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    • CMA symptoms can be managed by eliminating cows’ milk protein from your child’s diet.

      There are several substitutes available - including formulas containing cows’ milk proteins which have been changed or broken down (these are called ‘hydrolysed formulas’)and formulas that contain no cows’ milk protein at all (these are sometimes called ‘amino acid-based formulas’).

      Because all children need proteins for growth and development, proteins can’t be completely removed from your child’s diet. So milk proteins must be replaced by alternatives. However, the majority of infant milk formulas you may be familiar with contain ‘intact or whole’ milk proteins and protein fragments (in other words, cows’ milk proteins which haven’t been changed or broken down). So many baby milk formulas aren’t suitable either.

    • What are the types of infant formula?

    • Standard infant formulas that you can buy in a supermarket or local shop

      These are not suitable for babies allergic to certain proteins. This is because they are made with cows’ milk powder which has been modified to provide what is needed in a baby’s diet but still contain whole cows’ milk proteins. These proteins can cause allergic reactions in babies with CMA.

      Extensively hydrolysed formulas (eHF)

      These are formulas considered ‘foods for special medical purposes’ and are prescribed by a doctor for the management of CMA. Here the cows’ milk protein has been broken down into small fragments. However, depending on the type of milk allergy (immediate or delayed), eHFs may cause allergic symptoms in some children with severe cows’ milk allergy.

      Amino acid-based formulas (AAF)

      These formulas are also prescribed by the doctor for infants with CMA. They are similar to most other infant milks except for one important difference. Instead of being based on whole or broken down cows’ milk protein, they are based on amino acids, sometimes known as the building blocks of protein. These individual amino acids are so small that they are not recognised by the immune system and so are very unlikely to provoke any allergic reaction in children with cows’ milk allergy.

      Soya milk

      Soya formula used to be the only product that could be given to infants and children with CMA. Nowadays, formulas based on amino acids or hydrolysed proteins are widely available and are generally deemed to be more appropriate.

      Soya infant formulas contain soya protein derived from soya flour, and a mixture of carbohydrates in the form of sucrose and corn syrup. Medical guidelines in the UK and the USA do not recommend soya products for infants under the age of 6 months and so should only be used in specified circumstances. If your child is over 6 months and your child’s doctor suggests a soya formula because of CMA, tolerance to soya protein may well need to be checked first.

      Other milks

      In some countries, milk from other mammals such as goats and sheep, have traditionally been used for feeding infants with CMA. Such milks are not always tolerated by babies allergic to cows’ milk as the proteins are very similar in structure to cows’ milk protein. Cereal milks could be another option, but if these milks are not fortified, some vitamins and minerals may be missing, and there could be inadequate amounts of essential nutrients your baby needs. Equally, it is recommended by the UK’s Food Standard Agency that children under the age of 4.5 years do not consume rice milk.
    • Check with your child’s doctor or dietitian before feeding your child any of the alternatives above to make sure they can tolerate them and whether they meet your baby’s dietary requirements.

Next in this section Relieving Symptoms
Next section Growing up with CMA