Breastfeeding a Baby with CMPA

by Dr Marie-Therese (Terri) Lovis, General Practitioner


Advice for The Mother Regarding Being Dairy Free

A breastfeeding mother might feel that going dairy free is too daunting a task or a sacrifice too far. It is important to acknowledge this feeling and encourage her that with adaptations she can still have treats and snacks to keep her going in those long hours looking after a new baby.  By encouraging her and arming her with information (recognising she may have a wait until she sees a dietician) she may be assisted to continue breastfeeding. It is known that women who meet their breastfeeding goals have a lower risk for postnatal depression1.

An added bonus is that being dairy free often means making healthier food choices which may help with her own health.  Occasional snacks and treats are also available as dairy free options (see below).

All food labels should be checked as ingredients can change.


What to Avoid

  • Being dairy free means avoiding all milk products– that includes milk, cheese, yoghurt, cream, ice cream and fromage frais, but eggs can be eaten.
  • Products which contain milk as an ingredient also need to be avoided. If the product contains milk it will be shown in bold on the label.
  • Milk from goats, sheep and buffalo must also be avoided as the proteins in these milks are similar to cows’ milk protein so are likely to cause the same allergic reaction.
  • Foods containing: casein, whey, buttermilk, milk powder, ghee, calcium or sodium caesinate, lactoglobulin, lactoalbumin or lactose should also be avoided2
  • Ingredients in foods should always be checked, including in restaurants, as milk protein may be an unexpected ingredient.

 What to Eat

When dairy free one needs to ensure that one gets a good amount of calcium from other sources: leafy green vegetables, fish with bones in, calcium fortified cereals, dried apricots and alternative milks containing added calcium.

  • Breastfeeding mothers should have 1000-1200mg of calcium per day3, 4. Dietary calcium is preferable but if this is not possible a calcium supplement should be taken.
  • Breastfeeding mothers should also take 10mcg of vitamin D per day. 

Adcal D3 caplets (which are also soya free) can be purchase from a pharmacy if calcium and vitamin D supplementation is required. If the mother is able to meet her calcium requirements through diet alone, she can just take Healthy Start vitamin tablets which contain 10mcg vitamin D (available at Children’s Centres, baby clinics and shops), or a suitable alternative which can be purchased from a pharmacy or supermarket.

NHS Choices: Vitamin D

GPIFN: Vitamin D Supplementation


Vitamin Supplementation for the Breastfed Baby and Child with CMPA

  • Babies are now advised to have 8.5-10 mcg vitamin D per day from birth if breastfed or if receiving less than 500ml of formula per day.

It’s important to note that this guidance should not be read to suggest that breastmilk is insufficient, as the recommendation is precautionary due to low levels of sunlight in the UK (see our webpage on ‘Vitamin D Supplementation‘).  Children from 1-4 years old should have 10mcg vitamin D a day all year round and children 5 years and upwards and adults should consider taking 10mcg in Autumn and Winter.

Abidec drops are safe from birth (and are vegan). Healthy Start vitamin drops contain vitamin A, C and D (not vegan). They are free if eligible for the Healthy Start Scheme or can be purchased from Childrens’s Centres or local suppliers. They are currently licenced from 1 month (correct as of April 2017).


Dairy Alternatives for the Mother

  • Most supermarkets stock a dairy free range; check for the presences of other allergens including soya.
  • Dairy free milk alternatives– look for calcium enriched milks containing 120mg calcium per 100ml2.  Aim for 3 portions a day.  Oat and almond milk are good alternatives.  Soya milk is an option if the baby is not allergic to that too.
  • Soya milk curdles in coffee (but not in tea) so use an alternative in coffee. The Oatley range has a single cream alternative and a cappuccino range.
  • Dairy free spreads– shops own brand as well as Pure and Vitalite. Check that spreads don’t contain buttermilk.
  • Calcium fortified almond/soya/coconut yoghurts.
  • Replace cream/milk in cooking sauces with coconut cream/milk, oat or soya cream (if able).
  • Ice-creams- The Coconut Collaborative/Swedish Glace (contains soya)/Dream/Booja
  • Cheese- Violife do a range of cheeses; melting cheese for pizzas, lasagnes, cheese on toast etc. some slices for sandwiches, mozzarella replacement, parmesan replacement.  Use hard dairy free cheese for cheese sauces- better in the microwave as they stick to the pan!
  • Dairy free milks and custards sometimes stick to the pan so try the microwave when heating.
  • Try the Food Maestro app. You can enter your allergies and then scan products to check if they are safe (Co-developed by Guys and St Thomas’ Hospital).

References

  1. Borra C, Iacovou M, Sevilla A. New Evidence on Breastfeeding and Postpartum Depression: The Importance of Understanding Women’s Intentions. Maternal and Child Health Journal. 2014;19(4):897-907.
  2. British Dietetic Association (BDA) Food Fact Sheet: Milk Allergy July 2014
  3. NICE CKS: Cows’ Milk Protein Allergy in Children Revised June 2015
  4. British Dietetic Association (BDA) Food Fact Sheet: Calcium July 2014

Published April 2017