Cow’s Milk Protein Intolerance

Cow’s milk protein intolerance (CMPI) is one of the most common food intolerances I encounter in my practice. CMPI affects about 1 in 50 children in NZ, often to varying degrees.

The majority of children with a CMPI will have mild symptoms ranging from mild eczema to digestive troubles, but some will have more severe symptoms including anaphylaxis and severe eczema.

Most children will grow out of a CMPI by the time they are 5 years old, but some (very few) will still suffer in adulthood.

Cow’s Milk Protein Intolerance vs Lactose Intolerance Cow’s Milk Protein Intolerance is sometimes confused with Lactose Intolerance, but they are, in fact, very different conditions. CMPI is an intolerance to one or more of the proteins found in milk, while lactose intolerance is where the body lacks enough of the enzyme (lactase) needed to breakdown lactose – the main sugar in milk. Generally, a child will grow out of a CMPI before they reach school age. A Lactose Intolerance however is usually a lifelong condition.

Symptoms The signs and symptoms of CMPI are diverse and will differ from child to child. For most though, symptoms will involve the skin or the gastrointestinal (GI) system. GI symptoms generally include vomiting, wind, abdominal pain, blood or mucous in stools, and diarrhoea.

Skin symptoms are most commonly eczema and hives. Wheezing, irritability, ‘fussing’ during feeding, a persistent runny nose, chronic ear infections, sleep disturbance, behavioural issues (in an older child) and poor growth may also be present. It is important to note that any one of these symptoms present on their own may not mean anything significant, but several together can mean an intolerance. If you have any doubts please seek medical advice.

Diagnosis & Treatment The symptoms of CMPI usually appear not long after dairy is introduced into a child’s diet at around 7-8 months. Some cow’s milk proteins will pass into the Mothers breast milk though which, for some babies, can cause an issue right from birth.

As ‘standard’ baby formula is based on cow’s milk a formula fed baby will be introduced to cow’s milk proteins through formula, so symptoms may begin soon after beginning formula feeding.

A diagnosis cannot usually be found through blood tests, so once family history has been established an elimination of all cow’s milk products from both Mum and Baby’s diet is required. Treatment involves removing all dairy from the diet then, depending on the age of the child, conducting a dairy ‘challenge’ to determine the extent of the intolerance.

Dairy Alternatives Dairy products play an important role in a balanced diet so will need to be replaced with something equivalent. If you are still breastfeeding it will help if you continue to do so for as long as possible. Remember, they’re not reacting to your breastmilk just some of the foods you are eating.

It is a whole lot easier to remove dairy from your diet than it is to remove it from a child’s so stick with it. If you’re mixed feeding or formula feeding you will need to speak to your Dr about dairy free formulas. In some cases a hypoallergenic formula, goat milk formula or soy formula may be trialed, but in others prescription formulas will be needed.

For toddlers who are no longer breastfeeding replacing dairy can be a bit of an issue for some parents. Dairy products are a primary source of calcium, protein and fat in a young child’s diet so it is important that a suitable alternative is chosen.

There are a lot of alternatives available, but not all are created equal. Similarly, not all brands are created equal either so even once you have decided on your alternative you will still need to shop around to find the best brand for your family.

Alternatives such as soy, oat, almond, coconut, or rice milk are not suitable as a substitute for cow’s milk on their own (see table below), but with some careful planning they may be included in a toddlers diet. It is strongly recommended that you get help with planning your toddler’s diet if this is the route you decide to take.

If you have a somewhat fussy toddler (who doesn’t!?) and Goat’s milk is not suitable, then a dairy free formula may be your best option. Soy formula and hypoallergenic cow’s milk formulas are available at the supermarket.

For children who are also allergic to soy a prescription formula will be needed. The chart below should help to get you started with choosing a suitable alternative.

The Cow's milk is included as a reference to its dietary value. 

Having a dairy free child doesn’t need to be difficult. There are options out there for alternatives and support is easier to find than ever.

Please speak to your GP or Pediatrician, or make contact with a Dietitian or Qualified Nutritionist before making any changes to your child’s diet. Removing whole food groups without careful consideration of replacements can lead to nutrient deficiencies, and in some cases may make allergies worse.