{"id":21045,"date":"2024-10-02T13:43:30","date_gmt":"2024-10-02T12:43:30","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=21045"},"modified":"2024-11-28T10:33:29","modified_gmt":"2024-11-28T10:33:29","slug":"cows-milk-protein-allergy-cmpa","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/allergy\/cows-milk-protein-allergy-cmpa\/","title":{"rendered":"Cow\u2019s Milk Protein Allergy (CMPA)"},"content":{"rendered":"\n<p><strong>Information<\/strong><\/p>\n\n\n\n<p>These are guidelines for the diagnosis and management of suspected cow\u2019s milk protein allergy (CMPA) in primary care.<\/p>\n\n\n\n<p>Please note there are no allergy tests for non-IgE mediated CMPA. Diagnosis is based on resolution of symptoms on a cows milk protein free diet AND reoccurrence on re-introduction of milk. Re-challenge is essential for diagnosis of non-IgE mediated CMPA. <strong>Do not<\/strong> re-challenge for suspected IgE mediated CMPA.<\/p>\n\n\n\n<p><strong>Introduction<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>These guidelines are for the diagnosis and management of suspected cow\u2019s milk protein allergy.<\/li>\n\n\n\n<li>The prevalence of cow\u2019s milk allergy is up to 3% of infants during the first year of life.<\/li>\n\n\n\n<li>Cow\u2019s milk protein allergy is frequently over diagnosed with allergy formula milks being over-prescribed.<\/li>\n\n\n\n<li>Cow\u2019s milk protein allergy commonly presents in infancy, with most affected infants presenting&nbsp;with symptoms by 6 months of age.<\/li>\n\n\n\n<li>Cow\u2019s milk protein allergy&nbsp;can be classified into IgE mediated&nbsp;reactions (immediate onset) and non- IgE mediated (delayed onset).<\/li>\n\n\n\n<li>Cow\u2019s milk protein allergy will resolve in the majority of children during early childhood.<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"854\" height=\"1024\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5-854x1024.png\" alt=\"CMPA FLOWCHART V5\" class=\"wp-image-21704\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5-854x1024.png 854w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5-250x300.png 250w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5-768x921.png 768w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5-1281x1536.png 1281w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5-1708x2048.png 1708w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5-951x1140.png 951w\" sizes=\"auto, (max-width: 854px) 100vw, 854px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatricdietetics\/\" target=\"_blank\" rel=\"noreferrer noopener\">Dietetics \u2013 RefHelp (nhslothian.scot)<\/a><\/p>\n\n\n\n<p><a href=\"mailto:loth.cypdieteticsinfantfeeding@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">loth.cypdieteticsinfantfeeding@nhs.scot<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Appendix-1-CMPA-signs-and-symptoms-v2.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Appendix-1-CMPA-signs-and-symptoms.pdf<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Appendix-2-Infant-Allergy-Clinical-History-Assessment-Form-v1.doc\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Appendix-2-Infant-Allergy-Clinical-History-Assessment-Form-v1.doc\" target=\"_blank\" rel=\"noreferrer noopener\">Appendix-2-Infant-Allergy-Clinical-History-Assessment-Form-for Doctors and Health Visitors v1.doc<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Appendix-3-Prescribing-allergy-formula.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Appendix 3 PRESCRIBING-ALLERGY-FORMULA-MILKS.pdf<\/a><\/p>\n\n\n\n<p><strong>D.R.M &amp; L.W 15-11-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>Who can refer:<\/strong><\/h4>\n\n\n\n<p>GPs, Health Visitors, Paediatric Physicians, Family Nurse<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who to refer:<\/strong><\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Infants with suspected non-IgE CMPA who meet the criteria for specialist dietician management as per the above flow chart e.g:<\/li>\n<\/ul>\n\n\n\n<ol start=\"1\" class=\"wp-block-list\">\n<li>&lt; 12 months old<\/li>\n\n\n\n<li>Faltering growth<\/li>\n\n\n\n<li>Multiple allergies suspected including CMPA<\/li>\n\n\n\n<li>Blood in stools<\/li>\n\n\n\n<li>Feeding aversion<\/li>\n\n\n\n<li>Multiple maternal dietary exclusions<\/li>\n\n\n\n<li>Under family nurse practitioner<\/li>\n<\/ol>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Infants with suspected non-IgE CMPA who meet criteria for initial primary care management but who develop further symptoms following a subsequent milk challenge.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who not to refer:<\/strong><\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Infants with suspected IgE CMPA \u2013 Please refer these infants to RHCYP <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatricdietetics\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatricdietetics\/\" target=\"_blank\" rel=\"noreferrer noopener\">General Paediatric Dietetics<\/a>. <strong>Do not<\/strong> re-challenge for suspected IgE mediated CMPA.<\/li>\n\n\n\n<li>Infants with suspected non-IgE CMPA who can be assessed safely in primary care and who do not develop symptoms following a subsequent milk challenge following a period off dairy.&nbsp; See Primary Care Management tab.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer:<\/strong><\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A Sci-Gateway referral pathway is currently under development for this service.&nbsp; In the meantime please email <a href=\"mailto:loth.cypdieteticsinfantfeeding@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">loth.cypdieteticsinfantfeeding@nhs.scot<\/a> with allergy assessment form attached.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>After Referral:<\/strong><\/h4>\n\n\n\n<p><strong>Please see below detailing what families should expect from the Dietetic CMPA pathway <strong>following confirmation of CMPA diagnosis:<\/strong><\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Maternal dietary measures for breast fed infants, or allergy formula for formula fed infants, should continue whilst awaiting review (see Primary Care Management tab).<\/li>\n\n\n\n<li>Family will be called at 5 months of age and booked into cow\u2019s milk free weaning group (in person or online). To continue dietary measures for breast fed infants or allergy formula for formula fed infants.<\/li>\n\n\n\n<li>Family will be called at 12 months of age and booked into cow\u2019s milk reintroduction group (online)<\/li>\n\n\n\n<li>Discharged from dietetics after 12 months of age, unless ongoing dietetic review required. Prescription of allergy formula discontinued.<\/li>\n\n\n\n<li>One to one dietetic clinic appointments can be arranged as required where appropriate.<\/li>\n<\/ol>\n\n\n\n<p>We have close working relationships with RHCYP Medical Paediatrics and Allergy teams and can forward referrals as appropriate<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>The following patients can be safely assessed and have initial management carried out in primary care:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>&lt;12 months old<\/li>\n\n\n\n<li>No growth concerns<\/li>\n\n\n\n<li>Suspected single non-IgE allergy to milk<\/li>\n\n\n\n<li>No blood in stools<\/li>\n\n\n\n<li>No feeding aversion<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Step 1: <\/strong><\/h4>\n\n\n\n<p><strong>To confirm\/refute non-IgE CMPA diagnosis, complete 4 week dairy exclusion and subsequent milk challenge following guidance in the information sheets.<\/strong><\/p>\n\n\n\n<p>See <a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-breastfed-children-with-suspected-non-IgE-CMPA.pdf\" data-type=\"link\" data-id=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-breastfed-children-with-suspected-non-IgE-CMPA.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">parent information sheet for breast fed babies<\/a><\/p>\n\n\n\n<p>See parent information sheet for <a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-formula-fed-children-with-suspected-non-IgE-CMPA.pdf\" data-type=\"link\" data-id=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-formula-fed-children-with-suspected-non-IgE-CMPA.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">combination fed babies and formula fed babies<\/a>. &nbsp;<\/p>\n\n\n\n<p><strong><em>If baby was previously tolerating dairy through maternal diet and became symptomatic on introduction of formula milk please advise Mum to continue to keep dairy in her own diet.<\/em><\/strong><\/p>\n\n\n\n<p>For formula fed infants, please prescribe appropriate <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Appendix-3-Prescribing-allergy-formula.pdf\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/PRESCRIBING-ALLERGY-FORMULA-MILKS.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">allergy formula <\/a><\/p>\n\n\n\n<p><strong><em>PLEASE NOTE:<\/em><\/strong> <strong><em>If no improvement after 2 weeks minimum on extensively hydrolysed formula, consider trial of amino acid formula for a further 2 weeks minimum, or alternative diagnosis eg. gastro-oesophageal reflux.<\/em><\/strong><\/p>\n\n\n\n<p>See <a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-breastfed-children-on-solids.pdf\" data-type=\"link\" data-id=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-breastfed-children-on-solids.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">parent information sheet for babies on solids<\/a> <\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Step 2: <\/strong><\/h4>\n\n\n\n<p><strong><strong>If CMPA confirmed on re-challenge<\/strong>, please refer to infant feeding dietetics  &#8211; <\/strong><em>see the Referral Guideline tab <\/em>&#8211; <em>IFD mailbox \u2013loth.cypdieteticsinfantfeeding@.nhs.scot<\/em> (<em>SCI-gateway protocol under development)<\/em><\/p>\n\n\n\n<p>Please continue allergy formula milk<\/p>\n\n\n\n<p>Please see \u201cafter referral\u201d in the Referral Guidelines tab to inform family of what to expect from dietetics<\/p>\n\n\n\n<p>If no return of symptoms on milk challenge, resume normal diet and consider alternate diagnosis.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Appendix-2-Infant-Allergy-Clinical-History-Assessment-Form-v1.doc\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Appendix-2-Infant-Allergy-Clinical-History-Assessment-Form-v1.doc\" target=\"_blank\" rel=\"noreferrer noopener\">Infant Allergy Assessment Form for Doctors and Health Visitors<\/a><\/p>\n\n\n\n<p><strong>Milk challenge information sheets<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Milk-free trial and re-challenge information for breastfed children with suspected non-IgE CMPA: <a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-breastfed-children-with-suspected-non-IgE-CMPA.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-breastfed-children-with-suspected-non-IgE-CMPA.pdf<\/a><\/li>\n\n\n\n<li>Milk-free trial and re-challenge information for formula fed children with suspected non-IgE CMPA: <a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fpolicyonline.nhslothian.scot%2Fwp-content%2Fuploads%2F2024%2F04%2FMilk-free-trial-and-re-challenge-information-for-formula-fed-children-with-suspected-non-IgE-CMPA.pdf&amp;data=05%7C02%7CHeather.Levy%40nhs.scot%7C89a20ae2f4b349b1660408dcded9530a%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638630272180697157%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=BjiMkn3CM3UzrYsjFw%2BFHr%2FQZRHaKmLUSFXCrsQy0ts%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-formula-fed-children-with-suspected-non-IgE-CMPA.pdf<\/a><\/li>\n\n\n\n<li>Milk-free trial and re-challenge information for breastfed children on solids: <a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fpolicyonline.nhslothian.scot%2Fwp-content%2Fuploads%2F2024%2F04%2FMilk-free-trial-and-re-challenge-information-for-breastfed-children-on-solids.pdf&amp;data=05%7C02%7CHeather.Levy%40nhs.scot%7C89a20ae2f4b349b1660408dcded9530a%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638630272180706821%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=bCqJACsnXih290vYaahhJnVHSFvL6ny%2FIW6uHeb30Ac%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-breastfed-children-on-solids.pdf<\/a><\/li>\n\n\n\n<li>&nbsp;Cow\u2019s milk protein allergy \u2013 frequently asked questions.&nbsp;:&nbsp;<a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fpolicyonline.nhslothian.scot%2Fwp-content%2Fuploads%2F2024%2F04%2FCMPA-and-feeding-difficulties-FAQ.pdf&amp;data=05%7C02%7CHeather.Levy%40nhs.scot%7C884fbfab92484858e62708dd03f5b0c1%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638671075941488840%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=L%2FGpcc6ZPJF5RZoMbY9nW%2FXRTLWKzcFw7QAM6l2dwzc%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/CMPA-and-feeding-difficulties-FAQ.pdf<\/a><\/li>\n<\/ul>\n\n\n\n<p>Feeding difficulties in babies- what is normal: <a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2023\/03\/Feeding_difficulties_in_babies.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2023\/03\/Feeding_difficulties_in_babies.pdf<\/a><\/p>\n\n\n\n<p>Food allergy and eczema: <a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/07\/Food-allergy-and-eczema-FAQs.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/07\/Food-allergy-and-eczema-FAQs.pdf<\/a><\/p>\n\n\n\n<p>Dyschezia:  <a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/10\/Dyschezia-in-babies.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/10\/Dyschezia-in-babies.pdf<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/medical-paediatrics\/feeding-difficulties-in-infants-under-6-months\/\" target=\"_blank\" rel=\"noreferrer noopener\">Feeding Difficulties in Infants Under 6 Months \u2013 RefHelp (nhslothian.scot)<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatriceczemaatopic\/\" target=\"_blank\" rel=\"noreferrer noopener\">Eczema, Atopic \u2013 RefHelp (nhslothian.scot)<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Information These are guidelines for the diagnosis and management of suspected cow&rsquo;s milk protein allergy (CMPA) in primary care. Please note there are no allergy tests for non-IgE mediated CMPA. Diagnosis is based on resolution of symptoms on a cows milk protein free diet AND reoccurrence on re-introduction of milk. Re-challenge is essential for diagnosis<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":13346,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1169],"class_list":["post-21045","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-cows-milk-protein-allergy-cmpa"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/paediatric\/https-apps-nhslothian-scot-refhelp-allergy-services\/https-apps-nhslothian-scot-refhelp-cows-milk-protein-allergy-cmpa\/\" rel=\"tag\">Cows Milk Protein Allergy (CMPA)<\/a>","rttpg_excerpt":"Information These are guidelines for the diagnosis and management of suspected cow&rsquo;s milk protein allergy (CMPA) in primary care. Please note there are no allergy tests for non-IgE mediated CMPA. Diagnosis is based on resolution of symptoms on a cows milk protein free diet AND reoccurrence on re-introduction of milk. Re-challenge is essential for diagnosis","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/21045","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=21045"}],"version-history":[{"count":38,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/21045\/revisions"}],"predecessor-version":[{"id":21706,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/21045\/revisions\/21706"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/13346"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=21045"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=21045"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}