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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Allergies to Formula

milk_allergy_smallBreastmilk is the best form of infant nutrition and the most easily digested. If exclusive breastfeeding is not possible, infant formula is the next best option. The manufacture and marketing of infant formula is carefully controlled, to ensure that the products you buy are as safe and nutritious as possible. Although many babies thrive on these formulas, allergies, intolerances or certain medical conditions can make it difficult for some babies to digest traditional formula. Formula also takes longer to digest than human milk, giving the digestive system longer to become sensitive to the ingredients.

If you suspect that your baby is unable to tolerate regular formula or have any concerns about your baby's feeding and growth, consult your pediatrician for monitoring, diagnosis and treatment. Your doctor will be able to advise you about appropriate substitutes to traditional formula, if your baby is allergic.

Types of formula and allergy

The most common food allergy or sensitivity in infants is to cow's milk protein, which is found in most formulas. A distinction needs to be drawn between milk allergies and lactose intolerance (lactose intolerance is very rare in babies), or the body's inability to adequately process or digest cow's milk protein. Approximately half of infants who are sensitive to cow's milk are also sensitive to soya-based formulas. You may need to give your baby extensively hydrolyzed formulas (EHFs), in which the proteins have been broken down into smaller, more digestible portions. EHFs are hypoallergenic and are tolerated by most infants with allergies to milk and/or soy. Alternatively, amino acid-based formulas may be recommended. These are known as elemental formulas (EFs) and contain protein in its most basic form. EFs are well tolerated by children with severe food allergies, including eosinophilic esophagitis (swelling of the food pipe due to white blood cells called eosinophils). They are also used to prevent or delay the onset of allergic disease in high-risk children, especially those who are prone to developing food allergies and atopic dermatitis (eczema).

Although partially hydrolyzed formulas (PHFs) are regarded as easier to digest than traditional formula, they are not hypoallergenic and may still cause allergic symptoms in susceptible children. PHFs may be useful in preventing or delaying the development of allergic disease in high-risk infants.

Signs and symptoms

The following symptoms are possibly indicative of an allergic reaction to formula but can also be found in other unrelated conditions:

Skin symptoms:
  • Rashes
  • Hives (raised, red bumps)
  • Eczema (dry, scaly patches of skin)
  • A diaper-like rash around the rectum that doesn't clear up with diaper rash cream

Gastrointestinal symptoms:
  • Vomiting or spitting up more than is considered normal (persistent and in large quantities), both shortly after feeding and several hours later
  • Projectile vomiting may be associated with food allergy (where the infant expels the stomach contents, more than just a few inches away from the mouth)
  • Unusually hard or excessively loose, watery and foul smelling stools
  • Blood in stool
  • Excessive abdominal or intestinal gas

Behavioural symptoms:
  • Having a baby that is described as "colicky"
  • Continual fussiness or crying, shortly after you have started or finished a feed
  • High-pitched crying possibly indicating abdominal pain
  • Crying that is not responsive to consolation and lasts for hours
  • Refusing food

Respiratory symptoms:
  • Nasal congestion
  • Breathing difficulties, such as wheezing, asthma or shortness of breath
  • Mucous in the nose or throat that cannot be attributed to a cold

Other signs:
  • Weight loss
  • Poor growth or an inability to thrive
  • Sleep difficulties due to discomfort

Diagnosis
Food allergies can be diagnosed in several ways. Tests that may be performed include; stool and blood tests, as well as allergy skin patch testing.

Prevention
Allergies in general seem to be more common. One of the safest and most effective ways of reducing the number and severity of infant allergies is to breastfeed exclusively for the first six months. Some nursing moms may be advised to exclude diary products from their diets when feeding a baby with a diary allergy or intolerance. However, most babies tolerate breastmilk.

If you or your partner has a history of allergies, find out how you were fed as infants and whether you had any adverse reactions. If your baby is showing signs of a formula allergy, check with your paediatrician before switching to a new formula. The American Academy of Pediatrics recommends giving your child traditional formula unless your doctor specifically asks you to switch formulas for medical reasons. Parents of highly allergic babies may be required to replace whole chain proteins with amino-acid based formulas.

The FDA strongly advises parents to avoid giving their babies (infants less than one year of age) – whole milk, goat's milk or homemade formulas. These substances can potentially lead to illness and malnutrition.

Complications
If a formula allergy is undiagnosed or left untreated for an extended period of time, allergic babies may have difficulties gaining or maintaining weight, and may fail to grow and develop according to conventional milestones due to poor nutrition. Allergic babies who experience frequent vomiting and digestive problems may dehydrate or become anaemic, due to a lack of sufficient fluids and nutrients.

Babies with severe allergic symptoms involving respiration (such as a swollen throat and/ or airways) require immediate medical treatment. Parents of highly allergic babies may be advised to carry an Epipen, to deliver allergy-relieving epinephrine in emergency situations (although anaphylaxis in babies is rare).

Prognosis
Allergies to formula are not that common, affecting approximately 3% of babies. When introducing formula be on the alert for allergy symptoms, particularly if allergies run in your family. Discuss any concerns with your baby's doctor and only switch to a hypoallergenic formula at his or her advice.

References
Barger J. What are some of the signs that a baby is allergic to formula? BabyCenter. http://www.babycenter.com/404_what-are-some-signs-that-a-baby-is-allergic-to-formula_9138.bc . Published 2007. Accessed May 13, 2013.

Carson E. What to do if an infant can't tolerate formula. Livestrong. http://www.livestrong.com/article/238457-what-to-do-if-an-infant-cant-tolerate-formula/. Published September 9, 2010. Accessed May 15, 2013.

Harding S. Formula Allergy Symptoms. Livestrong.com. http://www.livestrong.com/article/83605-formula-allergy-symptoms-babies. Published March 23, 2010. Accessed May 25, 2013.

Moore D. Baby Formula Allergy. About.com Guide. http://allergies.about.com/od/foodallergies/a/babyformulas.htm. Updated February 8, 2009. Accessed May 15, 2013.

Rocker T. Signs of Allergies to Infant Formula. ModernMom.com. http://www.modernmom.com/article/signs-of-allergies-to-infant-formula. Published October 11, 2009. Accessed May 25, 2013.