Cow’s milk is one of the most common causes of food related allergies in children. Current findings report that around 2% (1 in 50) babies in Australia and New Zealand are allergic to cow’s milk and, like many allergies, there is no specific treatment or ‘cure’. The only way to manage it is for the child to avoid drinking or eating any milk, or milk containing foods.
It can be reassuring to know that most children, around 80%, outgrow their cow’s milk allergy by 3- 5 years, though the age this happens is unique for every child. However, some individuals never outgrown a cow’s milk allergy and are allergic for life.
How would I know if my baby has a cow’s milk allergy?
You may not know until you offer your baby cow’s milk or other dairy foods. Rapid onset allergic reactions usually occur within 15 minutes and can’t be missed.
The symptoms include one or more of these:
Mild or moderate allergic reactions
- Swelling of the face, lips and/or eyes.
- Skin hives or welts on the skin.
- Abdominal pain, vomiting and diarrhoea.
Severe allergic reactions/anaphylaxis
- Noisy breathing or wheeze.
- Swelling or tightness of the throat.
- Becoming pale and floppy.
The diagnosis of cow’s milk allergy is made if allergy symptoms happen soon after the baby has cow’s milk or dairy foods. Skin or blood tests can also be done to measure if specific antibodies to cow’s milk are positive; these are known as Immunoglobulin E (IgE).
Sometimes a delayed reaction occurs 2 or more hours after having cow’s milk or dairy foods. Thes reactions can be an increase in eczema or vomiting/diarrhoea. Diagnosing these types of reactions with allergy testing can be more difficult and there is a great likelihood of a negative result.
In babies who have a delayed reaction to cow’s milk and other dairy foods, treatment is usually around exclusion for a trial period. This is generally from 1-4 weeks to see how the child improves. A planned and slow reintroduction of cow’s milk and other dairy foods then helps to confirm the diagnosis and decide if exclusion is still needed.
I’m breastfeeding, do I need to stop drinking cow’s milk?
Excluding foods from a breastfeeding mother’s diet is rarely required. If it is recommended, this needs to be supervised and supported by a dietician.
It’s important for breastfeeding mothers to have good nutrition and to ensure they are eating sufficient nutrients to support their lactation and own needs.
How do I manage my baby’s cow’s milk allergy?
Before making any changes to your baby’s diet, speak with a doctor or healthcare professional. The only way to correctly diagnose a cow’s milk allergy is through skin or blood tests.
The key to managing cow’s milk allergy is to exclude all cow’s milk and other dairy foods from the baby’s diet. Most individuals who are allergic to cow’s milk will also be allergic to other animal milks, including goat, sheep, camel or horse milk.
Sometimes babies will tolerate cooked or baked foods which contain cow’s milk. This can be one way to slowly reintroduce cow’s milk based foods, under the direction of a healthcare professional.
What is the difference between cow’s milk allergy and lactose intolerance?
Lactose intolerance is a different type of reaction which does not involve the immune system. Although lactose intolerance can be uncomfortable, it’s not life-threatening or dangerous and does not cause anaphylaxis or rashes. Research has shown that drinking cow’s milk or eating dairy foods does not cause increased mucous production.
Milk contains a specific type of sugar, called lactose. To digest lactose the body needs to produce an enzyme known as lactase. Sometimes children and adults don’t produce enough lactase to digest lactose and break it down into simple sugars which can then be absorbed. This commonly happens after a bout of diarrhoea where the lactase secreting cells in the gut are temporarily damaged.
Symptoms of lactose intolerance include:
- Diarrhoea
- Bloating
- Gas
- Abdominal pain
What is the alternative to giving my baby cow’s milk?
Up to one year of age
There are a range of alternative milks which are suitable for babies with a diagnosed cow’s milk allergy. Be guided by your own healthcare professional about what’s right for your baby.
Generally, formulas which are derived from soy protein are tolerated by babies with a cow’s milk allergy. Cow’s milk formulas which have been extensively hydrolysed, also called EHF formulas, break down most of the milk proteins and can also be given. However, EHF is not suitable for babies who have had an anaphylaxis to cow’s milk.
Rice protein based formula may be used as an alternative to EHF or soy formulas. Another option is amino acid based formula where an EHF or soy protein formula is not tolerated by the baby.
Over one year of age
Soy milk, calcium enriched rice, oat or nut milk may be recommended by your baby’s healthcare professional. It’s important to check if these alternative milks contain enough levels of protein and fat to support a child’s growth.
Written for Sudocrem by Jane Barry, Midwife and Child Health Nurse, April 2024.
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