Frequently Asked Questions

A referral to a Paediatric Gastroenterologist may be required for cases of persistent symptoms of lactose intolerance in infants and young children. The following tests may be used to diagnose of lactose intolerance:

A trial of a lactose-free diet

When lactose intolerance is suspected, a lactose-free diet can be tried. During a diagnostic lactose-free diet, it is important that all sources of lactose be eliminated, requiring the reading of food labels to identify “hidden” sources of lactose. Generally, a 2-week trial of a strict lactose-free diet with resolution of symptoms and subsequent reintroduction of dairy foods with recurrence of symptoms can be diagnostic.¹

Many lactose containing foods are rich in calcium and Vitamin D, important nutrients for infants, thus an elimination diet should always be performed for a specified period, under strict medical supervision and preferably in consultation with a Paediatric Dietitian.

Stool acidity test

This test measures the amount of acid in the stool.  Undigested lactose fermented by colon bacteria creates lactic acid and other short-chain fatty acids that can be detected in a stool sample.¹ Fecal pH will normally be lower (5.0–5.5) in infants compared with older children and adolescents due to relative enzyme inadequacy in relation to the high amount of lactose in breastmilk.¹

Hydrogen Breath Test
Measures the presence of hydrogen in the expired air. Hydrogen is produced when lactose is fermented in the colon and diffuses into the blood stream and is expired through the lungs. This test is simple, inexpensive and non-invasive but is not specific to lactose since any unabsorbed carbohydrates can cause hydrogen production.¹ Antibiotic use within one month of the test may modify the gut flora and produce false negative results.¹

Removal or reduction of lactose containing foods is advised for the management of lactose intolerance, while ensuring an adequate nutritional intake.¹ Unless there is evidence of secondary lactase deficiency, most infants with cows’ milk protein allergy can tolerate lactose.⁵

Fully breastfed infants
Breastmilk is best for babies and infants with lactose intolerance, breastfeeding should be continued if possible.² In infants with congenital lactase deficiency, breastmilk or lactose-containing formula may cause persistent diarrhea and failure to thrive.² Consultation with a healthcare professional is recommended to determine if a lactose-free formula is an appropriate alternative for infants with congenital lactase deficiency.²

Partially breastfed infants
Lactose intolerant infants who are partially breastfed and partially bottle fed may benefit from smaller more frequent breastfeeds during the period of lactose intolerance in order to manage the lactose load. Partially formula fed infants may benefit from the use of a lactose free cows’ milk based formula. Infants who are partially breast and partially formula fed should be breastfed before the formula feed to protect the supply of breastmilk.

Formula fed infants
Formula fed infants with confirmed lactose intolerance may benefit from the use of a lactose free cows’ milk based formula.

Feeding solids to infants and young children
During periods of lactose intolerance, the provision of lactose containing foods should be avoided or minimised. Many lactose containing foods are rich in calcium and Vitamin D, important nutrients for infants, thus an elimination diet should always be performed for a specified period, under strict medical supervision and preferably in consultation with a Paediatric Dietitian.

Newborn infants need short frequent feeds and will typically feed every 2 to 3 hours (8–12 times per 24 hours) in the early stages. This is because breast milk is easily digested to meet a baby’s continuous demands for brain and body growth and the newborn infant’s stomach is small.

An infant will be getting enough milk if they:

• Have 6–8 wet cloth nappies or 5–6 disposable nappies per 24 hours.
• Have soft bowel motions.
• Generally settle after most feeds.
• Have bright eyes and good skin tone.
• Are gaining weight appropriate to age.

If an infant sleeps for long periods in the day it is important to wake them to feed. All infants have individual needs and a mother’s breast milk adjusts to an infant’s needs.

As breast feeding research continues breast feeding practices may change. The current recommendation is to feed a baby from one breast completely first and then offer the second breast. However, some babies will always take both breasts, some will sometimes take both, and others will only take one breast per feed. This is all normal in breast feeding and may in part be due to the individual storage capacity and production of the mother child dyad/bonding.18

It is much safer to prepare bottles of infant formula at the destination, rather than transporting bottles of prepared formula.

There are a number of special containers available designed to carry single serves of infant formula. It is also recommended to take one or more separate sterilised bottles of cooled boiled water at the correct volume, so the formula can be prepared at the destination. Alternatively, single-serve sachets of infant formula powder are available. Manufacturer’s instructions should always be checked before use.2

Ready-made bottles of prepared formula can be a breeding ground for bacteria if the bottles have been sitting in a car or baby bag for several hours, especially on a warm day. Because of the potential for growth of harmful bacteria during transport, feeds should first be cooled to less than 5°C in a refrigerator and then transported.2

• Prepare the feed and put in the refrigerator.
• Ensure feed is cold before transporting.
• Do not remove feed from the refrigerator until immediately before transporting.
• Transport feed in a cool bag with ice packs.
• Use feeds transported in a cool bag within 2 hours, as most cool bags do not always keep foods adequately chilled.
• Re-warm at the destination (for no more than 15 minutes).
• If the destination is reached within 2 hours, feeds transported in a cool bag can be placed in a refrigerator and held for up to 24 hours from the time of preparation.

Ensure investigation based diagnostic tests are done to confirm GERD before prescribing medication such as acid inhibitors as they can increase the risk of developing allergies.^10,11

Consider a cows’ milk protein allergy, because 92% of infants with CMPA suffer from 2 symptoms or more.^32,33 These symptoms include:

• Dermatological, up to 90% of CMPA infants will have atopic dermatitis, eczema, urticaria and rashes
• Respiratory, up to 30% of CMPA infants will have wheezing, chronic coughing, respiratory distress and runny nose
• Gastrointestinal, up to 60% of CMPA infants will have diarrhea, constipation, vomiting, frequent regurgitation and blood or mucous in the stools

Download a detailed diagnostic algorithm.    

No, food allergy or more widely known as ‘food hypersensitivity’ is an immune response whereas food intolerance does not involve the immune system.^3,5

Allergies are an overreaction of the body’s immune system to a normally harmless substance as if it were toxic. Such substances, known as allergens, may include certain foods, pollens, house dust, animal hair or moulds. Food intolerances describe non-immunological effects including direct pharmacologic effects of chemicals in food or metabolic defects such as lactase deficiency.

It can be hard to tell the difference between symptoms of food allergy and intolerance. Generally, in sufferers with what is known as IgE mediated allergy, symptoms usually appear fairly rapidly within first consumption of the food (from immediate to less than 1 hour) and usually involve the skin, respiratory and/or gastrointestinal systems.³

Signs or symptoms include:

• Swelling of the face, eyes, tongue or throat
• Itching
• Acute hives
• Vomiting
• Diarrhoea
• Breathing difficulties or, in severe cases, anaphylaxis.³

Food intolerance reactions are usually related to the amount and frequency of the food consumed. Symptoms may not occur until a certain threshold level of the food is consumed.¹

It has been demonstrated that mothers can produce adequate breast milk for their babies, even under sub-optimal conditions. However, breast feeding mothers do have a slightly increased requirement for most nutrients compared to mothers who do not breast feed as many vitamins and minerals in a breast feeding mother’s diet are transferred into the breast milk. Therefore, it is important for the mother to be encouraged to eat adequately to meet her own nutritional needs and to provide nutrition to the infant.

A breast feeding mother should eat regular nutritious meals and snacks to meet the extra energy requirement (approximately 500 calories/day or 2000–2100kJ/day). Consuming a variety of foods each day is important in meeting both the mother’s and infant’s nutritional needs.

It is important a breast feeding mother consumes a wide variety of nutritious food, such as:11

• Vegetables, legumes and fruits.
• Cereals (including breads, rice, pasta and noodles), preferably wholegrain.
• Lean meat, fish, poultry and/or alternatives. 
• Milks, yoghurts, cheeses and/or alternatives. Reduced fat varieties should be chosen where possible.
• Fluids, especially water.

It is also recommended when following a healthy balanced diet to:11

• Limit saturated fat intake, choose lean meat and unsaturated fat spreads, such as olive/safflower/ sunflower oil-based spreads.
• Choose unsaturated fats that are found in foods such as avocado, nuts and seeds, and olive and sunflower oils.
• Limit high salt foods, such as processed meats, potato chips and adding salt to meals.
• Avoid alcohol consumption, particularly in the first month after the infant is born until breast feeding is well-established.
• Limit intake of sugars and foods containing added sugars, such as high sugar breakfast cereals, lollies or sweets, cakes, biscuits and fizzy drinks.

Other nutrients of particular concern during breast feeding are:

Protein

A breast feeding mother requires additional dietary protein to ensure there is adequate amount of protein in her breast milk. While the mean protein intakes in both Australia and New Zealand demonstrate that protein intake in childbearing women appearssufficient to meet the additional requirements of pregnancy and breast feeding,11 evaluation of protein requirements should be made on an individual basis. Protein is vital for the growth, maintenance and repair of cells. The Recommended Daily Intake (RDI) for protein for breast feeding mothers is 67g/day (1.1g/kg of body weight).10

Protein is found in a wide range of foods such as meat (including fish and poultry), eggs, dairy, legumes (such as beans, pulses and soy products) and nuts. Smaller amounts of protein are found in grain-based foods such as bread and pasta.

Folate

Folate is a B vitamin needed for healthy growth and development.

The RDI for folate for breast feeding mothers is 500μg/day.10

Folate can be found in leafy vegetables, wholegrains, peas, nuts, avocado and yeast extract spreads (e.g. Promite,® Vegemite,® Marmite®).

Iodine

Iodine is an essential mineral needed for the production of the thyroid hormone which helps in brain and nervous system development.

The RDI for iodine for breast feeding mothers is 270μg/day.10

The NHMRC Australia12 and the New Zealand MOH13 both recommend all healthy pregnant and breast feeding mothers take an iodine supplement of 150μg each day.

Iodine can be found in seafood, milk, iodised salt and vegetables.

Supplements containing seaweed or kelp are not recommended for breast feeding women due to the variability in iodine content and quality.

Zinc

Zinc is a component of various enzymes that help maintain structural integrity of proteins and help regulate gene expression.

The RDI for zinc for breast feeding mothers is 12mg/day.10 Zinc can be found in lean meat, wholegrain cereals, milk, seafood, legumes and nuts.

Vitamin A/Beta-carotene

Vitamin A is vital for normal growth. Vitamin A helps provide resistance to infections.14

The RDI for Vitamin A for breast feeding mothers is 1,100μg/day.10

Vitamin A can be found in milk, cheese, eggs, fatty fish, and organ meats.

Beta-carotene, which enables the body to manufacture vitamin A, can be found in yellow-orange vegetables such as carrots and pumpkin, fruits such as mangoes and apricots and in other vegetables such as spinach and broccoli.

Vitamin B6

Vitamin B6 is important for the metabolism of protein and the formation of red blood cells.

The RDI for breast feeding mothers is 2mg/day.10

Vitamin B6 can be found in meat, poultry, fish, whole grains, brussel sprouts, green peas and beans.

Omega-3

Long-Chain Polyunsaturated Fatty Acids (LCPUFAs) consumed and accumulated in early pregnancy by the breast feeding mother provide a significant addition of LCPUFAs in the breast milk and subsequently the breast feeding babies diet.

The recommendation for Omega-3 for breast feeding is 145mg/day.10

Foods rich in Omega-3 are oily fish, green leafy vegetables, nuts and seeds and some plant oils (soybean, canola, flaxseed and walnut oils).

Water/Fluids

Breast feeding mothers should drink an average of 9 cups of fluid daily10 with the majority coming from water. Fluid intake can be a combination of water, milk, juice and other drinks.

It may be helpful for the breast feeding mother to drink after each breast feed, as well as drinking regularly throughout other times of the day.

Breast milk is best for infants. Considerable advances have occurred in recent years in the scientific knowledge of the benefits of breast milk and in understanding the mechanisms underlying these benefits. 1

Breast feeding is the biological norm for infant feeding and is a traditional practice in most cultures. It is the unequalled way of providing ideal food for the healthy growth and development of infants and toddlers. Breast milk is safe and clean and contains many functional components, including live cells and antibodies, which help to protect the infant against many common childhood illnesses.

Breast feeding forms a unique biological and emotional basis for the health of both mother and child and plays an important and central role in protecting the health of the infant and promoting physical, neurological and emotional development in the short and long term.2,3 These long-term protective effects appear to be related to the duration and type of breast feeding.4

There are numerous benefits of breast milk and breast feeding some of which include:

• Breast feeding provides the optimal nutrition for an infant and contains all the nutrients an infant needs.
• Breast feeding protects the infant from illness and infection.
• Research in developed countries provides strong evidence that breast milk decreases the incidence and/or severity of a wide range of infectious diseases including bacterial meningitis, bacteremia, diarrhoea, respiratory tract infection, necrotizing enterocolitis, and urinary tract infection.1
• It is completely natural, is always at the right temperature and is readily available.
• It is readily digested and absorbed.5
• It provides immunity factors and helps activate an infant’s developing immune system (both passive and active immunity).5
• Breast milk varies in composition over the lactation period and during a single feed to meet an infant’s individual and varying appetite and thirst.6

Breast milk provides the optimal nutrition for infants in their first 6 months of life.

Important health benefits of breast feeding and lactation have been described for mothers, these include:

• Decreases postpartum bleeding.1
• Encourages contraction of the uterus after birth.6
• Breast feeding may help the mother to return to her pre-pregnancy weight.1
• Breast feeding is associated with a reduced risk of developing pre-menopausal breast cancer and ovarian cancer.1
• Breast feeding may reduce the risk of osteoporosis and hip fracture later in life.1
• A baby sucks at a mother’s breast for comfort and, of course, for milk. Milk “let-down” is a reflex response to the suckling and kneading of the nipple (and sometimes in response to the sight, smell, and sound of the baby).
• It is ultimately affected by the secretion of oxytocin, a hormone secreted by the pituitary gland.7
• Breast milk is readily available at the exact temperature and does not need time to prepare.
• History of lactation is associated with a reduced risk of type 2 diabetes.8,9

Breast milk provides the optimal nutrition for infants in their first 6 months of life and in addition to complementary foods thereafter.

There are a number of safe ways to sterilise infant feeding equipment. The bottles, teats and collars should always be cleaned first to ensure no traces of milk or milk residue remain.

Steam: Electric steamers sterilise bottles in 8–12 minutes. They leave no unpleasant smell or taste but are not suitable for all equipment (i.e. breast pumps). It is important to ensure the openings of the bottles and teats are facing downwards in the steriliser and that the manufacturer’s instructions are followed.

Microwave: Steam sterilising units create steam in the microwave which sterilises bottles and teats in 8–10 minutes. It is important to follow the manufacturer’s instructions, especially concerning the correct amount of water to use. This method is not suitable for glass bottles, as glass retains heat and can become extremely hot in the time it takes to sterilise. Teats should be placed upright not laid flat, as this allows the steam to circulate to all areas of the teat.

Boiling: To sterilise a bottle by boiling, completely submerge all the feeding equipment in boiling water for 5 minutes. The water should cool before taking the equipment out and then shake off excess water.

Coldwater: Using an approved sterilisation tablet (prepare the sterilising solution according to the manufacturer’s instruction) takes about 30 minutes and is highly effective: it can touch the skin with no ill-effects. The solution should be made up in a large glass or plastic container. It is important that the bottles and teats are fully submerged in the container (no air gaps). The bottles can stay sterilised in the water for up to 24 hours.

There are a number of safe ways to sterilise infant’s feeding equipment. The bottles, teats and collars should always be cleaned first to ensure no traces of milk or milk residue remain.

Steam

Electric steamers sterilise bottles in 8–12 minutes. They leave no unpleasant smell or taste but are not suitable for all equipment (i.e. breast pumps). It is important to ensure the openings of the bottles and teats are facing downwards in the steriliser and that the manufacturer’s instructions are followed.

Microwave

Steam sterilising units create steam in the microwave which sterilises bottles and teats in 8–10 minutes. It is important to follow the manufacturer’s instructions, especially concerning the correct amount of water
to use.

This method is not suitable for glass bottles, as glass retains heat and can become extremely hot in the time it takes to sterilise. Teats should be placed upright not laid flat, as this allows the steam to circulate to all areas of the teat.

Boiling

To sterilise a bottle by boiling, completely submerge all the feeding equipment in boiling water for 5 minutes.

The water should cool before taking the equipment out and then shake off excess water. Cold water Using an approved sterilisation tablet takes about 30 minutes and is highly safe and effective.

It is important to prepare the sterilising solution according to the manufacturer’s instructions.

The solution should be made up in a large glass or plastic container.

It is important that the bottles and teats are fully submerged in the container (no air gaps).

The bottles can stay sterilised in the water for up to 24 hours.

Do not thaw or warm expressed breast milk in the microwave as this destroys the living cells in the milk.

Once breast feeding is well established (usually 4–6 weeks), there may be times where a mother may need or want to express breast milk.

Expressing milk by hand

Before expressing milk, the mother may find that softening her breasts beforehand will help with hand expression. This can be done by applying a warm face cloth, taking a shower or massaging them. The mother’s hands must be cleaned, and a sterilised, wide rimmed bowl is required to collect the milk.

By supporting the breast with one hand then massage down from the top of the breast to the nipple. Work all round it including the underside. Then put gentle pressure on the area behind the areola (the dark skin around your nipples) with the thumb and forefinger.

By squeezing them together and pressing backwards milk should be released. It is important to be aware that the milk can spray in lots of directions.

Expressing milk by manual or electric pump

Using a pump can be quicker and less tiring than using hands. The mother may find that softening her breasts beforehand will help with hand expression. This can be done by applying a warm face cloth, taking a shower or massaging them. The pump should be thoroughly sterilised before expressing. Depending on the pump used, it should take 20–45 minutes and should not cause any pain. It is important to read and follow the manufacturer’s instructions and ensure that the nipple is properly fitted, or expressing can be ineffective and cause damage.

Similar to other food intolerances, the onset and severity of lactose intolerance symptoms is related to dose, frequency of lactose ingested and the individual’s capacity to digest it.¹ Clinical symptoms may appear between 1-3 hours after consumption, however, this has been reported to be highly variable among individuals.⁵

The most common symptoms of lactose intolerance include:

• Stomach pain and cramps
• Flatulence
• Bloating
• Diarrhoea
• Nausea
• Vomiting¹

While a severe allergic reaction is not common in those who are lactose intolerant, eating dairy products is enough to cause pain and discomfort throughout the digestive system. A child that has a negative reaction to eating or drinking milk and dairy products should be tested for a lactose intolerance.

Lactose intolerance results from lactose malabsorption and is primarily due to alactasia (total absence of lactase activity) or hypolactasia (low lactase activity).¹ Lactose intolerance is diagnosed when there is a symptomatic response produced in response to substantial lactose malabsorption e.g. diarrhea, abdominal discomfort, bloating.⁵

It is important to distinguish between primary lactase deficiency related to genetics and secondary causes of lactase deficiency, including coeliac disease, infectious enteritis, or Crohn’s disease, which have distinct pathogenic and therapeutic implications.⁵ Lactose intolerance can be further subdivided into four classifications depending on its origin.¹

Congenital Lactase Deficiency
Congenital lactase deficiency is a very rare genetic disorder and is characterised by a total absence or significant reduction of the lactase enzyme.¹ This condition is present at birth and persists throughout the individual’s life.¹ There have only been a few dozen cases reported, mainly in Finland.¹

Developmental (Neonatal) Lactase Deficiency
Developmental lactase deficiency is defined as the low level of lactase activity observed in preterm infants (28-32 weeks).¹ Lactase and other disaccharide enzymes are deficient until at least 34 weeks’ gestation and reach maximum activity at birth.¹

Primary lactase deficiency or adult hypolactasia
Primary lactase deficiency results from a progressive and permanent decrease in lactase activity.¹ Approximately 70% of the world’s population have primary lactase deficiency.² The prevalence of primary lactase deficiency varies according to geographical region, ethnicity and is also related to the consumption of dairy products in the diet, resulting in genetic selection of individuals with varied capacities to digest lactose.² Although primary lactase deficiency may present with a relatively acute onset of milk intolerance, its onset typically is subtle and progressive over many years. Most lactase deficient individuals experience maximum onset of symptoms in late adolescence and adulthood.³

Secondary lactase deficiency
Secondary lactase deficiency is a temporary condition that occurs when the production of the enzyme lactase is interrupted due to different mechanisms such as chronic enteropathy, atrophy of villi or other gastrointestinal diseases that can damage the brush border e.g. infections.¹ Lactase is the first disaccharidase enzyme to be compromised and the last to regenerate following damage to the gut.¹ This condition is usually reversible once the underlying pathology has been resolved resulting in restoration of normal lactase activity.⁶

• 4–6 feeding bottles with caps.
• 4–6 teats.
• Teats are available in a variety of shapes and flows  – it is important to advise a care giver about the most appropriate one for their baby, or alternatively suggest they speak to their pharmacist.
  Teats condition should be checked regularly. Teats will wear over time and may need replacing, particularly if a baby has teeth and bites. Discard any teats with cracked collars.
• Bottle brush for cleaning bottles.
• Sterilising equipment – this depends on the sterilising method chosen e.g. either by boiling, using a sterilising solution or microwave sterilising.

If bottle feeding expressed breast milk

• A breast pump to assist in expressing breast milk may be used. When choosing feeding equipment ensure all parts of any equipment used to assist in expressing milk can be effectively cleaned. Always follow the manufacturer’s care and cleaning instructions.
• Breast milk bags – sterile bags for storing breast milk in fridge or freezer.

If bottle feeding formula

• A container or formula dispenser to safely carry formula powder for travelling.
• An insulated carry-bag to carry cool or warm, previously boiled water.

Teats will wear over time and may need replacing.

• 4–6 feeding bottles with caps.
• 4–6 teats.
• Teats are available in a variety of shapes and flows
  • it is important to advise the parent or caregiver about the most appropriate one for their infant, or alternatively suggest they speak to their pharmacist.
  • the teats condition should be checked regularly. Teats will wear over time and may need replacing, particularly if an infant has teeth and bites. Discard any teats with cracked collars.
• Bottle brush for cleaning bottles.
• Sterilising equipment – this depends on the sterilising method chosen e.g. either by boiling, using a sterilising solution or microwave sterilising.
• A breast pump may be used to assist in expressing breast milk. Ensure all parts of any equipment used to assist in expressing milk can be effectively cleaned.
• Breast milk bags – sterile bags for storing breast milk in fridge or freezer.

Do not thaw or warm expressed breast milk in the microwave as this destroys the living cells in the milk

Lactose is the primary carbohydrate of breast milk, including those belonging to animals; cow’s, goat’s and sheep’s milk contain high levels of lactose.¹ The carbohydrate is known as a disaccharide and is comprised of simple sugars, glucose and galactose¹.

Lactose is an important energy source for infants, providing almost 40% of their daily energy needs. Once digested, it also assists in the absorption of minerals such as calcium and iron¹.

Before lactose can be absorbed by the body, it must be hydrolysed to its two components, glucose and galactose, by the enzyme lactase.¹ A deficiency of this enzyme can result in lactose malabsorption.⁴ Lactose that is not absorbed is fermented by the gut microbiota which results in the production of gases such as hydrogen, carbon dioxide and methane. Lactose intolerance is clinically defined as substantial lactose malabsorption associated with gastrointestinal symptoms such as bloating, abdominal pain, diarrhoea and vomiting.⁴

Normal, healthy infants are born with the ability to tolerate lactose as it is the primary carbohydrate of breastmilk. In most infants, intestinal lactase activity reaches its maximum at birth.¹ Some children experience a physiological gradual decline of lactase activity (hypolactasia) after weaning, however, significant gastrointestinal symptoms generally do not occur before 5 years of age.³ The peak onset of hypolactasia related gastrointestinal symptoms occurs in adolescence and adulthood.³

Lactose intolerance is a physiological response to poorly digested and/or absorbed lactose in the gut due to lactase deficiency or inactivity. This does not involve the immune system, sticking to causing issues in a child’s digestive system.⁶

In contrast, cow’s milk protein allergy is an adverse immune system reaction to cows’ milk protein that can be either immunoglobulin E (IgE) or non-IgE mediated.⁶ Although their symptoms may be similar in some cases, intolerance is not the same as an allergy. An allergy can cause a severe allergic reaction and anaphylactic shock, whereas intolerances usually do not cause such a reaction.⁷

Lactose intolerance and cow’s milk protein allergy are often incorrectly used interchangeably due to similarities in the gastrointestinal clinical symptoms.³ Misdiagnosis or delayed diagnosis may result in inappropriate treatment options and/or unnecessary dietary restriction.³

Both the online and in-person events will consist of a 2-hour webinar with 5 short presentations and the opportunity to participate in a live Q&A session.

In-person attendees will have additional opportunities to network during lunch, afternoon tea, workshop discussions and drinks. Workshops will be facilitated by the local expert panel and focus on:

• Under Vs Overdiagnosis of CMPA – how to optimise timely and accurate diagnosis of CMPA
• Opportunities and concerns of using plant-based formulas in allergy management

Once conditions such as infections, neurological, anatomic, surgical, genetic or metabolic pathologies have been excluded through a medical history and physical examination then there are some practical steps to help decipher the diagnosis of an infant with persistent (1 week or more) regurgitation, vomiting and crying.

The first step in managing these babies is parental reassurance and education. In a vast majority of cases symptoms will resolve within 3-6 months. Overfeeding and positioning needs to be part of the education given to parents including correct preparation of infant formula if the baby is formula fed.^1,2,9

Train
Redfern Station is a 10-minute walk to the campus. Many students walk this route, and a free shuttle bus runs between Fisher Library and Redfern Station in the evening during semesters. Central Station is a 15-minute walk along City Road and George Street. There are frequent buses from Railway Square to Parramatta Road and City Road.

Bus
If you are arriving by bus, there are stops at the main entrances on Parramatta Road and City Road. Use the campus map to locate the closest bus stop to your destination.
Use Home | transportnsw.info to plan your trip.

Helpful links 

Link to getting to campus: Getting to campus – The University of Sydney
Campus map: Campus Maps (sydney.edu.au) 

For support with breast feeding, mothers can access the following:

• Their Lead Maternity Carer
• Midwife
• Plunket Nurse (NZ)
• Maternal and Child Health Nurse (Australia)
• Tressilian (Australia only)
• Karitane
• Local Community Health Centre
• Lactation Consultant
• Australian Breastfeeding Association, or visit: www.breastfeeding.asn.au
• General Practitioner
• Contact their local maternity unit for community breast feeding support services
• Danone Nutricia Advisory Team