By Guest Author: Dr Kyla Smith

Did you know that about 1 in every 50 Australian toddlers have a cow’s milk allergy? This means that drinking cow’s milk and eating other dairy products like yoghurt, cheese and custard, can make these kids feel pretty unwell.

Signs that your child might have a cow’s milk allergy

Most kids have allergy symptoms that could quite easily be related to other medical conditions, like reflux or gastroenteritis. This makes it tricky for parents (and doctors) to work out exactly whether the child has a cow’s milk allergy.

The timing of the symptoms may help your doctor to make a diagnosis. If your child’s symptoms start almost immediately after consuming cow’s milk or other dairy products, then your child might have a more severe cow’s milk allergy. If the symptoms are delayed, then your child might have a milder cow’s milk allergy.

Watch for these signs immediately after having cow’s milk or other dairy products:

  • Vomiting
  • Diarrhoea
  • Swelling, particularly around the face
  • Redness of skin
  • Hives (raised red bumps or welts), especially where the milk has touched the skin
  • Anaphylaxis (this is a severe reaction and needs IMMEDIATE medical attention. Symptoms include excessive coughing, wheezing, difficulty breathing or general body floppiness)

Children who react immediately to cow’s milk are also likely to have other allergies to foods, like peanuts. With a more severe allergy, you might notice that your child isn’t gaining enough weight over time.

If the symptoms are more generalised, and occur hours or days after cow’s milk consumption, then look out for these signs:

  • Vomiting
  • Diarrhoea
  • Eczema
  • Flecks of blood in stools (often with mucus)
  • Constipation (there’s limited evidence to show how cow’s milk allergy causes constipation, but it’s something that I see quite regularly in my practice)

Most kids who experience these delayed-onset symptoms are still growing well.

If you suspect any kind of food allergy, try keeping a food and symptom diary for at least a week. This will help your doctor understand your child’s symptoms.

Diagnosing Cow’s Milk Allergy

The time taken for symptoms to appear tells us a bit about the type of cow’s milk allergy your child might have, and the best way to diagnose it.

If you suspect that your child is having a reaction soon after having cow’s milk, then you can ask your doctor to arrange for allergy testing. The two best methods of testing are a skin prick test, or a blood test known as IgE testing.

Allergy Testing if Your Child has Immediate Symptoms

Skin prick test: This involves a small amount of the cow’s milk protein being placed on a small area of the child’s skin, and a gentle prick mark is made. The reaction on the skin can be interpreted by an allergist. Please know that this should only be performed by an experienced medical professional.

IgE testing (previously known as RAST testing): This blood test measures levels of specific IgE antibodies in the blood, which are elevated if your child is allergic to cow’s milk.

These two tests are the only reliable and well-accepted methods of testing for cow’s milk allergy.

Allergy Testing if Your Child has Delayed-Onset Symptoms

Your doctor may not order allergy testing if your child doesn’t have an immediate reaction to cow’s milk, because it is likely that the tests will come back negative. Children can still have a cow’s milk allergy if these tests are negative, it just means that your child’s reaction is different to what the tests pick up.

A negative test result might also mean that your child is not allergic to cow’s milk. If you try a cow’s milk free diet and don’t see any improvement, then you might want to investigate other causes, like reflux or other allergies. If your child has recently had a bout of gastro, then it is very common for the child to take a week or two to tolerate dairy foods again.

What to Feed Children With a Cow’s Milk Allergy?

First Things First

Before you do anything, please make an appointment to see a paediatric dietitian who specialises in childhood allergies. A dietitian can help you to understand which foods to choose to keep your child symptom-free, as well as making sure your child gets all of the nutrition they require.

Under 6 months:

If you are breastfeeding and your child is having allergy-related symptoms, then you might need to eliminate cow’s milk from your own diet. The good news is that you will usually see a change in your baby’s symptoms within 3 days, so you’ll know if the change in diet is helping.

If you are formula feeding, your doctor will prescribe a formula that has all of the protein pieces broken down, so as not to trigger your child’s allergy. In Australia, this might be a formula called Alfaré, Pepti Junior, Allerpro, Neocate or Elecare.

 

Older than 6 months:

If your baby has started solids, then you can continue to breastfeed while you introduce milk-free solids (see how to avoid milk and dairy foods below). You might need to exclude milk from your own diet, depending on your baby’s symptoms.

If your baby is formula fed, then your doctor might suggest that you use a soy-based formula. If that doesn’t help, then you might be prescribed a special formula called Alfaré, Pepti Junior, Allerpro, Neocate or Elecare. You will also need to offer solid foods that don’t contain any milk.

Feeding Your Toddler:

If your toddler has a cow’s milk allergy then it’s important to avoid all foods that come from milk, or include milk in the ingredient list. In Australia, the law states that any food containing milk must have this written on the label e.g. “This product contains milk.”

Foods To Avoid Ingredients to Avoid
  • Cow’s milk (including lactose free milk)
  • A2 milk
  • Goat’s milk
  • Cheese (all types)
  • Butter
  • Yoghurt
  • Cream
  • Ice cream
  • Custard
  • Buttermilk
  • Sour cream
  • Ghee (clarified butter)
  • Cheesy spreads
  • Milk powder
  • Whey
  • Casein
  • Milk solids
  • Caseinate
  • Lactalbumin
  • Lactoglobulin
  • Condensed milk curd
  • Milk protein
  • Hydrolysates (casein, milk protein, whey)
  • Milk derivative
Hidden Sources of Milk

Make sure you always check the label of packaged foods. Foods like Milo, cakes, biscuits, tinned soups, gravy and breakfast cereals will commonly include milk as one of the ingredients!

Getting Enough Calcium

Calcium: The Important Nutrient

When avoiding foods containing cow’s milk, it’s likely that your child might not get enough calcium. This is an important nutrient for healthy development of teeth, bones and muscles.

Drinks

The easiest way for your child to get enough calcium is to use soy products in place of traditional dairy products. After the age of 1, your child can drink regular soy milk (just check that it’s got at least 120mg of calcium per 100g on the nutrition information panel).

Rice or oat milks are not usually recommended to replace regular milk, because the amounts of protein and fat (which are important for growth) are much lower than in cow or soy milk.

Soy Products

Other soy products such as soy yoghurt and soy cheese can also be a source of calcium, although they don’t have as much calcium as regular yoghurts and cheeses. Again, check that the calcium listed on the nutritional panel is close 120mg/100g. If calcium isn’t listed, then it’s likely not a good source.

Brands of soy yoghurt available in Australian supermarkets include Soy Life and Kingland yoghurts. Brands of soy cheese include Kingland and Daiya. Soy ice cream is a popular replacement for regular ice cream, but just be aware that it provides very little calcium. Nuttelex is a good replacement for butter or margarine.

Other Sources of Calcium

Other foods can provide some calcium, but it can often be hard to meet your child’s dietary needs from these foods alone. Check out your child’s requirements below, and see which foods contribute some calcium. Fish, like sardines and salmon, can be an excellent source of calcium if you choose a type where you eat the small fish bones.

Calcium Requirements
  • Children aged 7-12 months need 270mg of calcium
  • Children aged 1-3 years need 500mg of calcium.
Food Amount of Calcium
1 cup of soy milk ~275mg
1 tub of soy yoghurt (200g) ~90mg
1 tin of sardines with bones (100g)
~367mg
3 florets of broccoli ~22mg
½ a cup of bok choy ~49mg
10 almonds with skin on
~30mg
75g of firm tofu ~240mg
1 tbsp. of sesame seeds ~6mg
100g tin of Australian salmon with bones ~350mg
30g serve of calcium-fortified breakfast cereal (e.g. Cheerios or Special K) ~200mg
1 tbsp. of Tahini (sesame seed paste) ~55mg
1 tbsp. of sunflower seeds ~15mg

Will my child outgrow their allergy?

The great news is: most likely YES! As a baby gets older, most breastfeeding Mums find that they can relax their own diet and start to include dairy products again. Current statistics suggest about 50% of babies with a cow’s milk allergy can tolerate cow’s milk through breast milk at 6 months and almost 95% can tolerate this after 9 months of age.

As your child gets older, your doctor might also recommend a ‘challenge’ to see if your child has outgrown their allergy. Depending on the severity of the allergy, this might take place in the hospital or at home. Dietitians use a tool called the Milk Ladder to show you the steps to gradually help your child tolerate dairy products again. Most children outgrow their cow’s milk allergy by 4 years of age.


If you have any questions about your child’s cow’s milk allergy, please get in touch with a paediatric dietitian. You can find an Australian dietitian on this website http://dmsweb.daa.asn.au/dmsweb/frmfindapdsearch.aspx

You can also find very reliable information about all food allergies on the Australasian Society of Clinical Immunology and Allergy (ASCIA) website http://www.allergy.org.au

Please note that the information in this blog is provided for educational purposes. It is not meant to replace the advice of a dietitian, nor medical care for a child. The calcium content of foods is taken from NUTTAB, Australia’s reference nutrient database.


About the author of this blog post:

Dr Kyla Smith is a paediatric dietitian specialising in fussy eating, feeding difficulties and childhood nutrition. She has a private practice called Mealtime Building Blocks in Perth, Western Australia. You can connect with Kyla on her website  and her Facebook page  or on Instagram 

You can also email her at kyla@mealtimes.com.aucows-milk-allergy-kyla-dietician-logo

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