8. August 2011 | 10:56

How will the doctor know?

Diagnosing CMA can take more than one step.

Your child’s Doctor will be able to lead you through the steps to diagnosis. He or she will use the information about your child’s symptoms and medical history to decide whether allergy tests are appropriate and, if so, which type of test would be suitable. This depends partly on the type of allergy suspected. The first step would be to eliminate the food to blame from your or your child’s diet; this will depend on the following:

Are you still breastfeeding?
Clinical guidelines recommend that breast feeding is continued if there is a suspicion of CMA in your breast-fed baby. It is advised that you as a mother need to eliminate cows' milk protein from your diet for 2-4 weeks. However, it is important to obtain dietetic advice to ensure adequate calcium intake from other sources.

Is your baby formula fed?
Your child’s Doctor will recommend you start feeding your infant a different formula. Options from formulae containing cow’s milk proteins which have been broken down to formulae that contain no cows' milk protein at all. These are called amino acid-based formulae. These are referred to as hypoallergenic specialist formulae and are available on prescription.

Does your child already eat solids?

When your child is on solids and your Doctor suggests starting an elimination diet, as he or she suspects CMA, all cow’s milk products should be eliminated from the diet. Before the age of 1 year, breast or formula milk continues to play a fundamental role as a source of nutrition whilst your baby adjusts to a mixed diet.

After 2 to 4 weeks on the elimination diet a follow-up visit should be planned. If the symptoms have disappeared, the Doctor may go one step further in the diagnostic process and perform some additional tests. Further allergy testing involves for example skin tests, blood tests or a food challenge. The type of test chosen depends on the type of the allergic reaction. For example, skin or blood tests would be performed in the case of early onset symptoms such as skin rash or swelling.

Symptoms such as eczema, diarrhoea or blood in stools can also appear several hours or days after the food is eaten, eventually even the growth of your child could be affected. Some children show mixed reactions. For late onset food allergies, the Doctor may recommend to reintroduce cow’s milk in your child’s diet in very small doses to see whether the symptoms return. This procedure is called “oral food challenge”. The first step is to decide whether the test can be performed at home or if it needs to be under direct medical supervision. There are many specific issues that must be considered in order to reach this particular decision. Your child’s Doctor will inform you of all the details.