I am teaching our local GPVTS trainees this week on faltering growth, food allergy and coeliac disease. As usual, I have learnt more from preparing their presentation than they are going to learn in the hour it will take me to present it! I have found a great GP training website set up by a GP in the north of the UK with similar altruistic aims to me. Have a look at what he has to say on faltering growth at http://www.gp-training.net/training/tutorials/clinical/paediatrics/pgrowth2.htm.
I have put together an algorithm for managing cows’ milk protein allergy and a table on various different infant formulas which you are welcome to download or comment on.
I used to work in Poole Hospital, Dorset and was pleased to find this patient information leaflet from the dieticians there on tips for families where a child is refusing to eat: http://www.poole.nhs.uk/documents/leaflets/nutrition/My%20Child%20Wont%20Eat.pdf. It is based on the leaflet “Help, my child won’t eat” which is put together by the Paediatric Group of the British Dietetic Association but not obviously available on-line.
This is a link to a recipe book of suitable stage 2 and 3 weaning foods for infants and young children with CMPA: http://www.allergyuk.org/downloads/news-and-media/cows-milk-protein-resources/Aptamil_Recipe_Booklet.pdf. Some of the meals look a bit grown up for the average 10 monther but presumably one can puree it all down if necessary.
Also on CMPA, this is the link to the Royal London’s home cows milk food challenge: http://www.paediatricpearls.co.uk/wp-content/uploads/Home-challenge-delayed-milk-allergy.doc. Be careful because a small number of non-IgE mediated CMPA children can progress on to IgE mediated CMPA. They are unlikely to have a full blown anaphylactic reaction at home but may get enough urticaria and swelling to significantly worry the family. If in doubt, refer to a dietician or paediatrician.
2012 Medical position paper from ESPGHAN on CMPA at http://espghan.med.up.pt/position_papers/Diagnostic_Approach_and_Management_of_Cow_s_Milk.28.pdf