A child with cow milk allergy needs to avoid cow milk and all foods, drinks and formulas derived from cow milk. Cow milk allergic children may develop allergic reactions to other foods proteins (allergens) too. This is thought to be most likely in the first six months of life because of the immaturity of the gut and immune system in young babies.

How do the parents of babies and young children with cow milk allergy go about avoiding cow milk and other potential new allergens?

For most babies, the best way to avoid cow milk and other allergens is through breastfeeding. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life for all babies and this is good advice for allergic babies too. But a baby may show allergic symptoms despite exclusive breastfeeding. This needs careful handling and is discussed in details with your doctor.

In the non-breastfed baby who is only consuming standard infant formula based on hydrolysed milk protein, the avoidance of cow milk is achieved through removing the standard infant formula and replacing it with a nutritionally complete, hypoallergenic formula, as Neocate. Most experts agree that, in such cases, no new foods should be introduced to the diets of such children until the age of six months.

After the age of six months, the baby’s gut and immune system have matured. For nutritional and developmental reasons, solid foods now need to appear in the diet. This provides more of a challenge because all of these solid foods need to be free of cow milk and there is also a risk of the baby developing food allergies to some of these new food proteins.

A common-sense approach to expanding the child’s diet while avoiding food allergic symptoms is as follows:

• As with any child, solid foods need to be introduced gradually. This basically involves a move from pureed food, to slightly lumpy food, to bigger lumps and chunks, to finger foods and eventually to family meals. Every child is different and the pace of progression through these stages can vary a lot.
• As stated, wait until six months of age before introducing solid foods. This decreases the risk of a child developing new food allergies.
• Introduce only one new food at a time (e.g. rice, an individual fruit, an individual vegetable, etc). If the child does react to a food, this approach will allow easier identification of the offending food.
• It is known that some foods are more likely to provoke allergic symptoms than others. It is probably best to introduce less allergenic foods (e.g. rice, fruits, vegetables, meats) first before moving on to foods more likely to cause allergic reactions (e.g. egg, wheat, soy, fish). The doctor or dietitian can help advise on the order in which new foods should be introduced.
• Modern processed foods often contain many different ingredients, including cow milk. In order to better control what their child eats, many parents of allergic babies choose to cook their child’s meal ‘from scratch’. Sometimes this even involves cooking one meal for the child with food allergy and another for the rest of the family.
• Although cooking ‘from scratch’ is probably the ideal solution for the food allergic child, modern lifestyles often make this impractical. If processed foods are to be used, parents and anyone else involved in the feeding of the allergic child needs to learn how to properly interpret food labels. The doctor or dietitian can assist with this.