Milk free diet for babies

CMPA Video 4 Thumbnail.jpg CMPA Video 5 Thumbnail.jpg

Formula feeding a baby with cow's milk protein allergy (video 4) Milk free weaning for babies with cow's milk protein allergy

Why a milk free diet?

Around 3% of children develop non-IgE Cow's Milk Protein Allergy (CMPA). In most cases a strict cow's milk free diet is needed to manage the symptoms of the allergy. This information will help you avoid cow's milk whilst making sure your child gets all the nutrition they need to grow and develop.

Which milk should be excluded?

Avoidance needs to include fresh, UHT, sterilised and dried cow’s milk. The diet should be free of cow's milk protein (casein and whey) and milk sugar (lactose). Other mammalian milks are not suitable alternatives to cow's milk as their protein structure is similar and may still cause an allergic response. Therefore, do not use milks such as goats, sheep, camel and buffalo milk.

Replacing cow's milk

Cow’s Milk is an important source of nutrition for babies and children. If you breast feed your baby, continue to breast feed, while following a milk free diet (milk free diet for breastfeeding mums). If your baby is taking an infant formula, it needs to be a milk free formula.

Important to remember - occasionally, breast fed babies can react to milk proteins transferred in breast milk from the mother’s diet. If your baby develops symptoms only on introduction of cow's milk in weaning/cow's milk containing feed (infant formulas), we encourage you to return to full breast feeding, and continue with milk free weaning. It is important to remember that if your baby does not have any symptoms on breast feed, while you (mother) are consuming cow's milk, you can continue to consume cow's milk containing foods in your diet.

Suitable infant formula free of cow's milk proteins

Your baby may have been prescribed a formula such a Alimentum, Althera, Nutramigen LGG, Aptamil Pepti (or more rarely Alfamino, Puramino, Neocate or Elecare). They should continue this until 12 months or as advised by your Health Care Professional.

Most babies aged 6-12 months need approximately 600ml (20oz) each day to ensure they are meeting their nutritional needs, especially Calcium.

Over 1 year this amount reduces to approximately 350ml (12oz).. Check with your Health Visitor or Dietitian if you have concerns about your child’s calcium needs.

Other alternatives to cow's milk for cooking

A variety of plant based calcium enriched cow's milk substitutes fortified with calcium are available to buy from most supermarkets. They can be used in cooking from six months of age or as a main drink after one year old.

Examples include:

Oat milk

Soya milk – soya milk should not be given to babies under 6 months of age. Soya can be introduced as part of weaning in the form of soya yogurts/pudding or cooking after 6 months if soya is safe for your child. Some children with non-IgE milk allergy may also be allergic to soya. Please be guided by your dietitian. Soya milk can be used as a main drink after 1 year of age.

Nut milk alternatives (almond, coconut, cashew, hazelnut),

Hemp milk/pea milk/coconut milk

Rice milk should not be given to children under four and a half years old. This is due to concerns about arsenic content.

Babies with milk allergies can and should have nuts (in the form of nut butters) introduced into their diets to reduce the chance of allergies in later life. (as long as they have not had any allergic symptoms)

Always choose a milk alternative that is fortified or enriched with calcium - they should provide at least 120 mg of calcium/100mls. Organic versions do not usually have calcium added - check the label.

Foods to avoid

Look for the list of ingredients printed on the package and avoid foods which have 'milk' in bold on the label. When eating out, food outlets need to provide you with allergy information by law, so always ask.

Check with your pharmacist about tablets or medicines which may contain milk protein and/or lactose.

Introducing solids (weaning)

Starting solids for a baby who has Cow's Milk Allergy should be the same as for a non-allergic baby, however you must not give any foods that contain cow's milk or dairy products (example yogurt, fromage frais, cheese, cream or butter). You should aim to start solid foods at around six months, but not before four months (17 weeks). If your baby is premature, check with your dietitian about the best time to start. For general information on introducing solids, check the NHS choice website page your baby's first solid foods - NHS (www.nhs.uk)

Adapting recipes

Many recipes can be adapted by using your chosen supermarket milk alternative. Use a milk free margarine instead of butter, milk alternatives in place of milk, and vegan cheese in place of cheese. Try making up batches of milk free meals/puddings and freezing them.

What about calcium?

Calcium is needed for strong teeth and healthy bones. It is important that breast feeding mum's and children on a cow's milk free diet our meeting that calcium requirement. The following table shows how much is needed for each age group:

Babies under 1 year of age – 525 mg calcium per day

1-3 year olds- 350 mg calcium per day

Breast feeding mothers – 1250 mg calcium per day

Sources of Calcium (portion size are not necessarily baby size!)

Best source - Food providing 250mg of calcium	Portion size
Sardines/pilchards - canned (including bones)	60g or half a tin
Soya cheese	55g
Tofu	50g
Calcium-enriched milk alternatives	200mls
Foods providing 150mg of calcium	Portion size
Curly kale/spring greens/spinach	90g
Tahini paste (sesame seed paste)	20g (1tsp)
Fortified breakfast cereal (check label for 'soya' and 'milk)	35g
Soya yogurt/dessert	125ml pot
Food providing 100mg of calcium	Portion size
Tinned salmon	115g or half a tin
Broccoli	90g
Baked beans / kidney beans	200g or half a tin
Food providing 50mg of calcium	Portion size
White bread	60g (2 slices)
White flour products e.g. milk free hot cross buns	1
Cabbage	90g
Dried figs	20g or 1 dried
Foods providing 25mg of calcium	Portion size
Dried apricots	50g or small handful size
Chapatti x 1	55g
Egg	1 medium
Hummus	50g
Dried fruit e.g. sultanas	50g or 2 tablespoons
White fish poached in water	170g
Wholemeal bread x 2 slices

What about Vitamin D?

Vitamin D is needed by the body to absorb calcium/regulate calcium and phosphate in the body. Our body creates Vitamin D from direct sunlight on the skin when outdoors. Vitamin D is also found in a small number of foods. Vitamin D is only found in a few foods so a supplement is recommended for everyone

A supplement containing Vitamins A, C and D can be given from 6 months, (Healthy Start Vitamins) (Department of Health advice). It is advised that breastfed babies take a vitamin D supplement from birth.

Supplements are available to purchase in pharmacies and supermarkets, or may be available online.

NB micrograms (mcg) can also be written as μg.

Target group	Recommended supplement (SACN 2016)	Do not exceed
Breastfeeding mothers	Equivalent to 10 micrograms/day or 400IU	100 micrograms/day
Breastfed babies up to 12 months	Equivalent to 8.5-10 micrograms/day or 350-400IU	25 micrograms/day
Formula fed babies up to 12 months	Only if less than 500mls formula/day	25 micrograms/day
Ages 1-4 years	Equivalent to 10 micrograms/day or 400IU	50 micrograms/day