I made it through 12 weeks of dietetics placement – and well done to everyone else who has been on a work placement or internship this summer! That first taste of adult life and not having a huge uni summer stretching ahead of you is tough! But I have thoroughly enjoyed this summer, and it has been a big learning curve.
Working in such a wide range of dietetic specialities has given me the opportunity to see a variety of patients, from infants to teenagers, working-age and elderly adults. I think the area which I have progressed in the most is paediatrics – I wasn’t very confident about working with children initially. It’s such a varied area – I could be seeing new-borns all the way through to 18-year-olds. One of the main reasons for referral that I came across in paediatrics was cow’s milk allergy, which I have written a little bit about below.
Cow’s milk allergy
According to Allergy UK 2-3% of 1-3 year olds are diagnosed with cow’s milk allergy in the UK. It occurs when the immune system reacts to the protein in cow’s milk causing either an immediate reaction, or a delayed-onset reaction. The infants that we saw in clinic usually experienced a delayed-onset reaction, where symptoms tend to emerge after a few hours, days or weeks. Many of the babies show symptoms of vomiting, reflux, diarrhoea or constipation, tummy pains, eczema or rashes, among others.
The only way to check for sure that the above symptoms are caused by a cow’s milk allergy is to exclude all cow’s milk and dairy from the baby’s diet and see if the symptoms improve.
Babies with a confirmed cow’s milk allergy must follow a completely dairy free diet. This means using a specialised infant formula or, if the babies are breastfed, the mothers must also exclude dairy as proteins from the cow’s milk can pass through the breast milk and continue to cause symptoms. However, we then work with mothers to ensure that their diets are nutritionally adequate, particularly providing enough calcium.
We also explain to parents that children often grow out of a cow’s milk allergy, so in the future we would work with them to slowly reintroduce dairy back into their child’s diet to see if they are still allergic.
** (Lactose intolerance is different to cow’s milk allergy. Lactose is the sugar present in cow’s milk and our bodies use an enzyme called lactase to break this complicated sugar down so that it can absorbed. Some people have lower levels of lactase, but the levels of lactase fall gradually and naturally as we get older and drink less milk than when we were babies. If people have particularly low levels of lactase they find it difficult to digest the lactose in milk so can start developing symptoms such as diarrhoea, bloating, stomach pain and wind. However, lactose intolerance more commonly occurs in older children or adults – very rarely in infants.) **
For more info on any of the above, I have included a couple of resources below. Always remember to visit your GP or a dietitian for any dietary advice.
BDA Food Facts sheet on ‘Suitable milks for children with cow’s milk allergy’ – https://www.bda.uk.com/foodfacts/CowsMilkAllergyChildren.pdf