was made all the stronger after my wife cut dairy out of her diet (as cows milk protein is passed on through breast milk) and finally things started to seem better - but it was hard to see the wood for the trees.
CMPA affects up to 7% of mixed-fed babies (only 0.5% of exclusively breastfed babies). It is an immune response to the proteins in cows milk (specifically casein and whey) and their components. The classic manifestations can be wide ranging: skin symptoms (redness, itching, hives, eczema), abdominal symptoms (reflux, vomiting, abdominal pain, blood in the stool) and general symptoms (faltering growth, tiredness, being unsettled) can all occur to varying degrees. CMPA tends to be associated with other atopic conditions such as asthma and eczema and babies are more at risk if one of their parents has either of these (as I did as a child).
Isabella exhibited very few signs other than the constant distress with feeding, so we just weren’t sure. We saw our paediatrician, who similarly was not totally convinced, but we all agreed to trial some specialised hypoallergenic formula milk.
Within a few days, she went from almost constant distress to being a contented, happy and smiley baby. The transformation was pretty incredible, and if I’m being honest it brought us both to tears. It had taken about ten weeks to get to this point, but with almost no sleep and seeing your child constantly in pain, it felt like much much longer. It was lovely to finally see our daughter happy, and start to enjoy parenthood as we had imagined it.
The whole experience from her birth to that turning point was a really testing time to say the least. Doctor or not, it showed me the importance of parental intuition - having the instinct that something isn’t quite right, but the fact that she had so few of the classical symptoms made the diagnosis quite difficult.
Something that cropped up time and again over this period was the issue of breastfeeding. It can be a challenge to establish and maintain anyway but when your baby is constantly writhing in pain, losing the latch and both mother and baby are exhausted as neither have slept for days, it’s even harder to build up a sufficient supply. Dairy and cows’ milk are so ubiquitous and present in so many foods we would never have expected, that changes to my wife’s diet were fairly drastic and didn’t always have a beneficial effect for Isabella. My wife persevered, but despite this it became necessary to supplement some feeds.There can be a lot of guilt associated with not being able to breastfeed exclusively, and this really shouldn’t be the case. Don’t get me wrong, breastfeeding is fantastic for mother and baby, but ultimately a baby needs to be fed, and a happy baby makes for a happy mother (and father)!
Coincidentally, after things started to improve I saw two mothers, both on the same day, both with babies having really similar symptoms to Isabella and both nearing the ends of their tethers. My recent experience made me much more suspicious their babies had CMPA, and sure enough this proved the case after exclusion of dairy from the mothers’ diet and use of specialised formula. It was heartwarming to use my own experience to make a difference to these young families’ lives at such a critical time, especially as I thoroughly empathised with them.
A lot of children will grow out of CMPA over time. Isabella is now seven months old - she’s sitting up more, has started solids (which she is chomping down with abandon) things are still on the up. She’s sleeping better, much happier and generally thriving. She still won’t sit still though…
For more information about CMPA, there is an excellent summary in NICE's Clinical Knowledge Summaries - click here
