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Living with CMPA
Cows’ Milk(CM)/
Dairy Free Diet -
Practical Advice
When your child is allergic to cow’s milk - what does it mean for you and your family?
When your child has been diagnosed with a milk allergy by a healthcare provider, it will mean some changes to help manage the condition. All foods containing dairy proteins should be avoided, including cows, sheep and goat milk, cheese, yoghurt, custard etc.
If you are breastfeeding then you may also need to remove most dairy from your diet but talk to your baby’s dietician or healthcare provider about this first. It is also important to learn how to identify dairy ingredients on food labels to avoid that your baby receives a hidden source of milk/dairy.
If you are not breastfeeding, there are alternative options such as specialty formulas to help ensure your baby’s nutritional needs are fully met. Your dietician or pediatrician will advise you which is the best alternative option.
Why Milk Is Still
Important
Why is milk an important part of my baby’s diet?
An infant will drink less breastmilk/formula after the age of 6 months as you start to introduce solid foods. However, breast or formula milk remains an important source of nutrition in early childhood. For formula fed babies on a milk-free diet, using their prescribed special formula (Althera® or Alfamino®) in foods and recipes can help improve intake of both energy and key nutrients like calcium.
Breastfeeding and complementary feeding
If you are breastfeeding your baby you should continue to do so. Note, only a very small number of babies will react to the traces of cows’ milk protein that transfer from the mother’s diet to her breastmilk. If you have been advised to exclude milk from your diet whilst breastfeeding, make sure you discuss it with your baby’s dietician – ensuring your own diet is nutritionally adequate which might mean supplementation (as advised by the dietician).
Getting your baby to take a new specialty formula
If your baby is taking a cow or goat milk formula, with or without breastmilk, your healthcare provider will recommend that you stop this formula and start your baby on a new specialty formula. This will help improve your baby’s symptoms.
In some circumstances you may need to gradually swap the old with the new formula by mixing them together for a few days (or mixing with expressed breastmilk), this is advised so that your baby becomes familiar with the taste. Eventually the old formula should be replaced entirely by the specialty formula.
What about vitamins?
The UK guidelines recommend giving vitamins to babies from 6 months of age unless they are drinking more than 500ml of formula per day. If your baby is breastfed, they should have a daily vitamin D supplement from birth. Breastfeeding mothers are also recommended to take 10μg vitamin D daily.
What Alternative
Milks Can I Offer?
What specialist milks can I offer my baby instead of cow’s milk?
The best milk for your baby is breastmilk, and you can continue breastfeeding even if you baby has a milk allergy. Talk to your baby’s dietician or healthcare provider about this and what extra nutrients you might need.
If you have chosen not to breastfeed then there are many formula milk alternatives to choose from. We have included a short list in the table below. You can also use plant-based drinks like oat, rice, soya etc., (bought over the counter). These can be used from 6 months of age but only for mixing with foods. These alternatives should not replace breastmilk or the specialty formula milk your baby has been recommended by the dietician or healthcare provider.
| From 4 - 6 months | > 6 months | |
| Milk substitutes | Extensively hydrolyzed formula – e.g., animal-based or plant-based | Extensively hydrolyzed formula – e.g., animal-based or plant-based |
| Amino acid-based formula | Amino acid-based formula | |
| Soya formula, if tolerated, can be used from 6 months of age | ||
| Not suitable |
|
|
Plant-based And
Vegan Options
Why are alternative plant-based drinks (bought over the counter) not possible to use as the main drink for my baby?
Plant-based drinks that you buy in the shops can be low in some important nutrient’s, such as protein, calcium, important fats and important vitamins (B12, B2, D, and E).
Protein, vitamins and minerals are needed for your baby’s growth and development. These drinks are therefore not suitable as the main drink for your baby and should not replace breastmilk or the special infant formula prescribed by your baby’s healthcare provider. They can be used however to mix with complementary feeding foods or when cooking, instead of cow’s milk. Ideally the unsweetened versions.
From 1 year of age your baby can have unsweetened calcium-fortified plant-based alternatives, such as soya, oat or almond drinks, as part of a healthy, balanced diet.
Rice drinks may contain arsenic and therefore should be avoided until your child is at least 5 years old. The British Association of Allergy and Clinical Immunology (BSACI) advice that a nutritionally complete specialist infant formula should be chosen, preferably up to 2 years of age.
Are vegan and vegetarian diets healthy and safe for my baby?
Well-planned vegan or vegetarian diets that are balanced, containing a variety of plant-based foods and fortified foods, are also safe for your baby. However, if your baby is vegan, we strongly advise that you seek advice from a dietician. This is to make sure your baby gets all the essential nutrients they need to grow and develop properly. When a vegan diet is not properly managed, it can lead to serious nutritional deficiencies.
So, if your baby is following a vegan diet and they are not taking a specialty formula, then they may need an additional supplement containing extra vitamins and minerals. Your baby’s dietician can help you select the most appropriate supplement.
Protein is important for growth so make sure your baby has a good supply of vegan protein sources e.g., beans, lentils, tofu, nuts and seeds (in an appropriate texture for your baby developmental stage). In addition, look for calcium supplemented plant-based drinks or yoghurts. Iron is another important nutrient for your baby and helps with their growth and development.
Good vegan sources of iron include fortified cereals, pulses, some nuts e.g., cashew (ground or butter), and seeds like ground chia, linseed, hemp or pumpkin seeds. These should always be in an appropriate texture for your baby’s developmental stage.
Finally, if you add vitamin C-rich foods, such as peppers, oranges, kiwi and broccoli to your baby’s meals, it will help them get more iron from their food.
Tips For Reading
Food Labels
Reading food packing labels is important to master when your child has a food allergy. Know that ingredients and manufacturing processes can change without warning, so try to read the label each time.
By law, food companies must label their products clearly if they contain milk/dairy. If a food item does not have a label, you have doubts about it, or you cannot read it, avoid giving your child that food.
When reading food labels for milk/dairy, look out for the following:
- Milk or Cow’s milk may be mentioned
- “Whey (milk)” "casein (milk)" or “milk proteins” in parentheses may be mentioned
- “Contains milk” might be included
Some food companies use precautionary allergen labels, for example “may contain milk” or “made in a factory with milk.” These labels can be confusing because they do not tell you if it definitely contains milk or not.
In this case, especially if your child has had a severe reaction, it is better to avoid the food, at least until you talk to your child’s dietician or healthcare provider about it. They can usually tell you if it’s safe for your child or not.
