Cows’ milk allergy (CMA) is common in infants in Australia. Approximately one in every fifty babies will be diagnosed with this condition1. Both breastfed and formula fed infants can develop cows’ milk allergy. Fortunately, most children will outgrow the allergy by their third or fourth birthday2.
Once your child has been correctly diagnosed with cows’ milk allergy, there some changes required to help manage the condition. Treatment involves removal of all foods containing cows’ milk from your child’s diet, or in some cases, from the diet of the breastfeeding mother. With the help of a hypoallergenic formula and your health care professional, the challenges of cows’ milk allergy can be easily navigated through the first year and beyond.
From birth to six months
Most infants will receive either breastmilk or infant formula as their sole source of nutrition for around the first six months of life. Breastmilk is the best nutrition for your infant and if possible, breastfeeding should be continued after diagnosis of CMA2. The steps needed to manage CMA for both breastfed and formula fed infants are listed below:
Cows’ milk allergy is less common in exclusively breastfed infants, however a cows’ milk allergy can sometimes occur2. Sensitive babies will react to cows’ milk protein, eaten in the mother’s diet, being passed through the breastmilk3. If an exclusively breastfed infant is diagnosed with CMA then the mother may need to remove cows’ milk protein from her diet1. It is important to check with your healthcare professional before making any diet changes.
If elimination of cows’ milk protein from the mother’s diet is required, it is important to ensure that alternative non-dairy sources of calcium are included. The mother’s diet not only affects her own health, but also the quality of her breastmilk4. Your healthcare professional will be able to provide advice regarding non-dairy substitutes and there are also some ideas provided in the allergy friendly shopping list section on this website.
Formula fed Infants
Formula fed infants diagnosed with CMA will need to be changed to an alternative cows’ milk free formula. Standard infant formulas are made by modifying cows’ milk to meet the nutritional requirements of infants. These formulas will cause symptoms in a baby with cows’ milk allergy. For infants under six months of age the substitute formula will usually be either an extensively hydrolysed formula (eHF) or an amino acid based formula (AAF). These formulas should be prescribed by your child’s doctor.
Extensively hydrolysed formulas are made from cows’ milk that has been treated with enzymes to break down the proteins that cause cows’ milk allergy1. Extensively hydrolysed formulas are usually the first choice to treat cows’ milk allergy for children under six months of age. A small number of children, however, will still react to the cows’ milk proteins that remain in eHFs. For these children, and for those with severe allergic reactions, AAFs are usually recommended. Amino acid based formulas are made from amino acids, which are the building blocks of protein. They contain no cows’ milk protein and should be tolerated by almost all infants with CMA1.
From six to twelve months of age
As your infant grows they will start to need more nutrition than breastmilk or infant formula alone can provide5. When your baby is developmentally ready, usually at around six months of age, solid foods can start to be introduced in addition to breastmilk or infant formula4. This is an exciting milestone for parents, but can also cause a lot of angst for parents of a child with cows’ milk allergy. Thankfully there is lots of support and information available to help you through this time.
Introducing solid foods is an important step in your child’s development. It will help your little one learn the motor skills needed for chewing, biting and swallowing5. A child’s early experiences with food will also help to shape their eating behaviours later in life5.
To help develop these skills, infants should be exposed to a wide range of flavours and textures. The textures that are suitable for your child will progress as they develop5. Generally children start with pureed foods and then move onto mashed and chopped foods. From around 8 months of age most children should be able to manage finger foods. By the time your baby reaches twelve months they should be eating with the rest of the family.
The first foods that are introduced should contain iron, like pureed meat, fish or fortified baby cereal. After this, foods should be introduced according to what your family usually eats. Australian allergy guidelines advise that there is no need to delay the introduction of other foods that commonly cause allergies, like eggs, soy, nuts, fish and wheat4. It is, however, advised that new foods are introduced every two to three days to allow for easy identification if a reaction does occur4.
Children with confirmed cows’ milk allergy will need to avoid all foods containing cows’ milk protein. This includes cows’ milk and all dairy products, such as yoghurt, cheese, butter and cream. Parents will also need to check the labels of all manufactured foods to make sure the food does not contain cows’ milk protein. To ensure your child receives the nutrients usually provided in cows’ milk, it is important to include calcium containing non-dairy substitutes. Some shopping tips and non-dairy substitutes can be found here.
Throughout the first year of life, breastmilk or a low allergy infant formula should be the main drink for your child5. For formula fed infants diagnosed with cows’ milk allergy after six months of age, they may be started on a soy based infant formula, rather than an AAF or eHF3.
As infants grow their nutritional needs change and this can be challenging when a child has an allergy, however with some support and creativity you will be able to introduce a world of food options to support their growth
- 2016. Cow’s milk (dairy) allergy. Australasian Society of Clinical Immunology and Allergy. Viewed 16 June 2016. http://www.allergy.org.au/patients/food-allergy/cows-milk-dairy-allergy
- Motala & Fiocchi. 2012. Cow’s milk allergy. World Allergy Organisation. Viewed 16 June 2016. http://www.worldallergy.org/professional/allergic_diseases_center/cows_milk_allergy_in_children/
- Vandenplas et al. 2007. Guidelines for the diagnosis and management of cow’s milk allergy in infants. Arch Dis Child. Volume: 902 pages: 902-908
- 2016. Information for health professionals: Food Allergy Clinical Update. Australasian Society of Clinical Immunology and Allergy. Viewed 16 June 2016. https://www.allergy.org.au/health-professionals/hp-information/asthma-and-allergy/food-allergy
- 2012. Australian Infant feeding guidelines: Information for health workers. Australian Government. Viewed 6 June 2016. https://www.nhmrc.gov.au/guidelines-publications/n56