Cow’s milk alternatives in CMPA

I have written a detailed blog post about this topic (here) but I wanted to summarise the main points…

Breast milk is the ideal milk for babies and children with CMPA and is recommended up to 2 years of age. Whether mum needs to exclude dairy from her diet or not has been discussed in a previous post.

What nutrition does cow’s milk provide?

We all know that cow’s milk provides a good source of complete protein, which means it contains all the essential amino acids (building blocks of protein) important for growth and repair of our cells. I am sure we all also know that milk is a great source of calcium (typically 120mg/100ml) but it is also an important source some other vitamins and minerals, such as riboflavin (vitamin B2), vitamin B12 and iodine.

CMPA babies and children

All babies under 1 year of age and up to 2 years of age, who cannot tolerate cow’s milk protein (or soya protein) should receive either breast milk or a suitable infant formula such as an extensively hydrolysed or amino acid based formula. I’ll speak more about these options in tomorrow’s post.

Fortified plant-based drinks can be used in cooking or over cereals for infants from 6 months of age, but should NOT be used as a main drink until the child is at least 18 months to 2 years of age and eating a diet sufficient in calories, protein, fats, vitamins and minerals. I would suggest an assessment by a registered paediatric dietitian.

My top tips

  • Always look for plant-based drinks that are fortified with calcium and vitamins (organic varieties are not fortified)
  • If your child is under 5 years of age, do not use rice milk, due to its arsenic content, rather choose another plant-based drink
  • Consider the nutritional content of the rest of your child’s diet…plant-based milk alternatives are generally low in calories and protein…calories, protein and fats can be compensated for in other foods. Such as nut butters, avocado, olives, olive/rapeseed oil, seeds, hummus as well as oily fish and eggs (if not vegetarian or vegan).
  • Nut-based drinks contain very few actual nuts….almond milk typically contains only 2% almonds!

Milk substitutes for under 2’s with CMPA

Breast milk is the ideal milk for babies. It provides all the nutrition that a young baby requires in their early months and the composition continually changes to meet your baby’s needs.

When a baby is diagnosed with CMPA, mothers who are breast-feeding should be supported to continue breastfeeding for as long as they are happy to, preferably until 2 years of age.

A breastfeeding mum of a baby with CMPA may be advised to exclude cow’s milk from her own diet. This should only be done after discussion with a dietitian, as it is important that breast-feeding mums eat a nutritionally balanced diet. Suitable supplements providing calcium and iodine in addition to vitamin D may be required. See my previous post for further information on ‘breastfeeding and CMPA’.

If you need to give formula milk in addition to breast milk or as an alternative, a range of hypoallergenic formulas especially designed for infants with cow’s milk protein allergy (CMPA) are available on prescription. These are extensively hydrolysed formulas and amino acid formula.

Extensively Hydrolysed Formulas

These formulas contain proteins that have been broken down (hydrolysed) into smaller segments so that the body does not recognise them as allergens. Therefore this type of formula is very unlikely to cause an allergic reaction.

There are different types of these formulas. Some are based on whey and others are based on casein, which are both proteins found in cow’s milk. Some hydrolysed formulas contain lactose and some do not.The majority of children with CMPA (90-95%) will tolerate an extensively hydrolysed formula.

Amino Acid Formulas

These formulas are based on the individual building blocks (amino acids) that make up a protein and are used for children with severe CMPA that still have have symptoms on extensively hydrolysed formulas.

Mammalian milks

Other mammalian milks such as goat’s milk formula, sheep’s milk, buffalo milk etc are not suitable for babies with CMPA because the proteins in all mammalian milks are very similar and therefore likely to also result in an allergic reaction.

Taste/smell of EHF and AAF

These specialist formulas have a very different taste and smell compared to breast milk or standard infant formula. Some children may take time to get used to this when theses are first introduced. Mixing the new formula with expressed BM and using a covered cup can help with the introduction of these specialist formulas. Speak with your dietitian for further support.

Use the milk substitute until your child is 18 months – 2 years of age.

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 and mineral supplement.


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