Transitioning from Breast Milk to Formula: Managing Vomiting and Rashes

Switching from breast milk to formula can lead to vomiting, rashes, and coughing?

Hello Doctor, my son is about to turn 1 year old.
Since he was two months old and had enough breast milk, he has been exclusively breastfed until now.
Due to insufficient milk supply, I want to switch to formula, but I've encountered some difficulties.
The first time he tried Meiji formula, he vomited it all after drinking half (40cc).
The second time, I switched to Mead Johnson formula, which he had from birth, and he finished it quickly (150cc), but shortly after, he had projectile vomiting, and then developed red rashes on his face, eyelids, and chest, along with persistent coughing.
These symptoms took a while to resolve.
Previously, he also had a similar reaction to yogurt, with rashes around his mouth and coughing.
Should I reduce the amount of formula to help him adjust (today I gave him one spoonful, and if that goes well, I’ll give him two spoonfuls tomorrow), or should I continue to switch formulas? Or since he is about to turn 1, can he just eat three meals a day without drinking milk? Thank you, Doctor, for taking the time to respond.

Chen Mama, 0~9 year old female. Ask Date: 2021/03/30

Dr. Xiao Kaiwen reply Pediatrics

Breastfeeding is recommended to continue until the age of two.
In fact, once a child turns one, they can start eating regular meals that are chopped or mashed from the family table, while dairy products become more of a supplementary food rather than a necessity.
There is no strict requirement on how much milk they should drink.
If there is a suspicion of a formula allergy, since an infant's immune system continues to develop, it is advisable to try a small amount again after three weeks.
Sometimes, they may not have an allergic reaction at that time (the ingredients in different brands of formula are quite similar, so the likelihood of having an allergy to the ingredients is not significantly different).

Reply Date: 2021/03/30

More Info

Transitioning from breast milk to formula can be a challenging process, especially if your child has experienced adverse reactions such as vomiting and rashes. Based on the symptoms you've described, it seems that your son may be experiencing some form of intolerance or allergy to the formula or dairy products. Here’s a comprehensive approach to managing this transition while considering his health and nutritional needs.

Understanding Reactions to Formula
1. Vomiting and Rashes: The symptoms of vomiting and skin rashes, especially after consuming formula or yogurt, could indicate a milk protein allergy or lactose intolerance. Milk protein allergy is an immune response to the proteins found in cow's milk, while lactose intolerance is the inability to digest lactose, the sugar found in milk. Given that your son has had reactions to both formula and yogurt, it is crucial to consult with a pediatrician or an allergist for proper evaluation.

2. Types of Formula: If your son is allergic to cow's milk protein, you might want to consider hypoallergenic formulas, which are designed for infants with such allergies. These formulas contain extensively hydrolyzed proteins, making them easier to digest and less likely to trigger an allergic reaction. Alternatively, there are also soy-based formulas, but some children allergic to cow's milk may also react to soy.

Transitioning Strategies
1. Gradual Introduction: If you decide to continue with formula, a gradual introduction can help your son adjust. Start with small amounts, as you mentioned, and monitor for any adverse reactions. If he tolerates a small amount well, you can slowly increase the quantity. However, if he continues to have symptoms, it may be best to discontinue that formula and consult a healthcare professional.

2. Dietary Alternatives: At nearly one year old, your son can start to consume a variety of solid foods. While milk is an important source of calcium and vitamin D, it is not the only source. You can introduce other calcium-rich foods such as leafy greens, fortified cereals, and fish. If he is not tolerating formula, you might consider offering fortified plant-based milk alternatives (like almond or oat milk) that are suitable for his age, but ensure they are fortified with calcium and vitamins.

3. Consulting a Pediatrician: Given the symptoms you've described, it's essential to consult with your pediatrician. They may recommend allergy testing to determine if your son has a milk protein allergy or lactose intolerance. Based on the results, they can guide you on the best formula or dietary alternatives for your child.

4. Monitoring Symptoms: Keep a food diary to track what your son eats and any symptoms that arise. This can help identify specific triggers and provide valuable information to your healthcare provider.

Conclusion
Transitioning from breast milk to formula is a significant step in your child's development, but it should be done carefully, especially if there are signs of intolerance or allergy. Gradual introduction, exploring alternative formulas, and consulting with healthcare professionals are key steps in ensuring a smooth transition. Remember, every child is different, and what works for one may not work for another. Your pediatrician will be your best resource in navigating this process and ensuring your son receives the nutrition he needs without adverse effects.

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