Bottle-Feeding an Infant With Cows’ Milk Allergy

Reviewed by Hansa D. Bhargava, MD on January 20, 2021 baby formula powder

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 cows' milk protein allergy, your doctor can recommend a hypoallergenic, cows’ milk protein-free formula.

Extensively hydrolysed formulas (eHFs): About 90% of infants with a cows' milk protein allergy can tolerate extensively hydrolysed 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 recognise 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 hydrolysed 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.

Can I Give My Infant Other Types of Milk?

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 cows’ milk allergy.

A soya formula is available for babies with milk intolerance, but infants with a cows’ milk allergy can also react to soya, so a non-milk, non-soya 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 cows' 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.

Show Sources


Allergy UK: “Milk Allergy.”

NICE Clinical Knowledge Summaries: “Cows' milk protein allergy in children.”

Nemours Foundation: “About Milk Allergy.”

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