Cows' milk is an important source of energy, protein, vitamins and minerals, particularly for babies and infants.
There is a wide range of cows' milk alternatives for children that are allergic. They are available on prescription for the younger child and over the counter for older children. It is vital that you discuss the available options with your child’s GP, Health Visitor or Registered Dietitian.
Breast milk is best for babies. It provides nutrition but also a range of other benefits eg antibodies. If your baby has been diagnosed as having a cows' milk allergy, you (mum) may be advised to exclude cows' milk from your own diet. This should only be done after discussion with a Registered Dietitian, as it is important that breast-feeding mums eat a healthy balanced diet.
From Birth to Two Years
Extensively Hydrolysed Formulas
Eg NUTRAMIGEN with LGG made by Mead Johnson, APTAMIL PEPTI – made by Milupa Aptamil. These are suitable for most children with cow’s milk allergy.
Amino Acid Formulas
These formulas are recommended when an extensively hydrolysed formula has not worked. Examples include NEOCATE LCP - made by SHS, NUTRAMIGEN PURAMINO - made by Mead Johnson.
Soya based Formulas
Soya based milk is not suitable in infants under 6 months old and should only be used if recommended by a healthcare professional after 6 month of age. It is known that some infants who are allergic to cows' milk protein may also have a soya protein allergy. Soya formulas should only be used > 6 months of age if a child has tested negative for soy allergy and other alternatives have proved unsuccessful or if the family want a formula suitable for vegans after discussion with a Registered Dietitian. Examples include: SMA WYSOY – made by SMA, INFASOY – made by Cow & Gate.
Many milk substitutes have an unpleasant or at least a very different taste and smell compared to breast milk or cows' milk. It can be difficult to get some infants/children to take these alternatives - it may take persistence, or else a strategy of mixing milks together, adjusting the mix over a week or two. A Registered Dietitian will be able to help.
Goats’ milk formula, sheep’s milk etc are not suitable for children with cow’s milk allergy because the vast majority of them will also be allergic to them or will become allergic to them.
Lactose free formula – is appropriate for lactose intolerance, but is not suitable for cow’s milk allergy.
Children Over 2 Years Old
A range of milk alternatives including soya, oat, hazelnut, coconut milks may be used as a main drink. Always use a brand that is fortified with calcium. If the product is not fortified with calcium (eg many Organic products), a calcium supplement will be required. Rice based milk is not recommended for children under 5 as their main milk alternative due to arsenic levels.
Transition is the idea that a child gradually takes over responsibility for their health from their parent or carer. This involves knowing about your condition, but also maturity in terms of understanding risks, about how health services work etc.
Your doctor may wish to let your child do all the talking to begin with, or may wish to see your child on their own, perhaps just for the start of a consultation. They will want to assess whether your child:
- Know their diagnosis
- Knows their triggers
- Knows what symptoms they might get, and the difference between a mild and a severe (anaphylactic) reaction
- Knows about their medicines and how/when to use them
- Knows how to look after their medicines and replace them if necessary
It may also be interesting to consider:
- Careers (armed forces, police and emergency services may not favour recruits with potentially life threatening allergies).
- Alcohol, particularly how it can lead to more risky behaviour
- Moving away
- Relationships eg whether your friends know about your allergy, kissing when you have a food allergy
Parents are of course an important part of this process, and you will be asked how you think this can best be done for your child. You may have to get used to hearing your child’s alternative views, however!