Australian guidelines advise that there are 3 types of formula appropriate for treating infants with cows’ milk allergy1. They are extensively hydrolysed and amino acid-based formulas (these are discussed in the section ‘What are the types of infant formula’) or soy based formulas. For older children, there are also a number of milk substitutes that are appropriate. The best formula or cows’ milk substitute depends on your child’s age and whether they have other food allergies. Below is a brief description of the different types of infant formula available and understanding their differences is important in children with cows’ milk allergy (CMA).
Standard Infant Formulas – these you can buy in a supermarket or pharmacy
These are not suitable for babies allergic to certain proteins. This is because they are made with cows’ milk powder which has been modified to provide what is needed in a baby’s diet but still contain whole cows’ milk proteins. These proteins are considered to consist of whole protein chains and can cause allergic reactions in babies with CMA because the proteins easily bind to immune cells.
Extensively Hydrolysed Formulas (eHF)
These are formulas considered ‘foods for special medical purposes’ and are prescribed by a doctor for the management of CMA. Here the cows’ milk protein has been broken down into small protein fragments. However, depending on the type of milk allergy (immediate or delayed), eHFs may cause allergic symptoms in some children with severe cows’ milk allergy.
Amino Acid-based Formulas (AAF)
These formulas are also prescribed by the doctor for infants and children with CMA. They are similar to most other infant milks except for one important difference. Instead of being based on whole or broken down cows’ milk protein, they are based on amino acids, sometimes known as the building blocks of protein. These individual amino acids are so small that they are not recognised by the immune system and so are very unlikely to provoke any allergic reaction in children with cows’ milk allergy.
Soy formula used to be the only product that could be given to infants and children with CMA. Nowadays, formulas based on amino acids or hydrolysed proteins are widely available and are generally deemed to be more appropriate.
Soy infant formulas contains soy protein derived from soy flour, and a mixture of carbohydrates in the form of sucrose and corn syrup. Dietary guidelines in the Australia and New Zealand do not recommend soy products for infants under the age of 6 months and so should only be used in specified circumstances. If your child is over 6 months and your child’s doctor suggests a soy formula because of CMA, tolerance to soy protein may well need to be checked first.
In some countries, milk from other mammals such as goats and sheep, have traditionally been used for feeding infants with CMA. Such milks are not always tolerated by babies allergic to cows’ milk as the proteins are very similar in structure to cows’ milk protein. Almond and Rice milks could be another option, but if these milks are not fortified, some vitamins and minerals may be missing, and there could be inadequate amounts of essential nutrients your baby needs.
Check with your child’s doctor or dietitian before feeding your child any of the alternatives above to make sure they can tolerate them and whether they meet your baby’s dietary requirements.
Nutricia supports the benefits of breast milk
- Kemp et al. 2008, Guidelines for the use of infant formulas to treat cow’s milk protein allergy: An Australian consensus panel Med J Aust; Vol 188 no. 2, p. 109-112.