In clinic. Just seen a distressed mum and a distressed baby boy, 10-month old. He is not sleeping,  crying,  screaming and waking every hour or so. Also, not eating and will only suckle from the breast. He’s not growing, he’s losing weight. Mother has sought help from a lot of different doctors and a paediatrician – she says she feels blamed for her child illness.

“Every time I go along to the doctors, I feel bashed down. It’s like hitting my head against a brick wall.  I began to think that I must be going insane. I became suspicious that it was all in my head.”

Yes.  It is all so easy to blame the mother … or blame the child for bad behavior.

But this baby has gastro-oesophageal reflux disease. He screams with food. He had colic and reflux early on. He needs medication to treat his heartburn. I expect him to be better very soon. We need to treat children seriously … it is not okay to blame the mothers.

The Childrens Clinic helps lots of these misunderstood families

Dr Rodney Ford

What Formula should my baby have?  This is the desperate question that many mothers ask me.  They know that cow’s milk is making their baby sick, and now they are searching for the best alternative.  They are ready to wean, but they are unaware of the various choices and what will best suit their baby.

Correct formula feeding is very important

There is no question that “breast is best”. However, it is important that a “next-best” option is available. This is otherwise known as artificial or formula feeding. The decision of how to feed a new baby is not a menu choice.  Formula feeding is not equivalent to breast feeding.  But it is an important strategy in some food allergy children.

What is a “Formula”?

A formula is a combination of food components that are manufactured to be as close as possible to the food value of breastmilk. At this stage these formulas do not have the same biological advantages of breastmilk and will never capture to depth of breast feeding.  However, they are an important part of nourishing children.

Possible food and nutritional components in formula

• Protein: Cow’s milk casein & whey (standard cow’s milk formulas).
• Goat milk casein & whey. (Karicare Goat)
• Cow’s milk hydrolysates. (Pepti-Junior)
• Amino acids (Neocate, Elecare)
• Soy protein (Karicare soy, Infasoy S26)
• Carbohydrates: Lactose, Glucose, Corn starch
• Fats: Polyunsaturated fatty acids (PUFA)
• Minerals (calcium, iron) and vitamins
• Fibre and prebiotics.
• Added thickeners (the AR anti-reflux milks)
• Water

Some concerns of formula feeding

Infection: sterilization of bottles, teats, storage of made up milk.

Cow’s Milk Intolerance: 5% of infants develop cow’s milk intolerance. As up to 40% of infants with gastro-oesophageal reflux have been shown to have cow’s milk intolerance.

Anaemia: unmodified cows milk feeding is associated with iron deficiency anaemia.

Obesity: growth rates of formula fed babies is faster. Feeding may not be well regulated.

Intestinal flora: lactobacillus, acidophilus growth is important.

What Formula are available for my baby?

Breastfeed for as long as you can. Breast milk exclusively to 4-5 months and then add solids from 5 months – keep breastfeeding to 12 months if possible.  But there comes a time when formula feeding is a good for your baby.  What are your options?

 Cow’s milk

• Standard cows milk formulas are based combinations of casein whey proteins.
• Whey-based formula are usually recommended for a start. 
• Follow-on formulas have a little more iron and are for babies over 6-months old.
• Anti-reflux (AR) formulas have added thickeners to help reduce vomiting.
• Lactose-free formulas are for lactose intolerance but not for babies allergic to cow milk

Other formulas (see dairy free formula)

• Goat milk (can have similar problems to cow’s milk)
• Soy milk (needs to be fortified – some concerns with phyto-oestrogens)
• Rice “milk” (lacks adequate proteins)
• Special milks (see Special milk formula):
     Partial cow’s milk hydrolysates (known as HA hypo-allergenic formula).
     Extensive cow’s milk hydrolysates (such as Pepti-Junior)
     Amino acids based formula (such as Neocate and Elecare).

 We can help you work out the best formula for your child at the Childrens Clinic | Allergy Centre

Lilly, by four days old, she was constantly screaming, distressed, and hard to feed.  She was going rigid and vomiting. She developed eczema and had intermittent blotchy red rashes.

Her local paediatrican gave her an odd diagnosis of the  “unsettled baby syndrome” – he said that there was nothing wrong, and that she was a “normal’ baby. Lilly’s mother was amazed and felt frustrated.

At the Childrens Clinic, we made the diagnosis of gastric reflux from a cow’s milk allergy. We put this poor Lilly on a special dairy-free formula (Neocate).

She is now “a different baby”.  She is smiling, gaining weight, and her rashes have gone.

“Unsettled baby syndrome” was a ridiculous diagnostic label. It means nothing and was of no comfort or use to her parents.

At least 60 food additives used in our foods which are questionable in terms of safety, or at worse, known to be harmful.

This has been highlighted by this campaign: http://www.additivealert.com.au/

Food additive colours on to-be-banned list are:
102, 104, 110, 122, 124, 129

Five years ago, studies from the University of Southampton UK (2007) confirmed that these 6 colours could cause hyperactivity in children. http://www.thelancet.com/journals/lancet/article/PIIS0140673607613063/abstract

As a result of this research, these 6 colours are being removed from ALL foods in the UK.  But they a still in many of the coloured food in New Zealand.
For your children’s sake, please keep these harmful food additives out of their diet.

Cows Milk Protein Allergy (CMPA) is the underlying cause in up to 40% of infants suffering from gastric reflux.

A recent review of GORD and treatment with acid suppression stresses that Cows Milk Protein Allergy (CMPA) is the underlying cause in up to 40% of infants referred for specialist management of GORD (Gastro-Oesophageal Reflux Disease) – yes, this is more evidence that gastric reflux is often caused by a food allergy/intolerance. Check this out.  Special infant formulas are often needed.  If your child has continuing gastric reflux symptoms, then a CMPA or a gluten sensitivity could be the problem.  Get tested. 

http://www.bpac.org.nz/magazine/2011/november/infant_reflux.asp 

How many times have a heard this.  I have just seen a boy with severe eczema, food allergies, who is quite miserable.  His mother is doing the best that she can and each time she takes him to her doctors they say “he will just grow out of it”.  How irritating for the parents to hear this each time.  This means that his doctor does not know how to manage allergies and is just fobbing these parents off. 

The same doctor is unlikely to say “just get over it”  to an adult with Rheumatoid Arthritis or Heart Disease.  In my opinion, established disease which causes symptoms should be managed – not ignored!  Children with eczema and other allergies can very much be helped. Start to think about food allergy/ intolerance.

When your child has just been diagnosed with food allergy, you probably will want some help as to what to next.

We interviewed a group of mothers who had recently attended their appointment at the Childrens Clinic | Allergy Centre. Their children had been diagnosed with food allergy. We asked them how we could help them more. They said that they would like to know:

• What to do first, when feeling so overwhelmed.
• How strict does an elimination diet have to be.
• Advice on what children can eat once they have finished formula: a list of practical allergen free foods, especially breakfast and snacks.
• A phone number of the support group: many mothers said that it would be good to talk with other mothers who have gone through similar experiences.

• The shops in Christchurch that supply dairy- egg- free foods.
• About egg replacer, where to get it and how to use it.
• The alternative foods that supply calcium to their child’s diet.
• When their child comes off the formula, how do they know that they are getting all the nutrients they need.
• What are the alternative sources high nutrient foods that can replace dairy, egg and nuts.
• Practical recipes that are egg-free, dairy-free and nut-free.

• A detailed list of what foods their child can have, and must avoid (for example: soy sauce, sesame seeds, dressings, preservatives, colourings, gluten-free products).
• More ideas of how to cook with Neocate/ Elecare / Pepti-Junior special infant formulas.
• More information about anti-histamines, when they sould be used, as well as side effects.
• More about the progression of food allergy, when might the child outgrow the problem.
• When is it a good time to see a dietitian? Is their child is getting all the nutrients he needs.
• Is it safe to completely eliminate all dairy and/or egg from the diet.
• More help in reading food labels.

These are the questions that you are asking for more help.  So we have answered all of these in detail. We have also produced you a practical and easy-to-use set of recipes so that you can feel confident your giving your child a fully nutritious diet that avoids milk, egg and nuts.

We have also gathered a list of useful websites related to buying safe foods for your child (we have asked these firms to check through and make sure that this information is correct).

If we haven’t been able to answer your questions, please let us know and we will help you even more.

A research paper by Wang & Sampson declare food allergy as very common. http://www.ncbi.nlm.nih.gov/pubmed/21364287

They say: “Food allergies affect up to 6% of young children and 3%-4% of adults. They encompass a range of disorders that may be IgE and/or non-IgE mediated, including anaphylaxis, pollen food syndrome, food-protein-induced enterocolitis syndrome, food-induced proctocolitis, eosinophilic gastroenteropathies, and atopic dermatitis (eczema). Many complex host factors and properties of foods are involved in the development of food allergy.”

Every one with on-going symptoms needs to be assessed for food allergy.

Clair, a mum, writes this to me:

“Dr Ford, it frustrates me so much to see so many babies on Zantac and comfort formula and still suffering. My daughter was one of those babies until she was diagnosed by you as having a milk protein allergy.

I moved back to the UK and my son was born.  It took him to have 3 blue spells before the medics took me seriously: that it was allergy and after a serious A&E appearance it was finally acknowledged as anaphylaxis and his inhaler was replaced with an Epipen. I find it very hard to see so many kids suffering from obvious allergic symptoms that are ignored.

I just feel very privileged to have had the opportunity to see you all them years ago.  As without your knowledge and diagnosis, I dread to think where we’d be.

Time that modern medicine woke up [to allergy and reflux disease]!”

My comment:

Thanks for your kind words, Claire.  Good to hear from you. Yes sadly, every day we see babies, children & adults who have been miss-diagnosed (or their diagnosis missed).  Their allergies have gone unnoticed or ignored, or even worse, their allergy has been denied.  Yes, so many people have unrecognised food allergy, with years or decades of symptoms.  We work to uncover and manage these problems at the Childrens Clinic | Allergy Centre in Christchurch.

Worse, every day we see mothers who are working extremely hard to care for their children, only to be told that their “lack of good mothering skills” is the reason for their child’s problems. The mothers are blamed for causing their children harm, whilst the children are often labeled as spoilt or naughty.  

But the truth is that these babies and children are in pain or very uncomfortable. They might have untreated gastric reflux, or severe eczema that is caused by a food allergy, or behaviour disturbances that are triggered by food intolerances.

ALL OF THESE CHILDREN NEED FULL ALLERGY ASSESSMENT!

Again, thanks Claire for writing.

Cheers
Dr Rodney Ford   

The medical evidence, without-a-shadow-of-a-doubt, shows that food allergy and eczema are strongly linked. However, this is the complete opposite to what most dermatologists will tell you. Why is this so? I don’t know.

For example, Kartina says:

“My son’s ex dermatologist clearly hasn’t read anything that’s ever been written! Was told straight up food allergies and eczema have nothing to do with each other. Funny, once we found what he was allergic to and removed it, his eczema is nearly but all gone! His incompetence is why we will NOT be returning to his practice.”

Sadly, at The Children Centre, we hear this sort of comment everyday.  However, it is our experience that most (80%) children with eczema do have food allergy triggers.  Find these troublesome foods and you have found a solution.  Most of the eczema children in our clinic get hugely better when we pay attention to food allergy.

Consequently, we test all children with eczema for food allergy.

Will be writing a whole section on this topic shortly.