Q: I am very concerned about my 20 month old grand daughter, a very cute and active child of my youngest daughter who lives in Dubai. She was born in American Hospital Dubai by an absolutely normal delivery. As she had atopic dermatitis she was put on homeopathic treatment. Her skin is fine now though she breaks into occasional rash. However, she is allergic to cow’s milk protein and cannot take any dairy products. She is on a hypoallergenic infant formula and also breast feeds. She hates soy milk. We have been trying dairy milk on her at frequent intervals giving a gap of 4 – 6 months but she gets a rash as soon as she has even a little bit of milk or milk products. The main problem is a tendency to vomit frequently when given any coarse food. She is still on finely pureed food and cannot tolerate coarse food and gags and throws up. It does not seem like she does not like the texture, but that she is not able to take it. My daughter has been trying different textures of food since she was 9 months old but nothing has worked. She keeps the coarse food in her mouth for 15 – 20 minutes and eventually throws up without the slightest change in texture. She doesn’t chew the food at all. We sometimes wonder if she doesn’t know how to chew, cannot chew or simply doesn’t want to chew! She cannot even eat biscuits and similar kinds of food without gagging. Doctors in Dubai also did a barium swallow test and opined that she has mild esophageal reflux. She was on Motilium (Domstal) for 10 weeks and she had slight relief. We have had her checked by several pediatricians and they are happy with her growth. Some opine that we should continue our trials on coarse food despite her vomiting while others think it is okay for her to be on pureed food till ‘she’ is ready. Some say she will learn to adjust to coarse food gradually. Some say she will be OK once she learns to chew. As long as pureed diet is given things go well though she has a tendency to vomit quire frequently on pureed food as well. My daughter is very worried about the following: 1.Will she ever start chewing the food because any attempt to introduce coarse food results in vomiting? What should our course of action be? 2.Is this common in other children or could it be due to some problem in this child? 3.Will she outgrow her milk protein allergy and, if so, when? Should we continue to try milk products despite her allergy or should we avoid it?

A:If the baby is gaining weight well, do not worry. She has cow milk allergy, but could be allergic to other products too. Is she still breast fed too, as allergic problems are less with breast milk? Her diet seems adequate, probably she was not given slightly coarse food at 6-7 months age due to her problems and has not learnt to chew food. Doctors that your daughter has visited are right that she will slowly outgrow her problem. Occasionally offer small amounts of slightly coarse food to give her a habit. Most children with cows milk allegy outgrow by 2 years of age. Some may take longer, about 3% remain allergic as adults with problems of skin allergy, asthma or rhinitis etc. I presume that the child's development is mormal as judged by developmental paediatrician. Some times neonates who have problems at birth have problems with solids, they need occuptional therapist help. The other condition is that child is given coarse food too late and learns to eat solids much later than most normal children.