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Dietary changes
Cows’ milk (CM)
free diet - practical
advice
When your child is allergic to cow’s milk - what does it mean for you and your family?
When your child has been diagnosed with a milk allergy by a doctor, it will mean some changes to help manage the condition. All foods containing dairy products including cow’s, sheep or goat milk, cheese, yoghurt, custard, should be avoided.
If you are breastfeeding then you may also need to remove most dairy from your diet but talk to your baby’s dietitian or doctor about this first. It is also important to learn how to identify dairy ingredients on food labels to avoid that your baby receives a hidden source of milk/dairy.
If you are not breastfeeding, there are alternative options such as specialist milks to help ensure your baby’s nutritional needs are fully met. Your dietitian or pediatrician will advise you which is the best alternative option.
Starting solid foods (or weaning) when your baby is allergic to milk.
Weaning or complementary feeding, as it is also called, is when you start giving solid foods to your baby. Solid foods should be started when you feel your baby is developmentally ready, commonly around 6 months of age, but not before 4 months.
Signs that your baby is ready for solid food is usually holding their head steady or being able to sit upright and showing an interest in food e.g., picking it up, putting it in their mouth and swallowing it (rather than spit it back out) (NHS, 2022).
What foods to
start with?
What foods can I start with when my baby has a milk allergy?
When you start giving your baby their first solids think about the texture. Ideally the first foods should be smooth like a puree (e.g. yoghurt consistency).
As your baby starts taking more solid foods (>6 months of age) you can adjust the texture to mashed with some lumps. In the table below we provided some examples. Some experts also advise that giving your baby cooked egg and then peanuts from around 4 months of age, may even protect your baby from developing other allergies (BSACI & BDA 2018).
| From 4 - 6 months | > 6 months | |
| Texture | Smooth purees (smooth porridge or fruit puree) | Well mashed foods, softer lumpier foods and softer finger foods (e.g., pieces of cooked carrots or pasta) |
| Vegetables | Root vegetables e.g., carrot, swede, sweet potato, parsnip, butternut squash, potato, yam Spinach, broccoli, green beans, courgette, cauliflower. | The same as for 4-6 months just adapt the texture. |
| Fruits | Soft, cooked pureed/mashed fruits e.g., apple, pear, banana, plum, peach, apricot, avocado | Soft mashed or soft pieces of fruit e.g. apple, pear, banana, plum, peach, apricot, avocado |
| Carbohydrates | Smooth cereals, e.g., ground rice, flaked rice, ground quinoa, cornmeal | Rice e.g., baby rice, cooked flaked rice Ground quinoa Polenta (corn meal) Gluten containing foods (wheat, barley, rye) – bread and cereals, oats, pasta, couscous, chapatti Potatoes |
| Protein | Pureed pulses/lentils Smooth nut spreads Non-vegan/vegetarians Meat and poultry (pureed) Well-cooked pureed egg |
Mashed lentils and pulses e.g., haricot beans, kidney beans, butter beans Nut spreads Non-vegan/vegetarians Red meats (lamb, beef), pork Poultry (pureed or finely shredded and chopped) Fish Well-cooked mashed boiled or scrambled egg |
Plant-based and
vegan options
Why are alternative plant-based drinks (bought over the counter) not possible to use as the main drink for my baby?
Plant-based drinks that you buy in the shops can be low in some important nutrient’s, such as protein, calcium, important fats and important vitamins (B12, B2, D, and E) (Luyt et al., 2014).
Protein, vitamins and minerals are needed for your baby’s growth and development. These drinks are therefore not suitable as the main drink for your baby and should not replace breastmilk or the special infant formula prescribed by your baby’s doctor. They can be used however to mix with weaning foods or when cooking, instead of cow’s milk. Ideally the unsweetened versions.
From 1 year of age your baby can have unsweetened calcium-fortified plant-based alternatives, such as soya, oat or almond drinks, as part of a healthy, balanced diet (NHS, 2022; US;l Luyt et al., 2014).
Rice drinks may contain arsenic and therefore should be avoided until your child is at least 5 years old (NHS, 2022). The British Association of Allergy and Clinical Immunology (BSACI) advice that a nutritionally complete specialist infant formula should be chosen, preferably up to 2 years of age (Luyt et al., 2014).
Why are alternative plan-based drinks (bought over the counter) not possible to use as the main drink for my baby?
Well-planned vegan or vegetarian diets that are balanced, containing a variety of plant-based foods and fortified foods, are also safe for your baby. However, if your baby is vegan, we strongly advise that you seek advice from a dietitian. This is to make sure your baby gets all the essential nutrients they need to grow and develop properly. When a vegan diet is not properly managed, it can lead to serious nutritional deficiencies (Female et al., 2019; Desmond et al., 2021; Gasparre et al., 2022).
So, if your baby is following a vegan diet and they are not taking a specialist formula, then they may need an additional supplement containing extra vitamins and minerals (Lemale et al., 2019). Your baby’s dietitian can help you select the most appropriate supplement.
Protein is important for growth so make sure your baby has a good supply of vegan protein sources e.g., beans, lentils, tofu, nuts and seeds (in an appropriate texture). In addition, look for calcium supplemented plant-based drinks or yoghurts. Iron is another important nutrient for your baby and helps with their growth and development.
Good vegan sources of iron include fortified cereals, pulses, some nuts e.g., cashew (ground or butter), and seeds like ground chia, linseed, hemp or pumpkin seeds. These should always be in an appropriate texture.
Finally, if you add vitamin C-rich foods, such as peppers, oranges, kiwi and broccoli to your baby’s meals, it will help them get more iron from their food (First Steps Nutrition Trust, 2017).
