Understanding formula, allergies and sleep | Cows milk protein allergy

Understanding formula, allergies and sleep | Cows milk protein allergy

Understanding formula, allergies and sleep | Cows milk protein allergy

Cows milk protein allergy

2-5 % of infants suffer from a CMPA

Signs of a Cows Milk Protein Allergy (CMPA)

These present as either stomach problems, which are gastrointestinal, breathing issues, which are respiratory. Or skin problems, dermatological.

Eczema, skin rashes, localized swelling and rashes.

Vomiting, reflux, colic,

Constipation, or Diarrhea, blood in the stools

Failure to thrive.

Persistent running nose, sore throat.


If you are breastfeeding you can eliminate cows milk from your diet and your breast milk will be cows milk protein free. It can take up to 2 weeks to fully clear your system, so it’s best to give any elimination diet a good 2 weeks’ worth of trial. It is important to discuss any elimination diets with your Doctor as some recent allergy research indicates in some situations 100% elimination is not the best long-term solution. Your Doctor is your best source of information in regards to this. If you are formula feeding, your Doctor or well child nurse will help you work out how severe your child’s intolerance or allergy is. In some cases you may be required to first try soy and goats formula before your Doctor will prescribe a special formula.

If your baby is only mildly intolerant to CMP, these might be ok. Unfortunately, a lot of babies who react to CMP, also react to soy and goats formula . To make matters even more confusing, if your baby is intolerant or allergic, a change in formula will often give you a 3 week “honey moon” period where it looks like their body is tolerating the new soy or goats formula, but once the levels build up, your symptoms return.

Once your Dr has determined (see assessment form) that no store-bought formula will work, they might prescribe you pepti junior which is a cows milk protein formula, which has been extensively hydrolyzed. This simply means that the cows milk protein which your body recognizes through and IgE response is chopped up into smaller pieces called peptides so that your body’s immune system can no longer see these proteins and react.

If your baby still does not tolerate this formula, and symptoms persist, or if your symptoms are extreme to start with your Doctor might start with a neocate formula. These are usually only prescribed by a specialist.

These formula’s are synthetic and are 100% amino acid based. You can see below an explanation of how amino acids are the small building blocks of peptides, which then join and fold into proteins. The bigger a molecule the easier it is for the body to react to it.

Lactose intolerance

While cow’s milk protein intolerance is a reaction to a protein, lactose intolerance is a reaction to a sugar found in all mammalian milks, including human breast milk.

Having a true primary lactose intolerance is extremely rare, a baby who is born lactose intolerant will failure to thrive from birth and show immediate signs of not being able to absorb the nutrients from their breastmilk.

Secondary lactose intolerance is a bit more common, and usually caused by gut damage through illness such as gastro, parasites, or an allergy to any food groups.

Signs of Lactose intolerance:

Failure to thrive.



Green frothy bowel motions.

Excessive wind.

FPIES allergy

FPIES stands for Food Protein-Induced Enterocolitis Syndrome.

FPIES is a non-IgE mediated immune reaction in the gastrointestinal system to one or more specific foods. Often the main culprit is Dairy, a.k.a cow’s milk protein. Babies with an FPIES allergy to cows milk, won’t have the same skin reactions that IgE allergy babies do.

Signs of FPIES allergy

Profuse vomiting 2-8 hours after ingestion


Dehydration and shock due to vomiting and Diarrhea.

Some babies with FPIES will cope and thrive on breast-milk, others may require Neocate formula to avoid reactions.

Amber had a Cows Milk Protein Allergy when her mum called me.

She thought she was lactose intolerant due to her diarrhea and reflux and sore tummy. Amber was waking frequently at night, unsettled and would only nap on mum throughout the day.

She had been breastfed for 4 months, and then someone had mentioned to mum that maybe Amber had lactose intolerance as she had reflux and was so unsettled particularly after a feed. This had led mum to unfortunately stop breastfeeding and swap to lactose free formula.

Two months on and Amber was 6 months old, just as unsettled and fully for formula fed. Now mum was rocking her and holding her back to sleep at night, as mum could no longer breastfeed her back to sleep. She thought if the lactose free formula hadn’t helped, then it must just be a sleeping issue and could we help.

Since Amber had not failed to thrive I explained to mum that she probably wasn’t lactose intolerant, and also explained just how rare it was since all mammalian milk contained lactose. I suggested she see Amber’s Doctor to discuss special formula’s before we moved ahead with working on her sleep.

Amber’s Doctor had her on a 3 week trial of pepti junior when I went to see her. She was 10 times happier within herself, but still waking numerous times a night and napping on mum. But the change in her temperament was down to the formula no longer hurting her tummy, and causing her reflux, she was a changed baby with her new formula.

We started working on gentle changing her associations from hold and rock to sleep, to using a small comforter she had had since she was a newborn. Amber had been in so much pain she was completely reliant on her mum to get her to sleep, but by looking at her timing, sleep environment and sleep associations we managed to teach her to sleep for a big 8 hour chunk at night, and she started taking her naps in her bed, not on mum!

Allergies play a huge role in how children sleep.

Getting their formula or breast milk right (through elimination diets) can be tricky and emotionally exhausting when your baby is unsettled and your Doctor wants you to try several different options for weeks on end.

Understand that if your baby has an allergy or intolerance, their sleep will suffer and you are best to assist them until you are certain you are on top of the allergy and they are pain free.

Once your baby is free from the allergens that have been upsetting their tummy you can gentle change the way they fall asleep.

Start to work on good timing, working with your babies natural biological clock, and encouraging them to fall asleep when their bodies are tired and physiologically wanting to sleep will immediately improve your situation.

Good sleep environment will make settling easier, and encourage more restorative sleep for your little one. Look at darkness, temperature and noise.

Assess your child’s sleep associations, what have we conditioned them to need to get from awake to asleep? Can we help them with new associations that are more conducive to longer sleep, by your baby being able to link their sleep cycles?

Do you have a good sleep routine? One which encourages sleep, encourages easy settling, and restorative sleep?

These are all things which before you even start sleep training can improve your babies sleep. Register for a free chat if you are interested in working with the Baby Sleep Consultant team on these issues.

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