Jeffrey Salazar
Breastfeeding mothers can eat almost anything, but some exclusively breastfed babies can have allergies or intolerances to food proteins that enter breast milk from their mother's diet. The most common food to trigger a reaction in susceptible babies is cow's milk, but other allergens could be a trigger as well. If your baby is suspected to have a cow's milk protein allergy, you may be asked to follow a dairy elimination diet for at least 3 weeks to see if your baby's symptoms improve. This involves removing all sources of dairy from your diet, including explicit dairy products like cheese, yogurt, and milk, as well as hidden sources like whey, casein, or milk solids.
Eliminating Milk Protein from a Diet While Breastfeeding
| Characteristics | Values |
|---|---|
| Reason | Babies can have allergies or intolerances to traces of food proteins that enter breast milk from their mother’s diet. |
| Common allergens | Cow's milk, egg, soya, fish/seafood, peanut or tree nuts, wheat or other grains, and certain fruits. |
| Symptoms | Colic-like symptoms, wheezing, vomiting, diarrhea, constipation, a rash, eczema, blocked nose, stomach, skin or breathing problems. |
| Diagnosis | A pediatrician may conduct a stool test to check for small amounts of blood. |
| Elimination diet | Remove suspicious foods that are causing an allergic response. |
| Foods to avoid | All dairy products, including explicit dairy like cheese, yogurt, and milk, but also hidden sources of dairy like whey, casein, or milk solids. |
| Foods to include | Broccoli, collard greens, kale, bok choi, pak choi, ground sesame seeds, blackstrap molasses, almonds, brazil nuts, canned sardines or salmon. |
| Supplements | Calcium and Vitamin D supplements. |
| Time to improve symptoms | 2-3 weeks. |
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What You'll Learn
Cow's milk protein allergy (CMPA) symptoms
Cows' milk protein allergy (CMPA) is an immune system response to proteins found in cow's milk, primarily casein and whey. It is one of the most common childhood food allergies, affecting around 7% of babies under one, though most children grow out of it by the time they are six years old. The risk of CMPA is highest in infants, occurring in 2%–3% of babies younger than one year of age.
There are two types of CMPA: IgE-mediated (immediate reaction) and non-IgE-mediated (delayed reaction). The two types have different symptoms, which can vary widely in onset and severity. IgE-mediated CMPA symptoms can occur within minutes of consuming cow's milk or up to two hours afterward. Non-IgE-mediated CMPA symptoms are typically delayed and can be difficult to diagnose as they vary widely and overlap with other conditions.
Symptoms of CMPA can include anaphylactic reactions involving multiple systems, such as urticaria, angioedema of the lips and eyes, vomiting, wheezing, or hypotension. Food protein-induced allergic proctocolitis (FPIAP) is another possible symptom, which involves a rectal bleed and mucus. Food protein-induced enteropathy (FPE) can also occur, causing diarrhea and failure to thrive. Other possible symptoms include hives, rashes, a runny nose, and stomach, skin, or breathing problems.
If you suspect your baby is sensitive to cow's milk protein, you can try removing dairy products from your diet and seeing if your baby's symptoms improve. It can take up to 21 days for all traces of cow's milk protein to leave your system, so it is recommended to wait for two to three weeks, or even up to six weeks, to evaluate the results.
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Non-dairy calcium sources
If you are breastfeeding and want to eliminate milk protein from your diet, it is important to know that you will need to make sure your diet is completely free from cow's milk to stop any proteins from dairy products passing through to your baby in your breast milk. This means avoiding all foods and drinks made with cow's milk, including pre-packaged foods and drinks like bread, biscuits, baked goods, processed meat and fish, crisps, breakfast cereals, sweets, and ready meals. You should also avoid all other mammal milks, such as goat, sheep, mare, and buffalo milk, as these contain similar proteins to cow's milk.
While dairy foods are one of our main sources of calcium, there are plenty of non-dairy alternatives that can provide you with the calcium you need while breastfeeding. It is recommended that breastfeeding women get around 1250mg of calcium daily. Here are some non-dairy sources of calcium to include in your diet:
- Canned sardines or salmon (with soft bones)
- Collard greens
- Broccoli
- Kale
- Bok Choy
- Pak Choi
- Ground sesame seeds
- Blackstrap molasses
- Almonds
- Brazil nuts
- Tofu
- Dried figs
- Fortified orange juice
- Fortified soy milk
- Fortified cereals and breads
- Beans
- Quinoa
These foods will help you meet your calcium requirements while avoiding dairy proteins. Remember that it can take up to 21 days for all traces of cow's milk protein to leave your system, so give it a few weeks to evaluate the results if you are eliminating dairy due to a suspected allergy or intolerance in your baby.
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Other common allergens
If you are breastfeeding and your baby is suspected to have a cow's milk protein allergy or intolerance, it is important to eliminate all dairy from your diet. This is because the large protein molecules from cow's milk can pass into human milk and cause an allergic reaction in your baby.
The Food Allergen Labeling and Consumer Protection Act (FALCPA) of 2004 identified eight foods as major food allergens: milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soybeans. In 2021, sesame was added as the ninth major food allergen. These nine foods account for 90% of food allergic reactions.
- Eggs: People with allergies to hen's eggs may also be allergic to other types of eggs (duck and quail) and poultry, especially chicken.
- Fish: This includes salmon, tuna, halibut, bass, flounder, and cod. About 40% of people with fish allergies experience their first allergic reaction as adults.
- Shellfish: This includes crustacean shellfish like crab, lobster, and shrimp.
- Tree nuts: Examples include almonds, walnuts, and pecans.
- Peanuts
- Wheat: This includes wheat products like bread, biscuits, and baked goods.
- Soybeans: Soy is often found in processed meat and fish products, canned soup, and vegetarian food products.
- Sesame: Sesame seeds are a good source of calcium for those who are allergic to dairy.
It is important to read food labels carefully to identify any potential allergens. Even if you have purchased a product before, always verify the labels as ingredients can change.
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Reintroducing dairy
If your baby has been diagnosed with a cow's milk protein allergy or intolerance, you will need to eliminate dairy from your diet while breastfeeding. This is because the proteins from dairy products can pass through to your baby in your breast milk.
Once you have eliminated dairy from your diet for the recommended period, usually between 3 to 6 weeks, you can start to reintroduce cow's milk. This is typically done as a ""home challenge"" to see if your baby's symptoms return. If they do, a non-IgE milk allergy is confirmed.
It is important to note that this reintroduction should be done under the guidance of a healthcare professional, such as a dietitian or doctor, who can advise on the timing and management of the process. They will also provide support and guidance on managing your nutrition, especially if the elimination diet is extended.
You can include non-dairy sources of calcium in your diet, such as broccoli, collard greens, kale, bok choi, pak choi, ground sesame seeds, blackstrap molasses, almonds, and brazil nuts. Additionally, calcium-enriched milk substitutes like soya, oat, rice, nut, and hemp drinks can be consumed.
Vitamin D supplements are also recommended for breastfeeding mothers, especially during winter and autumn when sunlight exposure is limited.
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Vitamin D sources
If you are breastfeeding and suspect your baby is sensitive to cow's milk protein, you may need to cut out dairy products from your diet. Dairy products are a primary source of vitamin D, so it's important to find alternative sources to ensure you and your baby are getting enough.
Vitamin D supports healthy bone development and helps prevent rickets, a condition that causes weak or deformed bones. While human milk contains vitamin D, breast milk alone does not provide infants with sufficient vitamin D. Shortly after birth, most breastfed infants will need an additional source of vitamin D through a supplement. The American Academy of Pediatrics recommends that breastfed and partially breastfed infants receive 400 International Units (IU) of vitamin D daily from the first few days of life.
If you are breastfeeding and have eliminated dairy from your diet, you can get vitamin D from supplements. Daily maternal vitamin D2 or D3 supplementation in the 10 to 50 mcg (400 to 2,000 IU) range may not deliver the daily requirement to an exclusively breastfed infant, so infants may need a daily vitamin D supplement of at least 10 mcg (400 IU). Daily maternal dosages of at least 100 mcg (4,000 IU) can potentially meet the 10 mcg daily infant goal intake.
You can also get vitamin D from spending time in the sun. In one study, increased outdoor activity and sun exposure during warmer months led to an increase in vitamin D levels in breast milk.
In addition to supplements and sun exposure, you can get vitamin D from certain foods. Fatty fish like salmon and sardines are good sources of vitamin D. Egg yolks, beef liver, and fortified foods like milk alternatives and breakfast cereals can also provide vitamin D.
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Frequently asked questions
An elimination or exclusion diet is one that aims to remove suspicious foods from one's diet that are causing an allergic response.
You should avoid all dairy products and all mammal milks (e.g. goat’s milk, sheep’s milk, mare’s milk, buffalo milk) as these contain similar proteins to cow's milk. You should also avoid foods that contain hidden sources of dairy like whey, casein, or milk solids.
The majority of infants with a cow’s milk protein allergy (CMPA) will show symptoms within the first month of life. Usually, babies will have two or more symptoms from two or more organ systems. Symptoms include rashes, eczema, other skin issues, colic-like symptoms, wheezing, vomiting, diarrhea, constipation, and a blocked nose.
It can take anywhere from 10 days to 3 weeks for cow’s milk protein to fully leave your system and even longer for your system to adapt and the symptoms to dissipate.
Good sources of calcium include broccoli, collard greens, kale, bok choi, pak choi, ground sesame seeds, blackstrap molasses, almonds, brazil nuts, canned sardines, and salmon (with soft bones). For vitamin D, try eggs, fatty fish (like tuna and salmon), and some fortified cereals.
