Why a milk free diet?

Around 3% of children develop Cow's Milk Protein Allergy (CMPA). In most cases a strict cow's milk free diet is needed to treat 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 well.

Which milk should be excluded?

For children with immediate symptoms to cow's milk or cow's milk products (yoghurts, cheese etc.) then usually soya does not need to be avoided. For children with delayed symptoms to cow's milk or cow's milk products then soya products do need to be avoided. Avoidance needs to include fresh, UHT, sterilised and dried milk. The diet should be free of cow's milk protein (casein and whey), milk sugar (lactose) and soya proteins. 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 and soya milk

Milk is an important source of nutrition for babies and children. If you breastfeed your baby, ideally continue to do so when introducing cow's milk and soya protein free solids. This is because breastmilk can protect against developing other food allergies. Breastfeeding mothers should also follow a milk and soya free diet (see milk free diet when you are breastfeeding).

If your baby is taking an infant formula, it needs to be a milk and soya free formula. 

Suitable infant formula free of cow's milk and soya proteins

Your baby may have been prescribed an allergy formula such a Similac Alimentum, Althera, Nutramigen LGG, Aptamil Pepti (or more rarely Alfamino, Puramino, Neocate or Pepti-Junior). 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 around 350ml (12oz). These amounts do vary according to the baby and their diet. Check with your Health Visitor or Dietitian if you have concerns about their calcium needs.

Other alternatives to cow's milk for cooking

Alternatives to milk that are 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: Nuts (Almond, Coconut, Cashew, Hazelnut), Oat or Hemp milks. Brands include Supermarket's own range, Alpro range or Oatly range. Rice milk should not be given to children under 4.5 years old. 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.

Please be aware that some milk alternatives may not be suitable for other allergies and some may be low in calories, protein, calcium and/or other vitamins and minerals. Discuss with your Health Visitor or Dietitian if unsure.

Foods to avoid

Some of the foods to avoid are obvious. However, many other foods may contain cow's milk and/or soya proteins and these should be avoided too. Look for the list of ingredients printed on the package and avoid foods which have 'milk' and/or 'soya' 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 or soya proteins and/or lactose.

Introducing solids (weaning)

Starting solids for a baby who has Cow's Milk and Soya Protein Allergy should be the same as for a non-allergic baby, except of course you must not give any foods that contain cow's milk, dairy products (see list). Aim to start around six months, but not before four months (17 weeks). For general information on introducing solids, check the NHS choice website (www.nhs.uk) and type in 'weaning' into the search box.

Adapting recipes

Many ordinary recipes can be adapted by using your milk alternative. Use a milk free margarine instead of butter, milk alternatives in place of milk, and soya/vegan cheese in place of ordinary cheese. Try making up batches of milk free meals/puddings and freezing them in ice-cube trays to allow you to serve small portions with less waste.

What about calcium?

Calcium is needed for strong teeth and bones. Babies under 1 need 525mg/day, 1-3 year olds need 350mg/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 an the best source is from the action of sunlight on the skin, however young children should not be exposed to the sun for long. 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, rather than Vitamin D alone (Department of Health advice). This is a precaution because growing children may not get enough of these vitamins, especially those not eating a varied diet, such as fussy eaters.

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