Milk Allergy

Dr. Greene, I have an 8-week-old son who started producing green stool with bits of blood about three weeks ago. The pediatrician said that he had a positive hemoccult test and that it was caused by colitis and eczema, resulting from an allergy to cow’s milk. He told me to stop breastfeeding and only use Nutramigen. But when I spoke with La Leche League, they said that dairy is out of your system in seven days, so I returned to breastfeeding a week after giving up dairy. But the doctor still disagrees. What do you think?

Milk Allergy

Dr. Greene`s Answer:

One of the most common reasons for blood in a young baby’s stools is an allergy to the cow’s milk protein in dairy products. The same allergy that can cause inflammation in the intestines (colitis) can also cause eczema in the skin. The allergy is not to breast milk, but it is true that enough cow’s milk protein from mom’s diet can come through in the breast milk to cause symptoms in an allergic baby. (Other food allergies can also do this. Milk is the most common, but enough soy, peanut, and eggs can also go through breast milk to cause allergic reactions).

La Leche League is right that the offending foods are usually gone from the breast milk within seven days of removing them from mom’s diet — often even sooner. Most allergic babies do get better while breastfeeding if their mothers give up cow’s milk and foods that contain cow’s milk (which can show up as whey, casein, milk hydrolysates, butter on food labels). But, even after avoiding cow’s milk, there are a few babies who do not improve. If your baby doesn’t get better, you might try eliminating all four of the most common allergens from your diet (milk, soy, peanuts, and eggs). Be sure you find another way to get plenty of calcium.

I would not stop nursing for this unless, perhaps, if your baby were anemic and/or had low protein on a blood test. Even then, I would recommend seeing a pediatric GI doc before deciding to stop. There would probably be a safe way to continue nursing.

Many doctors are not aware of this, but even though Nutramigen is a great hypoallergenic formula that can be very effective for babies who are allergic to milk-based formulas, it does still contain traces of milk. In my experience, those who react to traces of milk in dairy-free breast milk will also react to Nutramigen (within a few weeks, if not at first) and would ultimately need a formula called Neocate, which contains none.

In short, I admire your decision and your pursuing more information. The advantages of nursing far outweigh a tiny bit of inflammation and blood loss in an otherwise growing baby. I wouldn’t stop nursing for that.

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. Tucker's Grandmom

    Dear Dr. Greene,
    My grandson has been breastfed since birth. He has eaten organic yogurt (almost daily) since 6 months of age without any problems and some other organic milk/fruit smoothie type foods. On occasion he has had rashes/hives and we were never able to figure out why. One time when he got formula (when his mother was not around) he broke out with hives. Other times he got the formula, he didn’t break out. Now that he is over 1 year old, my daughter has tried him on cheerios with organic whole milk (hives on face after 3 bites), mac/cheese (hives on face in 3 bites), and the same with cottage cheese and American cheese. My confusion is why he is not having a problem with the yogurt or other milk smoothies but reacts to cheeses, etc.? He was very colicky for the first 3 months of age. Only other problem now are constipation regardless of amount of vegetables/fruits/fiber served, and he doesn’t sleep more than a couple hours at night before waking up. What type of allergy testing would you recommend? What are the chances of anaphylactic reaction if he gets milk products? Should we try goats milk products? Please advise.

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  2. Nicole

    Hi Dr. Greene and everyone that is reading all the comments. I have a son who is 7 weeks old and found out about a week ago that he’s CMPA. He’s on Nutramigen right now. He always gives me a weird funny face every time I feed him the Nutramigen. He doesn’t like but he’s drinking it anyway… I’ve been told by his Ped that it will take 6-8weeks for his rash to go away and the same as my breast milk. So I have to go on a strict diet for abt 2 months or so in order to give my baby breast milk. I understand that the cow’s protein takes a while to completely get it out of my system and at the same time people said different number… So which one is it for sure or at least close to??? Please help me!!! I’m battling with myself, whether or not to go on the CMPA diet and still wait 2 months later to be able to feed my son my breast milk or just go exclusively Nutramigen formula?????? I’m in this great emotional roller coaster… Not sure on what to do!!! PS: my milk supply is kind of low but I feel like it can get better. Please help me Dr. Greene!!!!!! Thank you.

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    • Hi Nicole,

      I’m not Dr. Greene, but I am a mom and I get where you’re coming from — wanting to nurse ASAP, wondering if it’s worth all the hassle. From my perspective, it’s worth it! Every bit of breast milk you can give your baby is a gift. If you need to supplement, because of low supply, it’s okay. What you can give is still a huge help.

      If must be frustrating to pump now when he can’t get your milk. Are you donating it to a breast milk bank? Just because your baby is CMPA, doesn’t mean other babies couldn’t benefit from your milk.

      I’ll let experts weigh-in on length of time you need to be cow milk free, but if your doctor says 2 months, I’d use that as the guideline.

      One last parting thought — have you tried cashew milk? It’s delicious.

      Hope that helps,
      @MsGreene

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      • Nicole

        Dear MsGreene,

        Thank you so much for your reply. Just Ike you said it is frustrating!! But I’m working on it.

        And yes I’m going to donate my breast milk and I’m very happy to do so because just like you said, just because my baby can’t have my milk doesn’t meant other babies can’t… In fact my baby actually recieved donors milk while he was in the NICU and I forever grateful for the that.

        Now I have the chance to do the same for other babies (even though it includes lots of tears and headache) like I mention, I worked so hard on getting my milk supply and now I can’t even feed my own baby.

        Anyway, it’s all set and done. Everything happened for a reason. I’m so much better and happy to see my baby getting better!!!! :D His rash is going away slowly… So hopefully next week it will be all gone :D

        Thank you once again MsGreen and everybody for your reply and ur opinions.
        It helps me greatly!

        Thank you :D

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  3. Denise F from Omaha

    Dr. Greene.
    I am a grandmother of a BEAUTIFUL :) three and a half month old baby boy. I am so disappointed in the course of action that I see from the doctor. It was apparent at two weeks that this baby was having a food related allergy. He had developed cradle cap and acne. He was spitting up a bit more than normal with breast milk. The mother went back to work at 4 weeks (YES-WOW). So the doctor recommended Enfamil (I hate commercial formula – believed that a non dairy and non soy product would have been the perfect answer- but what can I do- just the granny and parents believe that doctors know best)…so he had a violent reaction, that they allowed to go on for over a month. He had projectile type spit up…terrible gas and obvious stomach discomfort. So then the doctor said put him on Enfamil A.R, same reaction- Enfamil Gentle Ease- same reaction, Enfamil Soothe – same reaction. So I threw a big tantrum and they tried Holle Organic Stage 1. Less reaction- no projectile spit up, but still spit up, but still some cradle cap, acne and gas. So that told me that this is definitely a milk allergy. Then a few nutritionist, including a pediatric nutritionist said give him Gerber Good Start – because hydrolyzed is better…but I am thinking – we now know without a doubt it is a milk allergy so why give him more milk based formula??? But we did. Same reaction. Okay…so then the doctor says Nutramigen. broke out in a rash for a couple of days – but not as much spit up, but still cradle cap, and acne. Now, the baby has started scratching his scalp to the point that he needs gloves on. I wash his hair with castile soap and lather him in coconut oil to help. I wholeheartedly believe we should be making a coconut based formula…I keep him on the weekends and once, they forgot the Nutramigen….which is disgusting tasting and smelling and full of chemicals- really gross stuff…but I digress….so they left the formula and I went to Whole Foods, got some baby carrot juice and coconut juice and organic rice cereal and made some make-shift formula. He loved it. I have researched some formulas with added probiotic, whey proteins, molasses and cod liver oil as ingredients…and whatever works…but ANYTHING would be better that what he has experienced!

    I am so disappointed in what we have a options. I believe that this Nutramigen is making him a bit listless – and trust me I have hours of video and I watch, play and talk to him for hours and know exactly what his reactions are to these formulas.

    I have expressed all of my concerns. I pointed out that I have been saying food allergy since he was two weeks old. I have researched all the ingredients in these formula – many of which are on the government toxicology website but FDA says its okay because it is such a small quantity…(really??)

    I have voiced my concerns over and over – I have pointed out my observations….which, obviously they see too…(I don’t get it)
    So the parents have asked me this: “Why would the doctor tell us to give him this formula if that were so? We trust her judgment.”

    So I say this, most doctors only go by what you tell them in the office visit, they generally do not base their suggestions on long term documented observations- and from what I see, MANY, MANY people are getting the same standard advise and course of action.

    Boggles my mind. I want to give the doctor and the parents some shaken baby syndrome. I say wake up, look and listen to what this poor baby is telling you. He is speaking loud and clear!

    NO MILK
    NO SOY
    NO UNPRONOUNCEABLE INGREDIENTS

    OKAY….so the coconut formula he was happy, cooing, playful and bright eyed.

    PLEASE – PLEASE – PLEASE – Tell me what you think and suggest!
    HOW DO I CONVINCE THESE PEOPLE TO DO SOMETHING DIFFERENT!

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    • AB

      Denise,

      The baby might have a cow’s milk protein allergy. Most formulas are based on cow’s milk. There are some based on soy. However, a part of babies who are allergic to cow’s milk protein, are also allergic to soy.
      Hypoallergenic formulas like Nutramigen do contain cow’s milk protein, but in a hydrolyzed (i.e. broken down) form. So the protein is broken down to small pieces, which makes it harder for baby’s immune system to recognize it and react to it with an allergic reaction. the parents did try Nutramigen, but it was not very helpful, as you described. (I’m wondering why the Dr did not recommend it first, instead of the other “gentle formulas” (that are Not hypoallergenic in a true sense).

      I would recommend using an amino acid based formula like PurAmino (from Enfamil) or Neocate. Here, the cow’s milk protein is completely broken down to its smallest components, amino acids, so the baby’s immune system does not recognize them (to react to them in an allergic reaction). The body needs amino acids to make its own proteins.

      Definitely do not make a homemade formula! It is neither safe nor nutritionally adequate for an infant.
      I hope this helps! All the best!

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  4. ashley

    My son is 3 months old and his pediatrican determined he is allergic to protein. He is on similac alimemtum now. He doesn’t have blood in his stool now. But he still spits up often and is so fussy almost all day and worse at feedings. He is on zantac for reflux, but doesn’t seem to be helping. Can anyone give me some advice. I hate seeing my baby miserable.

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    • HLWmom

      Fyi whey protein is from cows milk.

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  5. Saaya

    My daughter developed eczema and threw up @ 6 months on eating dairy and wheat. We had her tested @ 1 and found out she has severe allergies to milk, eggs, peanuts, wheat,tree nuts, coconuts, lentils, chickpeas, peas, millet, sesame(IgE blood test and SPT confirmed).

    I continued to breastfeed her and still do at nights and gave her a lot of probiotics. Mothers milk is truly the best, I breast fed my son till he was 1 1/2 and he has no allergies. With my daughter I made it my goal to do until she was 2.

    She can now eat, lentils, chickpeas, coconuts and baked eggs. We will do a baked milk challenge and continue to heal her. If your baby still cannot handle it don’t worry, give him the neocate and continue to give him probiotics once he is on solids.

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  6. Lauren

    Some doctors have suggested that my 9 week old baby could have a milk allergy and some other professional say that he hasnt, he was given neocate milk and has been on it for around 5/6 weeks but just recently we have changed him back to aptimal as he would only take 2 oz bottles of neocate and his symtoms were still the same he didn’t seem any better on neocate, he is now taking 5 oz of apitmal milk. His symptoms are very colicky/silent reflux, he hasn’t got dirrera or his never projectile sick or got skin rashes, he will cry for hours on end in the evening and will cry during the end of his last feed at night! We do get quite a few smiles in the day time, if he had a milk allergy would he be in pain/poorly all day long?? I wish he could have a test so we knew for definite but doctors say that there isn’t one for him, any advise would be great thanks

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  7. dominique wilkins

    I have a 3 month old baby boy and he’s on nurimgon and he’s spits up a lot still and we don’t know what’s causing him to throw up so much

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