Cow's Milk Allergy and your baby

Next steps: Learn more about how your doctor can help to manage your baby's cow's milk allergy

The first and most important step is to visit your healthcare professional to find out if your baby has CMA. They will be able to give you advice on how to appropriately manage your child's condition.

CMA symptoms can be managed by eliminating cow's milk protein from your child's diet.

If your baby receives a diagnosis of cow's milk allergy, your doctor or dietitian will likely advise you to remove all cow's milk protein from their diet. If you are breastfeeding, your doctor will discuss with you whether to remove cow's milk protein (dairy products) from your diet, and will advise you on how to do this. You should never remove cow's milk from your or your child's diet without the supervision or advice of a doctor or dietitian, as milk contains many important nutrients for your baby.

Breastfeeding is best: however, when breastfeeding is not an option, your doctor or dietitian will be able to advise you as to whether it would be appropriate to give your child a specialised infant formula specially developed for children with cow's milk allergy. Most of these formulas are available on prescription only and should be used under medical supervision of a healthcare professional. Please speak to your doctor or dietitian for more information.

What are the types of infant formula?

• Standard infant formula that you can buy in a supermarket or local shop

  These are generally not suitable for babies allergic to the proteins in cow's milk. This is because they are based on milk powder and therefore contain whole cow's milk proteins. These proteins can cause allergic reactions in babies with CMA. If you are considering changing your baby to another type of formula, it is very important that you first discuss this with your child's doctor or dietitian as other commercially available standard infant formulas may not be suitable. Please speak to your doctor or dietitian for more information.

• Extensively hydrolysed formulas (eHF)

  Extensively hydrolysed formulas are specialised formulas that can be prescribed by a doctor for use in the dietary management of CMA. In these formulas, the cow's milk protein has been broken down into small fragments which are less likely to cause an allergic reaction. However, as eHFs still contain fragments of milk protein, they may still cause symptoms in children with severe cow's milk allergy. Please speak to your doctor or dietitian for more information.

  eHFs are classed as 'Foods for Special Medical Purposes' and should always be used under medical supervision of a healthcare professional.

• Amino acid-based formulas (AAF)

  Amino acid-based formulas are specialised formulas, also available on prescription. Instead of being based on whole or broken down cow's milk protein, they are based on individual amino acids. Amino acids are also known as the building blocks of protein and, as they are very small, they are not recognised by the immune system. As a result, they are very unlikely to provoke an allergic reaction in children with cow's milk allergy. Please speak your doctor or dietitian for more information.

  AAFs are classed as 'Foods for Special Medical Purposes' and should always be used under medical supervision of a healthcare professional.

• Other Milks

  Soya-based infant formulas contain soya protein derived from soya flour, and a mixture of carbohydrates in the form of sucrose and corn syrup. Medical guidelines in the UK and the USA do not recommend soya products for infants under the age of 6 months. If your child is over 6 months and your child's doctor or dietitian suggests a soya formula because of CMA, tolerance to soya protein may well need to be checked first. Please speak to your doctor or dietitian for more information.

  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 cow's milk as the proteins are very similar in structure to cow's milk protein. Cereal milks, such as oats milk, 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. Equally the UK's Food Standard Agency recommends that children under the age of 4.5 years do not consume rice milk. Please speak to your doctor or dietitian for more information.