Use the below example as a guide when introducing standard formula back into your babies bottle. Remember to only complete the challenge in the first morning bottle

If you require any further information then please Guide for Parents:

contact the Paediatric How to complete a dairy Dietitians on 01896 827231 re-challenge to confirm Day Total volume Standard Hypo Allergenic whether your infant has in morning formula (Cow’s formula bottle milk based for- cows milk protein allergy mula)

Number of Number of (mls) scoops scoops Day 1 210 1 6

Day 2 210 2 5

Day 3 210 3 4

Day 4 210 4 3

Day 5 210 5 2

Day 6 210 6 1

Day 7 210 7 0 Department of Nutrition and Dietetics

Date of review: 2016

You have been advised that your baby requires a cow’s milk re-challenge. This has been arranged How to complete the re-challenge B) Infants who are formula fed or receiving a to determine if your child has and allergy to the combination of formula feeds and breast protein found in cows milk. Cow’s milk protein feeds allergy (CMPA) is relatively common and can A) Infants who are exclusively breast fed affect 2-7.5% of infants in the first year of life. It is

usually short term and approximately half of Each day increase the amount of standard cow’s Start using cow’s milk and cow’s milk containing infants will outgrow CMPA by the age of 1 year milk formula given in baby’s FIRST bottle of the day. and most children will outgrow it before they go to foods in your own diet over 1 week (cow’s milk pro- Day 1: 30mls of standard formula into ONE morning school. teins will pass through in your breast milk) bottle only – i.e. 30mls (1 scoop) standard + 180mls

To diagnose CMPA, it is very important that an (6 scoops) hypo allergenic formula. If you see any obvious symptoms, e.g. sickness, exclusion of dairy is completed to determine if Days 2 – 7: Continue to increase the standard for- your babies symptoms improve. This must be tummy pains, rash, itching in your child, STOP mula in the ONE morning bottle only and reduce the followed by a re-introduction of dairy to fully and go back to your milk free diet and inform hypoallergenic formula using the example on the establish whether your infant truly has CMPA. your GP. next page. This leaflet explains how to complete the re- If you do not see any symptoms in your child then challenge at 4 weeks. If you see any obvious symptoms e.g. sickness, you can go on drinking cow’s milk and eating cow’s tummy pains, a rash, itching, STOP the chal- Do NOT start this challenge if your child is unwell, milk containing products, e.g. cheese and yoghurt. lenge. Go back to the previous formula your baby e.g. In some children symptoms of a cow’s milk protein was taking and inform your GP or Health Visitor allergy may appear at a later time. This may be when  Has a cold or any other lung infections or  If you have not seen any symptoms in your you wean your child or if you start using cow’s milk breathing problems child by day 7 (when you have completely re- formula. If this happens then contact your GP placed one bottle a day with cow’s milk for-  Any tummy/bowel problems e.g. tummy ache mula) you can try giving standard formula for or loose nappies each feed they would usually have from a  Any ‘teething’ signs that are upsetting your bottle. child  If you have also been avoiding milk whilst  Eczema has flared up breastfeeding, milk and milk products can be reintroduced into your diet. If your baby has Do NOT start this challenge if your child is having begun weaning then they may now have dairy any medication which may upset their tummy, e.g. in solids. antibiotics. Do NOT try any other new foods during this  If no symptoms occur within 2 weeks of con- challenge. suming more than 200mls cow’s milk formula per day, then your baby does not have cow’s Try to write down what your child eats and drinks milk protein allergy. during the challenge. Also note any symptoms e.g. sickness, loose nappies, rashes, changes in their eczema.