Cow's milk is an important source of energy, protein, vitamins and minerals for the growing child. If your child is allergic to cow's milk, it is very important to replace it with a milk alternative that will provide the same nutrition.
This fact sheet is a guide to the range of options that are available, but should not be used to replace individual professional advice.
Get medical advice
A wide range of cow's milk alternatives are available on prescription for younger children and over-the-counter for older children.
It is important that you discuss the available options with your child’s doctor, health visitor or dietitian to ensure they get the best choice for them.
Breast milk is best for babies. It provides all the nourishment that a young baby needs, as well as many other non-nutritive factors such as antibodies.
The nutrients in breast milk are easily digested and absorbed and the composition of your milk continually changes to meet your baby’s needs. If your baby has been diagnosed as having a cow's milk allergy and has ongoing allergic symptoms (for example diarrhoea and/or eczema) while being breastfed, you may be advised to exclude cow's milk from your own diet. This should only be done after discussion with a dietitian, as it is important that mums who breastfeed have a healthy balanced diet.
If you are not breastfeeding, or are mixed feeding, your doctor or other healthcare professional will prescribe you the most suitable ‘hypoallergenic’ formula milk. This is suitable for an infant with a cow's milk allergy.
Hypoallergenic formulas from birth to two years
Extensively hydrolysed formulas - these formulas contain proteins that have been broken down into smaller segments so they are less likely to cause an allergic reaction. It is important to discuss the best option with your healthcare professional. Examples include:
- extensively hydrolysed formulas based on casein (a protein in cow's milk)
- extensively hydrolysed formulas based on whey (a protein in cow's milk). Some of these may contain prebiotics that promote the growth of good bacteria in the gut and lactose, which improves the taste but may not be suitable for all babies.
Amino acid formulas - these formulas are based on the individual building blocks (amino acids) that make up a protein and are tolerated by most babies with a cow's milk allergy. Amino Acid formulas are recommended when an extensively hydrolysed formula has either not been tolerated or is not an appropriate first choice.
Soya based formulas - these formulas are not suitable as a first-line alternative for infants under six months of age. In infants over six months of age, your dietitian can advise whether a soya formula is suitable.
Children over two years old
It is currently recommended that a hypoallergenic formula is continued until two years of age. However if dietary intake is adequate your dietitian may change this to an alternative milk after the age of one. Ready-made soya, hemp, oat, coconut or other milk alternative may be used as a main milk drink after two years of age, but the choice may depend on your child’s nutritional status.
The Food Standards Agency does not recommend giving rice milk to children before they are four-and-a-half years old.
Always try to choose a brand that is fortified with calcium where possible. Note: Organic products do not always have added calcium. If the product is not fortified with calcium, it is likely that a calcium supplement will be required.
If you are unable to get your child to take any of the above milk substitutes, it is important to seek advice from a dietitian as it may be necessary to start a vitamin or mineral supplement.
Other cow's milk alternatives
Other animal milks (goat, sheep etc.) are not suitable because children who are unable to tolerate cow's milk are at high risk of allergic reactions to other animal milks.
- Many milk alternatives have a very different taste and smell compared to breast milk, regular infant formula or cow's milk.
- It can take time for some infants and children to get used to the taste of a new product, so allow some time before you give up trying to introduce it.
- A dietitian will be able to give you advice about how to encourage your child to take the milk alternative or suggest suitable alternatives.
It is really important that you get individual advice from a qualified health professional so that you can give your child the best possible start. There are different types of hypoallergenic milks which are suitable for different age groups of babies/children with a cow's milk allergy. You can also use alternative milks such as soya or coconut once your child is two, and rice milk once your child is over four-and-a-half years old.