• Dr Andy Raffles

Alternatives to Milk Formula - When & Which to Use?

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 poor growth, reflux, 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.


Where a mother chooses not to breastfeed then the most likely substitute is an infant formula, based on cow’s milk. These have been scientifically modified to give the best possible nutrition. If a baby does not tolerate cow’s milk based formula, then an alternative can be used. 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.


Below 6 months of age

The only alternatives for children 6 months and younger, recognised as nutritionally complete, and reducing the risk of an allergic response, are the cow’s milk hydrolysates or amino acid preparations. There are now many different commercially available but prescription only types and use is determined by personal preference and experience.


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.


It is currently recommended that a hypoallergenic formula is continued until 2 years of age. However if dietary intake is adequate your Dietitian may change this to an alternative milk, after the age of one. There are a range of suitable milks now available, some are partially digested – called partial hydrolysed milks, suitable for many babies with cow’s milk sensitivity. These are pre-digested and are designed to be safe and nutritionally complete. They are lactose free. Others are amino acid formulas – suitable for babies with cow’s milk protein allergy. Both types are prescription only treatments and should really only be used on the advice of a Doctor and Dietitian.


For Older Children

Cow’s milk for older children, is an important source of energy, protein, vitamins and minerals for the growing child. Its importance reduces as the child eats a widening range of mixed solid food. If your child is allergic to cow’s milk, it is important to replace it with a milk alternative that will provide the same nutrition.


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.


Ready-made soya, 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. Always try to choose a brand that is fortified with calcium where possible. Organic products do not always have added calcium so check the label. If the product is not fortified with calcium, it is likely that a calcium supplement will be required.


The Food Standards Agency does not recommend giving rice milk to children before they are 4½ years old, due to issues relating to the concentration of certain non-food chemicals in the water, used to manufacture the milks and the need to concentrate the rice protein, to reach a satisfactory nutritional concentration. 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 Animal Milks

Goat, sheep etc milks, are not suitable because children who are unable to tolerate cow’s milk are at high risk of allergic reactions to other animal milks. Goat’s milk based formula, is ineffective in reducing allergic related symptoms, and is no longer recommended for otherwise healthy infants before age one year.


Follow-On Milks

Such milks which contain iron, are really only useful for babies of about one year of age who have extra nutritional needs, such as long term lung problems, or other chronic illnesses, and who are unable to tolerate solid diets.


Anti-Reflux Milks

There are several cow’s milk based formula available which have a ready added thickener for babies who have problems with reflux. They are especially useful for the mild reflux baby, where the fuss of adding Gaviscon can be avoided.


In short, 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 2, and rice milk once your child is over 4½ years old.


Food Fact Sheets on other topics including Breastfeeding and Vitamins for Babies and Children are available at https://www.bda.uk.com/food-health/food-facts.html


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