When Elfin was born she was perfect. Within three short weeks her poor little face was covered in awful pustules and her skin was as terrible as a teenage boy’s. I never questioned whether it was milk spots (also known as baby acne) or a more serious milk rash allergy, such as CMPA, assuming the latter out of ignorance. It’s easy to question whether your infant has baby acne, milk spots, or milk rash – and what’s the difference between them? Are your baby’s spots harmless, or a more serious allergy reaction rash? Thankfully and by complete fluke, a consultant diagnosed Elfin soon after: she had a classic CMPA rash, also known as cow’s milk protein allergy or milk rash – I was breastfeeding and she was reacting to the dairy in my breastmilk.
It broke my heart and made me want to weep.
What Is Newborn Milk Rash?
I never vocalised the extent to which it upset me that my beautiful baby’s face was blemished with hideous acne, because I was her mother and if I wasn’t going to advocate for her then who would?
But it did bother me a great deal; partly for fear that she was suffering discomfort or even pain, and – admittedly shallow – I couldn’t bear the thought that people may consider my adorable tiny baby’s skin unsightly.
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Milk Spots (or Baby Acne) vs Milk Rash/CMPA Rash
If you’re reading now then chances are your baby is displaying a similar milk rash. So let me start off by saying that baby acne certainly does exist – my first daughter had it – but it’s not on the same scale as the angry spotty rash exhibited in CMPA babies. So how can you be sure which it is?
What Does CMPA/Milk Rash Look Like? Does My Infant Have Cow’s Milk Protein Allergy?
If you suspect your infant may be suffering from CMPA, you’ll be curious to see an example for comparison. I didn’t take many photos of my baby at this time, but the following one is quite a good representation of her skin problems.
What is Milk Allergy Rash / What is CMPA?
CMPA is an allergy – not an intolerance – which is where the body detects a substance it thinks is a threat (in this case cow’s milk protein), triggering an abnormal response by the immune (defence) system.
N.B. If your baby is allergic to cow’s milk protein there’s a significant possibility that they will also react to soya, with studies suggesting than more than 10% are affected.
How Common is CMPA?
CMPA affects 2 – 3% of babies, but it’s far more uncommon in breastfed babies, affecting only around 0.5% through breastmilk.
What Is Milk Rash: Pictures
Following are a series of images showing the difference between baby acne and CMPA rash in babies:
Below I’ve also put together a checklist of all the different symptoms to be alert for and help you determine the cause:
What Symptoms Does a Milk Allergy / CMPA Cause?
CMPA and other allergies produce four sets of reactions, and depending on the type and severity, your baby may present with a combination or all of the symptoms.
- Contact Dermatitis
- Rashes including hives
- Swelling of the eyes and/or lips, or possibly the whole face
- Excessive pain
- Reflux / silent reflux
- Stomach pain
- Distended stomach
- Mucousy or bloody stools
- Persistent runny nose and/or eyes
- Poor sleep
- Cannot be soothed when in pain
- Slow weight gain in some cases
How Serious is CMPA?
In rare and extremely severe cases anaphylaxis may occur which can be life threatening and should be treated as a medical emergency.
How Can I Confirm a Milk Allergy / CMPA in My Baby?
Unfortunately, the only way to be certain is through eliminating the allergen and seeing the symptoms disappear.
The proteins take three weeks to be eliminated from your baby’s system, and if you’re breastfeeding, an additional three weeks to be eliminated from yours. This means you’ll need to be dairy (and soya) free for six weeks to get a true indication as to whether your baby’s symptoms will improve on the elimination diet.
There are two types of food allergy, and while tests do exist, they only give a positive diagnosis for IgE allergies. Non-IgE allergies would return a false negative result, and therefore the tests are rendered unreliable. My daughter would have tested negative, yet she responded to an elimination diet.
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Confirmed Milk Rash / Allergy / CMPA Rash Diagnosis – What Next?
If you suspect your baby is suffering from CMPA or another allergy, it’s important to identify the allergen/s and remove them from your baby’s milk. If you’re breastfeeding, the very best thing you can do for your baby is to continue breastfeeding (this is advice I received from a consultant at point of diagnosis), which will mean big changes to your diet.
It’s daunting but it’s more than possible. I recommend following Dilan and Me for advice and guidance.
Regardless of whether your baby is breast or formula fed, I highly recommend visiting your GP for support – though sadly many simply do not have up to date training. It’s likely to be that you may struggle to find the help you need and online resources will become invaluable. Dilan and Me also runs a fantastic support group on Facebook which has been a bit of a lifeline to me.
They even share a list of treats which is updated on an ongoing basis!
This essentially means that despite cutting allergen/s such as dairy and soya from your diet, you won’t have to miss out on your favourite foods – you simply need to educate yourself on where to buy the best chocolate and ice cream! This list will help you with that.
Confirmed CMPA – Where Do I Go From Here?
Once the milk rash / CMPA rash (or other symptoms) are confirmed as being due to an allergy, you have a long road ahead of you whichever route you choose. Often, babies outgrow their allergies, but the only way to be certain is through trialling the allergens at various intervals, known as ‘challenges’ – and it’s recommended to do this with the support of a dietitian. It’s absolutely worth persisting for a referral to a consultant for diagnosis and a dietitian for assistance with managing your / your baby’s diet.
In the meantime, there is a lot of help available on the internet, but naturally this should not take the place of a qualified doctor’s advice.
I hope you’ve found this introduction to allergies in babies helpful with regards to baby acne vs milk allergy, and determining whether your infant is displaying a milk rash / CMPA rash. If so, please consider sharing!
For more breastfeeding posts, head over to Breastfeeding – Help, Advice, Support.