What do I feed my baby?
If your doctor suspects that your baby may have an allergy to cow’s milk protein, or a diagnosis of cow’s milk allergy has been confirmed, you’ll need to remove cow’s milk protein from your baby’s diet to prevent the symptoms coming back. Fortunately, there are lots of healthy cow’s milk protein-free options that your doctor can discuss with you – you should always follow your healthcare professional’s advice. Find out which options are generally recommended for this type of food allergy and which are not below.
If you’re breastfeeding, you should continue doing so as breast milk provides the best nutrition for your baby.
However, if you eat any foods containing cow’s milk protein, you could pass this onto your baby through your breast milk. Because of this, your doctor might advise you to eliminate cow’s milk-containing products from your own diet – and this should include anything that contains goat’s and sheep’s milk protein; not just cow’s milk protein. It’s especially important that your diet is nutritionally complete at this time and your doctor will provide support and guidance through this process, and may refer you to a specialist for some extra help.
You’ll usually need to go on a cow’s milk protein-free diet for 2–4 weeks to see an improvement in your baby’s signs and symptoms. You should stay on this diet until your baby is completely weaned off breast milk, or your doctor recommends reintroducing cow’s milk to your baby. You should only come off the cow’s milk protein-free diet under the supervision of a healthcare professional.
Extensively hydrolysed formulas
Standard baby formulas contain intact cow’s milk proteins, which would trigger an allergic reaction in babies with cow’s milk allergy. So if you’re bottle-feeding, you’ll need to switch your baby onto a hypoallergenic formula specially designed for babies with cow’s milk allergy that doesn’t contain whole cow’s milk proteins.
Extensively hydrolysed formulas that are recommended by healthcare professionals are a type of hypoallergenic formula that are suitable for the vast majority of babies with cow’s milk allergy. The cow’s milk proteins in these formulas have been broken down considerably into very short chains, so they’re no longer recognised by the immune system as whole cow’s milk proteins and are unlikely to cause an allergic reaction. In fact, extensively hydrolysed formulas are effective in at least 90% of infants with cow’s milk allergy.
You should follow the advice of your healthcare professional and only use extensively hydrolysed formulas under their guidance.
Amino acid-based formulas
These are a type of hypoallergenic formula designed for the small number of babies with cow’s milk allergy who have tried an extensively hydrolysed formula that has been recommended by a healthcare professional and still notice symptoms, or who have severe allergic reactions or multiple food allergies.
Amino acid-based formulas don’t contain any protein chains at all – they only use the basic building blocks of protein – amino acids. These formulas contain no milk protein chains at all, so they’re unlikely to trigger an allergic reaction even in babies who are severely allergic.
You should follow the advice of your healthcare professional and only use amino acid-based formulas under their guidance.
Will my baby get enough nutrition from hypoallergenic formulas?
Some hypoallergenic formulas designed for babies with cow’s milk allergy are nutritionally complete and can be used from birth, providing key nutrients like fats, proteins, carbohydrates, vitamins and minerals that your baby will need. Others are specifically designed to support the growth and development of infants from weaning onwards, with additional nutrients to supplement their solid foods.
Speak to your healthcare professional to find out which formula your baby should be on. Rest assured that your baby doesn’t need to miss out on any nutrients just because they are on a cow’s milk protein-free diet.
Partially hydrolysed formulas
These formulas, also advertised as “comfort formulas”, are designed to manage irritability and wind but are not suitable for infants with cow’s milk allergy because even though the cow’s milk proteins in these formulas have been broken down a little, they’re still long enough to be recognised by the immune system and may cause an allergic reaction.
Partially hydrolysed formulas are therefore not suitable for babies with cow’s milk allergy.
If your baby has cow’s milk allergy, it might at first seem like a good idea to switch to a formula that isn’t made from milk proteins, such as one made with soya protein. However, soya-based formulas are not recommended as a first choice in babies with cow’s milk allergy. Experts don’t recommend using soya-based formulas in babies aged 6 months or younger, and shouldn’t be the first choice in older infants unless recommended by a doctor. What’s more, some babies with cow’s milk allergy are allergic to soya too.
These formulas are designed for babies with lactose intolerance, who can’t digest the sugar (called lactose) in milk. However, they are NOT hypoallergenic as they still contain whole cow’s milk protein, which will cause an allergic reaction in babies with cow’s milk allergy.
Lactose-free formulas are therefore not suitable for babies who are allergic to cow’s milk protein.
Pre-thickened, anti-reflux formulas
These formulas are designed for babies with reflux. They are NOT hypoallergenic as the cow’s milk proteins haven’t been broken down, so they will still be recognised by the immune system and cause an allergic reaction in babies with cow’s milk allergy.
Pre-thickened, anti-reflux formulas are therefore not suitable for babies who are allergic to cow’s milk protein, and should only be used under the guidance of a healthcare professional for symptoms of reflux.
Other milks (e.g. goat’s milk, sheep’s milk, other “milks”)
Milks from any other animals are not recommend for babies with cow’s milk allergy, as the proteins in these milks are very similar to the ones in cow’s milk, and will most likely trigger an allergic reaction in the same way.
Rice “milk” is not advised before the age of 4½ years as recommended by the Food Standards Agency. Ready-made soya, pea, oat, coconut or other milk substitutes may be used as a main drink after 2 years of age, but the choice may depend on your child’s nutritional status. Try to always choose a brand that is fortified with calcium where possible. Note: organic products do not always have added calcium. If the product is not fortified with calcium, it is likely that a calcium substitute will be required. There’s more information on choosing suitable milks for children with cow’s milk allergy from the British Dietetic Association.