Monday, 11 March 2019

What are the Safest Childcare Options for an Allergy Baby?

In three short weeks, my maternity leave will come to an end and I will have to leave Matilda for  four days a week when I return to work. Every Mum knows how scary this step feels when you leave  your baby to once again enter the workforce, but when you add into the mix a baby with an allergy, this fear is heightened. In fact, it is frankly overwhelming. You have spent every minute since your little one was born, nurturing and protecting them, learning everything you can about your child's allergy so that you can keep them safe and healthy. Now you have to trust someone else to take as much care and pay the level of attention to detail as you have, that includes everything from hidden ingredients to cross contamination risk. They were not there in the days before you received your child's diagnosis, they didn't witness the level of suffering your child has gone through. They are not you and nor can they be. Only you can have 'mummy instincts,' for your own child. And so it made me question, what are the safest childcare options for babies with allergies?

Childcare Options for an Allergy Baby





As far as I am aware there are three main childcare options currently available in the UK. In this post, I hope to summarise all of them, highlighting the strengths and drawbacks of each.

1. Family Member


I am very fortunate, as when I had my eldest, my Mum decided to take early retirement so that she could look after my son so that I could return to work. If I wasn't able to look after my son who better than to care for him that my Mum? Two years later, they have a beautiful bond and now he has started Preschool, she will be looking after Matilda when my maternity leave finishes. My Mum is very supportive and although is not as aware of how to manage a Cows Milk Protein Allergy (CMPA) in a baby as I am, she wants to learn, and next week we will be sitting down to go through everything. She has also asked for a list of 'safe,' foods (I will be printing off a copy of my Quick Shopping Guide) and a weekly meal planner, which I know she will stick too without fail. It definitely makes that return to work less stressful. Having a family member who is able to cover childcare, even if it is only for a day or two, not only saves on childcare costs, but is also brilliant as they have been on your allergy journey with you, right from the start. They love your child and already have a bond which reassures you that your child will be safe and well looked after. There is not the time restraints of working hours as with other child care options, meaning you can sit down and discuss your child's needs as long as you like, anytime you like and they will follow everything you need/want for your child. Most likely your child will also be looked after 1:1, which greatly reduces the chances of accidental ingestion and cross contamination. It is definitely the cream of the crop when it comes to childcare. That said, it only works if the person offering childcare is supportive and understands your child's allergy, if they are not this may not be the greatest of options for you, as it could put strain on your relationship if there are differences of opinion. Another possible drawback, one we found last time round when my Mum look after our son, was that because she looked after him during the week, we felt we couldn't ask her to look after him at any other point and with no other family nearby and our friends also having young families of their own, it meant we didn't have any babysitters if we wanted a date night. However, this was a small price to pay for having such great child care on hand.

2. Childminder


The lovely thing I have always felt about childminders, is that you child will be in a home environment. The quality of childcare can very from childminder to childminder but there are some outstanding childminders out there that provide a first rate experience for you and your child. I think with childminders it is important to find one that is a good 'fit' with your family. You will know as soon as you meet them whether they are right for you. They tend to have a small number of children to look after and all meals are prepared in a home kitchen. It would be easy for them to manage any cross contamination risks and they could provide your child with any dairy free snacks or meals you send or recommend for them. However, one of the drawbacks from having a child minder is that some childminders do not accept the Government 30 hour funding for 2 and 3 year olds. Which, if you are entitled to it, is a massive financial saving. Also, when your childminder books holiday, which can sometimes be in term time, there is no other staff to cover their leave and so you need to either take leave yourself or make other childcare arrangements for that period which can sometimes be difficult.

3. Private or School Based Nursery


Private or School based nurseries provide a very varied and stimulating environment for all children. The large class sizes also mean there are great opportunities for your child to extend their social skills and become more independent. All good and outstanding nurseries will put together a health care plan with you for you child, outlining their allergy and what steps should be taken if accidental ingestion should occur. Unfortunately, I know some people who have not always had the best experience with private or school based nurseries, in regard to allergies, however most should be very accommodating and if not there will be one out there that is. Nearly all private and school based nurseries now accept the 30 hours funding, greatly reducing childcare costs which is an added bonus. However, there are some drawbacks to this childcare option. Firstly, they do usually have a larger number of children, this naturally increases the risk of accidental ingestion as another child could offer your child something containing dairy without an adult seeing, especially as most nurseries deliver milk and fruit during circle time. Even with the best intentions and strategies, it is not possible to watch every child every second of the day and unfortunately, I have known accidents to happen. Also, there is usually a set menu for meals and it maybe harder for them to accommodate your child's needs.

Conclusion

All childcare options come with some element of risk, but if we are completely honest, there is also some risk when we are looking after our child on our own. We are only human after all. We can  make mistakes, especially when sleep deprived. All we can do, is be prepared, educate the people around you the best you can and have faith in all the precautions you have put in place.

What has been your experience of childcare and allergies? Good or bad, let me know. What worked best for your family?





Thursday, 14 February 2019

The Sibling Debate: When one child has a food allergy and the other doesn't

What do you do when one child has food allergies and other child doesn't?

I have a gorgeous 3 year old allergy-free son, with a personality that is larger than life and now a beautiful 9 month old daughter, Matilda, who has a severe cows milk protein allergy. Since Matilda started weaning, my husband and I have often discussed...

 Should we make the whole family dairy free or just keep Matilda dairy free?

At our first paediatric dietitian appointment when Matilda was 6 months, our dietitian said that our whole household would most likely eventually end up dairy free, to which my husbands response was simply, 'no chance.' Myself however, having been on a strict dairy free diet while breastfeeding up to this point, knew it was easily manageable. And thus began our debate.

Should you deny one child because the other cannot have it?

The answer is not straight forward and neither can it be. Every child's allergy is different and so is their type of reaction. In cases where the child reacts when allergens are airborne or by touch than it is without doubt that the allergen needs to be eradicated from the environment. It is never worth the risk.

However, if an allergic reaction occurs when the allergen is ingested, is it easier to control the environment so that an allergic reaction can be avoided?

Matilda only reacts when cows milk is ingested. When we were about to begin weaning, my husband and I had to decide whether we needed to eliminate dairy completely from our household. Up until this point, I had been dairy free breastfeeding and as an adult was able to safely ensure I did not consume any dairy. Then after six months, I made the difficult decision to stop dairy free breastfeeding which you can read about more on my post The End of Dairy Free Breastfeeding: My Experience This meant that my three year old had six months experience of me being dairy free. He was used to offering me food and me responding 'thank you darling, but that has milk in it and milk makes Matilda sick.' He even used to frequently ask me whether the food he had contained milk and on a couple of occasions, including in one very busy restaurant, shouted across at me while I ate, 'MUM YOU CAN'T EAT THAT, IT HAS MILK, YOU WILL MAKE MATILDA SICK.' even long after I stopped breastfeeding! He was very aware and conscious of it. By having those six months of me being dairy free and the discussions that came with it, we felt he was very well prepared for when Matilda started weaning. He has never tried to feed her something without checking with me first and he still asks if something contains milk while I am feeding her. Therefore, we were able to keep dairy in the household for my husband and son to safely consume.

However, the situation is now changing. Matilda started crawling early and is now nearly walking. Her increased mobility has increased the risk factor. It is now no longer safe for my son to eat dairy containing snacks as Matilda will cheekily try to steal it from him, or if he drops a single crumb, she races there at the speed of light attempting to eat it before I remove it from her grasp.  

Our main concern now, is by having dairy containing products in the house, we are creating the risk of her accidentally ingesting it and having a severe reaction. After all mistakes are easily made, especially when we are tired or distracted. I have a severe allergy to penicillin and once managed to accidentally ingested it when my son had been prescribed penicillin for a bad chest infection. One day, as I administered him his dose, a small drop fell on my hand, as I was trying to persuade him to take it. I automatically licked the drip of my hand before realising what I had done. I could have kicked myself, its not something you would do even if you weren't allergic, but the endless sleepless nights from him coughing had clearly affected my ability to think clearly.

And this is where the problem lies. Even with the best intentions and highest level of organisation and 'control,' we are only human. We do make mistakes. Therefore, in keeping food that contains an ingredient that one child is allergic to, does increase the element of risk. And as a mum of a child with allergies, don't we spend all our time striving to eliminate that risk?

Our snacks are therefore, now all dairy free and with Matilda now being at the stage where she can pretty much eat the same as us, our meals are becoming more and more dairy free also. It has been a natural progression for our family. One that at the beginning, we thought would be impossible, but actually hasn't been as big a sacrifice as we first thought. The ever growing vegan population and increased products available has been a great help. One we couldn't be more grateful for. 

It is a tricky one and I don't feel we can judge others for what decision they make for their family and child. As I said earlier, every child's allergy and reaction is different. What works for a baby may not work for a toddler, or again for an older child or even an adult. It is such a minefield, an exhausting one. Just remember, you can only do what you feel is best at the time and somethings, as scary as it is, are just not in our control.

Wednesday, 6 February 2019

What happens when CMPA symptoms don't disappear with a dairy free diet?

Three months ago Matilda transitioned from dairy free bottle feeding to an amino-acid based formula and we also began our weaning journey. From day one, she began to wheeze briefly after her bottles, which at the beginning we put down to her just adjusting from breastfeeding to the fast flow of a bottle, but when it continued after a period of time, I began to worry.

This wheezing also occurred after eating some foods, but I just could not determine if it was one particular food setting this off or something else as it did not happen consistently when she ate.

Matilda was also screaming in pain with every bowel movement. It was the same ear piercing scream we experienced early on after she was born, before we discovered her CMPA.

Another symptom that caused me great concern was after feeding Matilda a homemade dairy free tomato and spinach frittata, she developed a rash across her face. It was the first time she had eaten both egg and tomatoes, so one of those must have triggered it.

All of this together gave me the following concerns:
1. Is Matilda allergic to the Neocate formula? She had already had a reaction to the Nutramigen,   could it be happening again? If so, what options do we have left?
2. Does Matilda have other food allergies than just cow milk protein?

So I rang out Paediatric Dietitian's office and left a message with her assistant relaying the issues and concerns we were having. Yesterday, just over a week later, she returned my call.

Firstly, we discuss the concerns over the wheezing after her bottles as well as sometimes after eating. She seemed concerned but reassured me that it could not be the Neocate formula causing this. My dietitian claimed that the chances of a child being allergic to the Neocate are extremely rare and that Neocate was really the last resort option for formula feeding Matilda. Instead she explained to me that sometimes after children with CMPA allergies omit dairy from their diet, they can still experience symptoms and may need referred on to a Paediatric Gastroenterologist. She urged me to make an appointment with my GP and get Matilda checked over and discuss the possibility of a referral.

We then discussed the rash Matilda developed after eating the frittata and both agreed it was most likely the egg that caused the rash. My dietitian urged me to be brave and try Matilda again with egg but have it baked in something and see how she tolerates it. If Matilda reacts again, I need to inform her right away and she would make a referral to the allergy clinic for testing.

Later that day, I took Matilda to see our GP to discuss what the dietitian had said. I had my larger than life three year old with me at the time which if you have ever tried to have any important discussion with a three year old around, you will know how challenging it is. I packed a box of snacks, including a chocolate reindeer he had left over from Christmas for bribery and set off on our short walk to our local doctors' surgery. We were half way there when my darling three year old screams 'I need a poo.' I should know by now this always happens at the most inconvenient of times, so we rushed back home, did his business and set off again. Luckily, I am obsessed with time keeping and had allowed half an hour for a ten minute walk.

I felt a massive sense of relief when I walked into the duty doctors office and saw which doctor it was. We have meet with this doctor before regarding Matilda's allergy and he was brilliant, some of the other doctors unfortunately were not always as supportive and knowledgeable as he was, but today we were in luck. My dietitian had already sent him an instant message detailing what we had discussed during our earlier phone call which made life so much easier. While my three year old worked his way through his bribery stash, we discussed my concerns and he examined Matilda and was in agreement with our dietitian. Egg was to be removed from our diet and to gradually try and challenge her with foods that had egg baked in them. The wheezing he concluded was done to silent reflux, making it hard for her to catch her breath sometimes while eating and drinking, and the painful bowel movements he put down to colic. We were the prescribed Ranitidine to be taken twice a day to relieve these symptoms but if nothing improved, we had to return and would be referred to the Paediatric Gastroenterologist. 

Just when I thought we were getting into the swing of things with the dairy free diet, we are thrown a curveball. We will follow the medical advice and proceed with what was proposed. Fingers crossed it all works out...

Sunday, 3 February 2019

My Quest to find the Perfect Dairy Free Cheese

So I am on a mission to bake the perfect dairy free cheese scone. Cheese scones are a family weakness. We just love them. My three year old especially adores them and they soon became our go to snack while on the go when he was younger. There are so many reasons why cheese scones are a fantastic snack for young children. On top of being utterly delicious, they:

- are easy and quick to make using ingredients you usually already have in your home.
- they don't squish or fall apart in a lunch box or sandwich bag so are easy to transport.
- they fit into little hands easily and do not slip out, so are perfect for eating on the go in a pushchair.
- they are rather filling as well as being super tasty when served either hot or cold.

Therefore, despite Matilda's milk allergy, I really wanted to find a way of making them for her. I decided the best way to start was to simply swap the dairy products in my usual family recipe for dairy alternatives. I swapped cows milk for Oatly whole and tried the Violife block instead of my normal cheddar cheese. Here are the results...


Although they passed the Matilda taste test, I wasn't 100% satisfied. They were a little drier than normal and the flavour was very mild. She was happy with them but I wanted something that had more flavour for her, especially as I hoped I could convince the dairy eaters in our household to switch over to the dairy free option. It just wouldn't do. I needed to try again.

I had read recommendations about Tesco's Free From Mature Cheddar having a good strong flavour so decided to give that a go in my next batch. I once again followed my family recipe, swapped the Violife cheese for the Tesco alternative and just increased the dairy free butter alternative by 10g. This time round the consistency was much better, they were not dry like the previous batch and they did smell very cheesy. Great I thought, this is it! Oh how wrong was I. They were hideous and tasted of sick. The Tesco Free From Mature Cheddar just did not work for this recipe. The last lot may have only had a delicate flavour but at least they were easily edible. I couldn't make it past one bite of these ones. The kids however, including my very opinionated three year old, enjoyed them. But despite the children enjoying them, I am just not satisfied.

Overall, the Violife gave a better taste but was just not strong enough to make it taste cheesy. Both cheeses even when grated finely, did not melt fully or blend in with the rest of the mixture, making it a little lumpy in places. My quest continues...

I may have only tried two different cheese alternatives so far and I am not ready to give up on my dream of the perfect dairy free cheese scone, but it has made me wonder...is there really a good dairy free alternative to cheese?

Our dietician told us there wasn't and just to avoid them as they were all disgusting. But with the rise of veganism, there must be the perfect non-dairy cheese out there somewhere for us.

So I was wondering, have you found your perfect dairy free cheese? If so let me know!


Tuesday, 29 January 2019

Switching from breastfeeding to formula with a CMPA baby: My Experience

In my post The End of Dairy Free Breastfeeding: My Experience, I discuss how I came to the decision to stop breastfeeding Matilda and the emotions of making such a big change. 

Once the decision was made, I had to determine how I was going to do this. My GP advised me to make the change gradually, increasing the volume of extensively hydrolysed formula each day. I was to start with one feed per day and gradually increase it every few days. 

Matilda had always happily taken expressed breastmilk from a bottle without hesitation so I thought switching from breast to bottle would be easy. I soon found out I thought wrong!

Day 1, I excitedly made up her first bottle, cradled Matilda in my arms and offered it to her. She just looked up at me with her big blue eyes and kept her mouth tightly shut. Maybe she wasn't hungry. So I wait until she showed signs of needing a feed and tried again. This time she screamed at me! What was wrong? Whenever I offered her a bottle of breastmilk she would grab it excitedly and gulp down the whole bottle without coming up for air. Matilda was so worked up, I knew it just wasn't going to happen today, so I put the bottle aside and feed her at breast. She calmed down, fed happily and fell asleep. It's ok, it was just the first try, I would try again tomorrow.

The next day however was no different and I ended up breastfeeding her again after another failed attempt. Was I giving in too easily? Is weaning her off breast really the right decision? I decided to do my research. The first formula we were prescribed was Nutramigen and if you have ever smelt it, you will know it has a very unpleasant stench. Kind of like wet peeled potatoes. Maybe it was the smell putting her off. I read about other mums' experience of using Nutramgien and there were several things they commonly recommended to try which they had found worked.

These were:
1. Mixing small amounts of the formula into breastmilk and gradually increasing the amount of    formula in mixture until it consists of formula only.
2. To add a small amount of vanilla essence to the formula to make it sweeter like breastmilk and to help mask the smell. 
3. Completely withhold breastfeeding until they were hungry enough to take it.
4.  'Dream feed,' the formula while they slept to get them used to the taste.

The first option made the most sense, so I started there. I mixed 1oz of formula with 6oz of breastmilk and offered it to her. It was such a small amount of formula I was sure she would take it. But once again she refused. I tried this method a couple more times but will no success. It was time to try option two. 

I didn't like the idea of adding vanilla essence to the formula. I was concerned that it would give Matilda a sweet tooth but I needed to try something different and a lot of mums had claimed they had great success with this method. So I cautiously added one small drop of vanilla to her formula bottle. It certainly made it smell better. Maybe this was it...or maybe not! Once again Matilda just wasn't interested. This time she had attempted to try the bottle, but after one taste, she turned away grimacing. It was progress I suppose and maybe one that would have worked if I had continued to try but in the end I decided just to try another tactic. 

The idea of completely withholding breastfeeding until the baby is so hungry they would take it, didn't sit easy with me. I had seen Matilda is pain and discomfort when she was reacting to the cows' milk protein in my breastmilk and I couldn't bare the thought of her in any kind of distress again. So I decided to skip this step and move straight on to the final suggestion...dream feeding!

I waited until the evening, Matilda had been breastfeed before going down to bed and was due to wake up within the hour for her next feed. I made up the bottle of Nutramigen and gently pressed it against her lips. To my surprise, and relief, she began to suck. Result! She managed 2oz before she fully woke and refused any more. I then breastfeed her to finish off her feed and she gently dozed back off. I was so happy to find something that worked. Unfortunately, as I have mentioned before,  Matilda had a reaction to the Nutramigen, which apparently is very rare and we had to move onto Neocate, an Amino Acid based formula. (For more information on formula options for babies with CMPA see my page Bottle Feeding Dairy Free: Formula Options)

The new formula still had a slight smell but it was nothing compared to the Nutramigen. I decided to keep with the dream feeding tactic and within a couple of days Matilda was happily taking her bottles while she was awake without any ill effects. I continued to combination feed until we were both ready to fully stop breastfeeding. She now is completely bottle fed, happy, healthy and meeting above and beyond her milestones.




Friday, 25 January 2019

The End of Dairy Free Breastfeeding: My Experience

Breastfeeding is a wonderful thing to do if you can, for yourself and for your child. But lets face it, it can be hard. I was completely unsuccessful first time round with my son, who ended up being exclusively expressed breastfed. I remember the guilt I felt that it hadn't worked. The middle of the night crying sessions because he just wouldn't latch or from the stinging pain from mastitis when he did manage to. I remember thinking how can something so natural be so hard to do. So I didn't expect it to work with Matilda either. I was shocked and amazed at how easily breastfeeding came second time around. Maybe it was because I didn't put as much pressure on myself, or set myself too high an expectation, as I knew I could express breastfeed again if I needed to. Anyway, it worked and I couldn't have been more pleased.

Then, very quickly we discovered Matilda was allergic to cows milk protein and thus began our dairy free breastfeeding journey. To read more about my experience of dairy free breastfeeding, click here.

One of the main reasons I decided to dairy free breast feed, on top of the usual benefits of breastfeeding, was because it gave me a sense of control and also the reassurance that so long as I stayed cautious and did not ingest any dairy, Matilda would be a perfectly healthy baby. This was a very comforting thought. I did not have to worry about trusting anyone else for my daughters safety and wellbeing.

The second reason I choose to dairy free breastfeed was that if Matilda could not have the usual standard formula, what would she be putting into her body? I wasn't aware of my options at this point and I hated the idea of her having something over processed or synthetic at such an early age.

So I breastfeed happily for just short of 6 months. But it was challenging, my three year old really struggled with the amount of time it took, becoming extremely jealous every time she fed, and juggling two young children was difficult. I remember being at the park with my friend and her young children when Matilda needed fed. I got myself comfy and watched happily as my son slide down the slide, shrieking with excitement. This is perfect...or so I thought! I was awoken from my blissful illusion by my three year old shrieking 'Mummy I need a poo!' At this moment, I have to point out it had been five days since his last bowel movement as he had suddenly developed a fear of them and would not go to the toilet. I couldn't believe his timing. My friend was a superhero that day, she whisked out a portable potty from under her pushchair and set it up for me. He quickly moved the potty to where he was most comfortable and sat down to do his business. Unfortunately, where he decided he would be most comfortable was at the bottom of the slide. In a very busy park! Great. I knew he would be there for sometime, so I sat myself down on the muddy, hard floor of the park next to him, Matilda still attached to my breast while they both saw to their basic needs. I looked up at my friend and we both laughed. You just could not write this stuff. The glamourous life of being a mother.

We were also about to embark on an exciting trip to Italy for my Mum's 60th Birthday. I had dreamed about going to Italy since I was a young girl and I was really looking forward to it. I knew it probably would have been easier to continue breastfeeding whilst travelling, all you need to take with you is your breasts after all, but I was really concerned that I would not be able to guarantee what I was eating was dairy free. I was, after all, going to the land of pizza, fresh pasta and gelato.

So I discussed the  breastfeeding challenges I was facing with my Health Visitor and decided to see my GP about the formula options for children with a cows milk protein allergy. (For more information about formula options click here). My doctor wrote me a prescription for Nutramigen and I collected it from my local pharmacy and took it home.

The Nutramigen sat in a cupboard in our kitchen for ages. I was still deciding. I would have endless conversations with my husband about whether it was the right decision. What if I stop breastfeeding and she has an allergic reaction? Once my milk is gone it would be so difficult and painful to get back, or so my Health Visitor informed me. Was I being a selfish, bad mother for not continuing? It weighed heavy on my mind night after night.

In the end, I decided I would go ahead and try combination feeding. That way Matilda could have a couple of bottles in the middle of the day, when I was out and about (I didn't want any pooing in the park repeats!) and I could breastfeed her the rest of the time. This also meant that I could give Matilda formula while we were away in Italy and just 'pump and dump,' while we were there to keep my supply going and protect against any unintentional ingested milk incodents. Unfortunately, the Nutramigen did not agree with Matilda and her symptoms came back immediately. Which since, I have found out is very uncommon. So we were moved on to Neocate LCP which agreed with her much better and happily began our combination feeding journey.

However, my joy at finding what felt like the perfect combination for us, didn't last long. Although lots of people have success using combination feeding, my body did not respond well to it and I noticed my milk supply was dwindling. Matilda was getting frustrated while breastfeeding and would be on and off me like a yo yo all night. Feeling comforted about the fact Matilda was responding well to the Neocate and that my son was feeling more included and enjoyed feeding her a bottle, I decided, after a few more nights of debating with my husband, it was time to end my dairy free breastfeeding journey.

I was sad about it ending and there are times when I do miss it, but when I look at Matilda happy and healthy and look at my son finally enjoying having a baby sister, I know I made the right decision for our family at the time.

Only you can decide when to stop dairy free breastfeeding. You may feel sad and you will worry, but you are not a bad mother because of it. Do what is best for you and your family. We will not judge you what ever you decide.


Wednesday, 23 January 2019

Hope for the Future Treatment of Food Allergies

Earlier this week, I shared an article on my Instagram page from The Independent online, that highlights a medical study by Italian and US doctors around gut bacteria and its role in the treatment and prevention of allergies.

The article, titled 'Gut Bacteria transplant shown to prevent deadly allergic reaction, giving hope to future treatment,' states that the research has shown how levels of single-celled microbes in the gut play an imperative role in the development of food allergies. Their research has shown how transplanting gut bacteria into a subject can prevent severe reactions such as an anaphylaxis response to an allergen such as cow's milk protein. They believe their data is 'paving the way for innovative interventions for prevention and treatment of food allergy.'

As a mum of a child with a cows' milk protein allergy, this is the kind of thing I want to read about. Like any mum, I would happily swap places with Matilda to prevent her any suffering. Although the article is an overall positive read, there are many questions it raises. Will it just prevent an anaphylaxis reaction or all types of reactions? What would a gut bacteria transplant physically involve? And what is it's success rate?

The article states it is giving hope, let us hope it does not turn out to be false hope.

The read the article yourself and make up your own mind, click here

What are the Safest Childcare Options for an Allergy Baby?

In three short weeks, my maternity leave will come to an end and I will have to leave Matilda for  four days a week when I return to work. E...