Caring For A Baby With Cow’s Mil​k Protein Allergy

After hearing that your baby has cow’s milk protein allergy, you may have wondered "What do I feed her?" Fortunately, there are lots of healthy dietary options for babies with cow’s milk protein allergy that your doctor can review with you.

 

They include:

Maternal Cow’s Milk Protein Elimination Diet

When you nurse, some of the nutrients from the foods you eat are passed along to your baby in breast milk. When you consume a food that contains cow’s milk protein (such as milk products), your baby may be exposed to allergenic fragments of cow's milk protein. But this is not a reason to stop nursing! Breast milk provides the best nutrition for your baby. Instead, your doctor may suggest eliminating all dairy products from your diet. Milk and milk products such as yogurt and cheese are obvious sources of dairy, but other foods like breads, cereals, and salad dressings can contain milk too. You will have to read labels carefully for hidden milk ingredients like casein and whey. You may need to be dairy-free for two weeks or longer before your baby's allergic reactions subside.
You will need to remain dairy-free until your baby is completely weaned off breast milk or until your doctor recommends reintroducing cow's milk protein into your baby's diet. Do this only under a doctor's recommendation and supervision. You may want to also talk to a dietitian about finding alternative sources of calcium and other nutrients to replace what you were getting from dairy products. 
If your baby’s food allergy does not resolve after a trial of eliminating cow’s milk protein from your diet, your doctor may suggest eliminating soy from your diet as well. Many babies who are allergic to cow’s milk protein are also allergic to soy protein.

Formulas Recommended for Infants with cow's milk protein allergy

It's the cow's milk protein in routine infant formulas that causes allergic reactions in infants with cow's milk protein allergy. Hypoallergenic formulas are specially formulated to reduce an infant's risk of allergic reactions to cow's milk protein. The two types of hypoallergenic formulas recommended for infants with cow's milk protein allergy include extensively hydrolyzed formulas and amino acid-based formulas for babies who have more severe allergies.

Extensively Hydrolyzed, Hypoallergenic Formulas for cow's milk protein allergy

Proteins are made of numerous amino acid building blocks linked together to form long chains. The immune system of a baby with cow's milk protein allergy mistakenly sees some cow's milk protein chains as harmful, and allergic reactions occur as it tries to fight them off. Imagine breaking apart these long protein chains into lots of smaller chains. That's what the cow's milk protein in Nutramigen® A+® with LGG® looks like. The cow's milk protein chains in extensively hydrolyzed, hypoallergenic formulas like Nutramigen A+ with LGG are so thoroughly broken into tiny pieces (what's known as hydrolyzed) that the immune systems of most infants with cow's milk protein allergy no longer recognize the milk protein as a threat.

 

Amino Acid-Based Formulas

 

Most babies with cow’s milk protein allergy do well on an extensively hydrolyzed formula, however, in some severe cases, an amino acid formula (such as PURAMINO A+®) may be recommended.
Unlike routine infant formulas where hundreds of amino acids link to form long chains of cow's milk protein, or extensively hydrolyzed formulas where fewer amino acids link to form small protein chains, amino acid-based formulas contain no cow’s milk protein. Amino acid-based formulas are made with the building blocks of proteins: amino acids. An amino acid-based formula like PURAMINO A+® contains no cow's milk protein. Many doctors prescribe amino acid-based formulas for infants who experience severe allergic reactions (such as serious breathing difficulties and anaphylactic shock) to cow's milk protein. Amino acid-based formulas may also be recommended for infants with multiple allergies to foods, including cow's milk protein, soy, eggs, wheat, peanuts, tree nuts, and fish.

Products Not Recommended for Infants with cow's milk protein allergy

With so many infant formulas on the market, it can be difficult to figure out which one is best for a baby with cow's milk protein allergy. You should always follow your doctor's advice. In general, though, the following formula types are not recommended for infants with cow's milk protein allergy:
Partially Hydrolyzed Formulas for cow's milk protein allergy
Partially hydrolyzed formulas might seem like a good option for babies with cow's milk protein allergy because they're designed to be tummy friendly. But even though the cow's milk protein chains in these formulas are partially broken down or hydrolyzed, they're still big enough to cause allergic reactions in infants with cow's milk protein allergy (that means these formulas are not hypoallergenic).
Lactose Free Formulas for cow's milk protein allergy
Lactose is a naturally occurring carbohydrate, or sugar in milk. Lactose Free formulas are cow’s milk based formulas with the lactose removed. Lactose Free Formulas still contain whole intact cow’s milk protein and are therefore not appropriate for babies with cow’s milk protein allergy.
Soy-Based Formulas for cow's milk protein allergy
If a protein in cow's milk is bothering your baby, it might seem like a good idea to switch to a formula that isn't made from dairy, such as one made with soy protein. However, many babies with cow's milk protein allergy also are allergic to soy protein. Therefore, the Canadian Pediatric Society and the American Academy of Pediatrics do not recommend soy formulas for babies with cow’s milk protein allergies.1,2
Other Milk Sources

Formulas made with goat's or sheep's milk are not recommended for infants with cow's milk protein allergy because their milk proteins are very similar to cow's milk protein and can cause allergic reactions. Other milks made from soy, almonds, coconut and rice are not nutritionally complete and should not be given to infants.

 

1. Bhatia J et al. Pediatrics 2008;121:1062-8. 2. Canadian Pediatric Society. Pediatr Child Health 2009;14:109-13.