Bottle-Feeding an Infant With Cows’ Milk Allergy

Medically Reviewed by Dan Brennan, MD on December 06, 2022
2 min read

Babies should be fed exclusively breast milk or infant formula for the first 6 months of their lives, at which point you can start to introduce solid foods, though breast milk or formula should remain the main drink. If you are bottle-feeding your infant, and they have a cow's milk protein allergy, your doctor can recommend a hypoallergenic, cow’s milk protein-free formula.

Extensively hydrolyzed formulas (eHFs): About 90% of infants with a cow's milk protein allergy can tolerate extensively hydrolyzed formulas. Although these are based on cows' milk, so the nutrient content is the same as normal infant formulas, they have been extensively broken down into tiny parts so that the child's immune system is less likely to recognize the protein. There are a number of products available, and your doctor or dietitian will be able to recommend an appropriate one for your child.

Amino acid formulas (AAFs): If your child has difficulty with a hydrolyzed formula, or has severe symptoms -- such as severe skin or gastrointestinal symptoms or has had an episode of anaphylaxis -- an amino acid formula may be recommended. A number of products are available, and your doctor or dietitian will be able to recommend an appropriate one for your child.

There are a number of different types of milk, but it should not be assumed that these are suitable for a baby or child with a cow’s milk allergy.

A soy formula is available for babies with milk intolerance, but infants with a cow’s milk allergy can also react to soya, so a non-milk, non-soy formula is a better choice. But a soya formula can be given to a child from 6 months of age if an allergy specialist has established that the infant does not have a soya allergy. As soya formulas often have added glucose syrup as a sweetener, if you do give your infant a soya formula, ensure you take special care of your baby's teeth.

Milk products from other animals such as goats, sheep, buffalo, and horses, should not be given to a child with a cow's milk protein allergy. The proteins in their milk are similar to those in cows' milk, so they can also trigger a reaction.

Soy, oat, coconut milk, and plant-based milk substitutes are not suitable as a replacement for infant formula, but can be given to children over 2 years old, and rice milk can be an option once they reach 4 1/2 years old. Look for brands that have been fortified with calcium.