Why is my baby fussy?
By Dr. D Yacob, GP and Mother of Two
"Why does my baby not settle? Is this normal? Is there something wrong? Sometimes she is ok, sometimes she is not. These are all the questions that most mothers want the answers to when it comes to trying to understand their babies. These questions tormented me daily with my first child. Even though I am a GP and ‘should’ know the answers to these questions, I was still a first-time mum, trying to read and understand my baby.
I have two girls; 4 and 2, and both ended up being diagnosed with Cow’s Milk Protein Allergy. My eldest daughter was not diagnosed for an entire year. I tortured myself trying to understand why she is always a ‘chesty’ and ‘colicky’ child. We had multiple viral illnesses and three episodes of croup, which landed us in A&E.
She was breastfed until 4 weeks of age, after which I lost my milk supply, and I went through the grieving process of feeling like I had failed. We moved her on to Aptamil formula until she was 12 months of age. When she was 12 months old we started her on Whole Milk. Between 12-13 months, we had a child that was very poorly! It was all her previous symptoms; coughs, sneezes, runny nose, dry skin, and mushy poos, but amplified. I still had my mum goggles on and still could not see her diagnosis clearly right in front of me.
One emotionally drained night where I was at the breaking point of multiple emotions, I said to my husband (who is not a doctor); What have we done differently recently? Why is she so unwell this much? He turned to me and said ‘Could it be the milk?’ The penny dropped! Oh my god! My daughter has had CMPA this whole time! I could not believe it was under my nose this whole time and not one of my colleagues or me had even considered it when I had her checked. This was almost 5 years ago and CMPA was not as well-known and widely discussed as it is today and there are more guidelines and advice for healthcare professionals now.
I switched her milk to Oat Milk and within 5 days I had a brand new 1-year-old. All of her symptoms magically disappeared. I remember crying for days because of the guilt I felt. At times, I could not watch some of her videos back of her younger months, like one where she would laugh so much she was wheezing.
Then began the journey of going dairy-free. I started to be more involved in the cooking and having to prep meals and snacks to take out with me. I found it very hard to find a lot of dairy-free options. I remember trying to find her an on-the-go ham sandwich, that had no butter, which was like trying to source gold. In the end, I had to buy separate ingredients and make little lunches to carry around – along with all the other bits and bobs you carry around with you for the baby!
With my second child, I was so much more prepared. I noted the early signs within the first 6 weeks of her life and this time went to see my GP and discuss my concerns. She had a lot of dry skin and baby acne in the early weeks and her colic was very intense. I managed to breastfeed to 8 weeks with my second child and I went dairy-free after 4 weeks. Everything I ate I had to check had no dairy – not even traces of milk powder in the ingredients. Luckily, packaging shows dairy in bold so its easy to check whilst out and about. We decided to put her on prescribed extensively hydrolyzed milk after my milk supply went down and she thrived and managed really well in comparison to my eldest.
CMPA is a condition where your immune system responds to the cow's milk protein as if it’s a harmful substance and attacks it. The symptoms start in the few weeks to months of life and there are two subtypes of how a baby can react; immediately (IgE) or after days (Non IgE) and often babies can present with a mixed picture.
IgE mediated responses usually happen within the first 2 hours of coming into contact with the cow's milk protein. These symptoms are skin reactions like hives, vomiting, diarrhea, and wheezing.
Non-IgE mediated responses happen after 2-72 hours after contact and these symptoms are colic, reflux, constipation, blood in poos and dry skin.
If you are worried about any of the above symptoms, I encourage you to see your GP who will guide you on an elimination diet, where you go dairy-free, for 2-4 weeks and see if there is an improvement. If there is, you reintroduce dairy again to test if the symptoms come back to confirm it. That can be a really daunting concept to reintroduce the cow's milk and have your ‘fussy unsettled’ baby back but it is all part of confirming the diagnosis. Once confirmed you can either continue a dairy-free (mother's diet) if you are breastfeeding exclusively, or prescribed formula if bottle-fed.
Most babies are then referred to dieticians to have help in reintroducing the cow's milk protein via the Milk Ladder from around age 9-12 months. This is a stepwise approach to introducing the protein back to the baby in small quantities and most children by age 2 are back on a dairy diet.
I tell my patients all the time to stick their maternal instincts and if you feel that something is not quite right then please do seek advice via your midwife, health visitor or GP. There are plenty of fantastic resources online like Allergy UK, which provide you with more information on the condition and reintroduction of cows milk.
Take home message to all mums; be kind to yourself, trust in your instincts and talk to others/professionals because you are not alone."
- Dr. D Yacob, GP and Mother of Two