Article by Dr. Catherine Cranford | Allergy Partners of Western North Carolina

Cow’s Milk Allergic Children

Understanding Formulas and Alternative Milks

For infants and young children diagnosed with cow’s milk protein allergy, it can be stressful to think about finding a replacement for the milk which provides so much of the fat, protein, and calcium crucial to early nutrition. Fortunately, many new products can act as substitutes for children with this allergy.

A small percentage of patients will not tolerate soy, sometimes due to a coexisting soy allergy.

ALTERNATIVE

Fortunately, many products now exist which can act as substitutes for children with this allergy. Once cow’s milk allergy has been identified, many children will be switched to a soy-based formula such as ProSobee, Isomil, or Nestlé Good Start Soy.

CASEIN-BASED FORMULA

If a soy-based formula is not an option, alternatives include extensively hydrolyzed formulas and amino acid-based formulas. Alimentum and Nutramigen are both extensively hydrolyzed formulas. These examples are casein-based. These formulas contain cow’s milk protein broken down to the point where most children with milk protein allergy will tolerate them

A whey-based extensively hydrolyzed formula is Gerber Extensive HA.

Amino acid-based formulas are also sometimes used in the management of another allergic disease, eosinophilic esophagitis.

AMINO ACID-BASED FORMULA

Casein and whey are both proteins within cow’s milk to which children can be allergic, so some patients
may not tolerate these formulas. For patients intolerant to these formulas, an amino acid-based formula is an alternative which is almost universally tolerated. Examples include Elecare and Neocate.

RIPPLE MILK

As children age, they may decide to try different plant-based milks. Soy milk is the most similar to cow’s
milk among the plant-based alternatives with similar protein and calcium contents but lower fat compared to cow’s milk.

Ripple milk is a green pea-based milk which has lower carbohydrates than the other milks discussed but has similar fat, protein, and calcium content to soy milk.

Almond, coconut, oat, and rice milks contain similar amounts of calcium in a 1 cup serving compared to cow’s milk, but have significantly lower amounts of fat and protein than cow’s milk.

OTHER OPTIONS

With the exception of soy and Ripple milk, other plant-based products tend to be low in protein as compared to cow’s milk. Some fortified products exist, but labels should be
read carefully to ensure they have enough of the essential nutrients required to be a main source of nutrition.

Other grain-based and tree nut-based milks exist, again with similar pitfalls

CONSULT YOUR DOCTOR

In older children, most will get enough protein from meat and other sources to make up for the lower content in these milks, but if a child has multiple allergies or is a picky eater, a consultation with a nutritionist may be required. Toddler formulas provide a more complete source of nutrition for some children.

Keep in mind that many children who react to cow’s milk will also react to goat’s milk.

Article by Dr. Catherine Cranford | Allergy Partners of Western North Carolina

Cow’s Milk Allergic Children

Understanding Formulas and Alternative Milks

For infants and young children diagnosed with cow’s milk protein allergy, it can be stressful to think about finding a replacement for the milk which provides so much of the fat, protein, and calcium crucial to early nutrition. Fortunately, many new products can act as substitutes for children with this allergy.

A small percentage of patients will not tolerate soy, sometimes due to a coexisting soy allergy.

ALTERNATIVE

Fortunately, many products now exist which can act as substitutes for children with this allergy. Once cow’s milk allergy has been identified, many children will be switched to a soy-based formula such as ProSobee, Isomil, or Nestlé Good Start Soy.

A whey-based extensively hydrolyzed formula is Gerber Extensive HA.

CASEIN-BASED FORMULA

If a soy-based formula is not an option, alternatives include extensively hydrolyzed formulas and amino acid-based formulas. Alimentum and Nutramigen are both extensively hydrolyzed formulas. These examples are casein-based. These formulas contain cow’s milk protein broken down to the point where most children with milk protein allergy will tolerate them

Amino acid-based formulas are also sometimes used in the management of another allergic disease, eosinophilic esophagitis.

AMINO ACID-BASED FORMULA

Casein and whey are both proteins within cow’s milk to which children can be allergic, so some patients
may not tolerate these formulas. For patients intolerant to these formulas, an amino acid-based formula is an alternative which is almost universally tolerated. Examples include Elecare and Neocate.

Ripple milk is a green pea-based milk which has lower carbohydrates than the other milks discussed but has similar fat, protein, and calcium content to soy milk.

RIPPLE MILK

As children age, they may decide to try different plant-based milks. Soy milk is the most similar to cow’s
milk among the plant-based alternatives with similar protein and calcium contents but lower fat compared to cow’s milk.

Almond, coconut, oat, and rice milks contain similar amounts of calcium in a 1 cup serving compared to cow’s milk, but have significantly lower amounts of fat and protein than cow’s milk.

OTHER OPTIONS

With the exception of soy and Ripple milk, other plant-based products tend to be low in protein as compared to cow’s milk. Some fortified products exist, but labels should be
read carefully to ensure they have enough of the essential nutrients required to be a main source of nutrition.

Other grain-based and tree nut-based milks exist, again with similar pitfalls

Keep in mind that many children who react to cow’s milk will also react to goat’s milk.

CONSULT YOUR DOCTOR

In older children, most will get enough protein from meat and other sources to make up for the lower content in these milks, but if a child has multiple allergies or is a picky eater, a consultation with a nutritionist may be required. Toddler formulas provide a more complete source of nutrition for some children.

For more information about food allergies, visit www.foodallergy.org or speak with an Allergy Partners physician about diagnosis and management of cow’s milk protein allergy.