Milk Allergy in Babies and Toddlers

Read time: 3 minutes

Cow milk allergy can be relatively common, affecting about 2 to 3 percent of babies in the US.^2,3

Even though many babies go through it, that doesn’t make it any easier on their parents.

The good news is that there are now many baby formula and food products that help make navigating a milk allergy a little easier.

Learn about what a milk allergy (cow milk protein allergy) is and how you can help manage it in your baby and toddler if needed.

What is a cow milk protein allergy?

A cow milk protein allergy (CMPA or CMA) or intolerance (CMPI) happens when the body has an overreactive immune response to the protein, triggering an allergic reaction.¹

Even though CMA is one of the most common allergies in young children, many will eventually outgrow this allergy as they get older and their digestive and immune systems mature.⁴

Signs of a cow milk protein allergy in babies and toddlers

Reactions usually happen within 1 to 2 hours after being exposed to cow milk protein, whether from:

• Breast milk, after the mother has eaten a food containing cow milk protein

• Cow milk-based baby formula, or

• Eating dairy in a meal.²

Reactions may range from mild and delayed, to fast-onset and life-threatening.

Common 'slow onset' milk allergy signs may include:

• Crying, fussiness, irritability, refusal to eat

• Diarrhea or constipation

• Mucous or blood in stool

• Abdominal pain and gas

• Eczema

• Arching back, bringing knees to chest^1,4,5

Common 'rapid onset' milk allergy signs may include:

• Rubbing eyes, itching, or red eyes

• Skin rash, itching, hives

• Stomach pain, vomiting, spitting up

• Coughing, wheezing

• Swelling of the lips, tongue, and throat^1,4,5

Anaphylaxis is a severe and potentially life-threatening allergic reaction that can occur within seconds to up to 2 hours after exposure to an allergen.⁶

It can, among other things, cause a sudden drop in blood pressure and impaired breathing. If your child has known allergies, make sure you speak to your physician or allergist to get an emergency plan in place so that you are always prepared.

Testing for cow milk protein allergy in babies

If you feel your little one has an allergy, speak with their healthcare provider immediately. The pediatrician will ask about their diet and when the symptoms tend to show up.

Tests that may help identify a cow milk protein allergy:

• Skin prick test: usually done by an allergist

• IgE test: a blood test that can help diagnose an allergy

• Diet elimination: Taking out all dairy from the diet for 3 to 4 weeks to see if symptoms improve¹

A temporary diet elimination should be done with the help of a Registered Dietitian to ensure that your little one continues to get the nutrients they need for growth and development, even when temporarily eliminating a food group.

Management of a cow milk protein allergy in babies and toddlers

If your little one is diagnosed with a cow milk allergy, some changes will need to be made so that their diet avoids cow milk proteins.

Formula feeding and cow milk protein allergy

Formula-fed babies will likely need to switch to a non-dairy formula. Note that soy formula may or may not be a good alternative as some babies with CMA may also have a reaction to soy protein.⁷

Breastfeeding and cow milk protein allergy

When breastfeeding an infant allergic to cow milk protein, all dairy products and ingredients that contain cow milk protein will need to be eliminated from the breastfeeding person’s diet. As long as these foods can be cut out, breastfeeding does not need to be stopped.

Toddlers and cow milk protein allergy

If your toddler has a cow milk protein allergy, all dairy and dairy ingredients must be cut out from their diet.

Find out about getting the right nutrition while eliminating dairy

Even though you may be able to add back in dairy-containing foods eventually if the CMA allergy is outgrown, if diagnosed with a cow milk protein allergy, these foods must be removed from the diet.

Cutting out these foods can seem daunting, but when done the right way, you, your baby, and/or your toddler will continue to get the nutrients needed to grow and develop.

Reach out to your child’s healthcare provider

If you suspect that your child has a cow milk protein allergy, call their healthcare provider immediately. They can make sure you and your little one are getting the support you need, as well as help you make informed decisions for moving forward.

Read labels

When eliminating dairy, whether from your own diet or for an allergic toddler, reading labels is critical.

The following list includes some of the ingredients that indicate the presence of milk in the product:

• Milk, cream, half-and-half, buttermilk

• Cheese, cottage cheese, yogurt, sour cream, custard, pudding

• Lactose, lactulose, lactoferrin, lactic acid starter

• Whey (in all forms)

• Casein and caseinates (in all forms)

• Curds

• Milk by-products (like butter, ghee, butter fat, butter oil, butter esters)

• Dry milk solids or powder, condensed or evaporated milk⁸

Get enough calcium, vitamin D, and protein

Milk products are rich in these nutrients, so it’s important to make sure your baby, toddler, or your own diet contains other foods that provide these.

• Food sources of calcium: Fortified plant-based milk alternatives, fortified orange juice, canned sardines and salmon with bones, fortified dairy alternatives such as a non-dairy yogurt, tofu, soybeans, spinach, kale.⁹

• Food sources of vitamin D: Salmon, fortified plant-based milk alternatives, fortified cereals, egg, canned light tuna, and portabella mushrooms. Note that our body makes vitamin D from sunlight, so chat with your child’s pediatrician about small amounts of safe sun exposure.¹¹

• Food sources of protein: Fish, poultry, meat, beans, legumes, peas, nuts, seeds, tofu, eggs, whole grains.

Remember to offer these foods to your older baby and toddler in sizes and textures that they are able to handle.

Read more:

Why Calcium Matters for Babies, Tots, and Mama

Why Vitamin D Matters for Babies, Tots, and Mama

Protein: Getting Enough and the Best Sources

Pack your diet with nutrient-dense, dairy-free foods

All whole fruits, vegetables, legumes, nuts, seeds, meat, poultry, fish, grains, and eggs are dairy free. When it comes to meeting your and your child’s nutritional needs, choose a variety of these non-dairy-containing foods.

Look for dairy alternatives

The good news is that there are plenty of dairy-free substitutes available now. You can find coconutmilk based yogurt; plant-based milk alternatives such as almond- and oatmilk; and even vegan dairy-free butter! These allow you to enjoy dairy-like foods in your day.

If you are choosing a plant-based milk alternative, look for ones that are fortified with calcium and vitamin D and limit added sugars.

Read more: What Type of Milk Should my Toddler Drink?

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Our Happy Experts are a team of lactation consultants and registered dietitian nutritionists certified in infant and maternal nutrition – and they’re all moms, too, which means they’ve been there and seen that. They’re here to help on our free, live chat platform Monday - Friday 8am - 6pm (ET). Chat Now!

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For more on this topic, check out the following articles and recipes:

Nutrients to look for at 6-12 months

Introducing Major Allergens to Your Infant

Meal Plan & Recipe Ideas for Your Diary-Free Baby or Tot