Frequently Asked Questions
You may have questions about what cow’s milk allergy means for your baby and here are the answers to some commonly asked questions. This information is not intended to replace the advice of a healthcare professional.
Can I use softened water when making up Nutramigen?
When making up any infant formula, the NHS advices to use freshly boiled drinking water from the tap to reduce the risk of infection. Artificially softened water or water that has been boiled before are not recommended to use.1 Some softened waters have minerals added, one may be sodium. Additional sodium may be hard for your baby to eliminate. High levels of salt can be dangerous for babies because their developing kidneys are not yet able to process it and may become damaged as a result.3 If you have a water softening system, you should contact the manufacturer about the amount of sodium and any other minerals that may be added to your water.2 The actual level of these substances will be different depending on the initial hardness of the water and the settings used on the softener.
Please seek information from your child's doctor for advice regarding the use of softened water in your child's formula drink or medical food.
Why is Nutramigen 3 with LGG® vanilla flavoured?
Nutramigen 3 with LGG® is an extensively hydrolysed hypoallergenic formula designed to meet the daily needs of babies with cow’s milk allergy from 1 year onwards. The vanilla flavour has been added to help compliance in toddlers from 1 year onwards. This may make it easier to meet the formula intake recommended for children in this age group.
Is my baby on the right formula for their age?
You should always speak with your child’s doctor about which formula is right for your baby and ensure you follow their recommendation. Nutramigen with LGG® has three age adapted formulas for the dietary management of infants with cow’s milk allergy:
- Nutramigen 1 with LGG® is nutritionally complete so can be used as the only source of nutrition from birth to 6 months of age
- Nutramigen 2 with LGG® is suitable for infants from 6 months onwards as part of a varied diet
- Nutramigen 3 with LGG® is suitable for children from 1 year onwards as part of a varied diet
Nutramigen PURAMINO is nutritionally complete and suitable as the only source of nutrition for infants up to 6 months of age. Unless your doctor recommends otherwise, infants who are doing well on Nutramigen PURAMINO don't need to change formulas as they grow, because this amino acid-based formula can be used as part of a varied diet from 6 months onwards.
What is cow’s milk allergy?
If something enters the body that is perceived as harmful, your baby’s immune system reacts to fight it off. This is good because it helps protect your baby. Sometimes though, immune systems respond incorrectly to substances that are harmless, such as the proteins found in cow’s milk. If your little one has cow’s milk allergy, their immune system will react to cow’s milk protein every time they consume milk-based foods. This can result in persistent allergic reactions like colic, hives, rashes and respiratory and digestive problems. While it might be upsetting to hear that your baby can’t have dairy products, there is a very good chance that this won’t always be the case. Most children outgrow cow’s milk allergy naturally by the time they are 3-5 years old.
How did my doctor diagnose cow’s milk allergy?
When your doctor suspected your baby had cow’s milk allergy, it’s most likely that they suggested you manage your baby’s allergy by eliminating cow’s milk protein from their diet to see whether their symptoms improved.
For breast-fed babies: because cow’s milk protein can be passed from mother to baby in breast milk, breastfeeding mums may have been asked to completely remove milk products from their own diets for around 4 weeks. You shouldn’t stop breastfeeding because breast milk provides the best nutrition for your baby.
For formula-fed babies: an elimination diet involved switching to a formula that is hypoallergenic, meaning it has been specially designed to not cause allergic reactions in most children with cow’s milk allergy. Hypoallergenic formulas for infants with cow's milk allergy include extensively hydrolysed formulas and amino acid-based formulas.
After cow’s milk protein was eliminated from your baby’s diet and when symptoms had improved, your doctor may have requested an oral food challenge, which involved feeding your baby a very small amount of a milk-based product and carefully monitoring for any signs of allergic reactions. This process will normally take place at a doctor’s surgery or hospital clinic, or your doctor may have asked you to gradually reintroduce routine cow’s milk formula into your baby’s diet while you noted any reactions or behavioural changes. You should only introduce your baby to foods made with cow’s milk while under medical supervision.
Occasionally, a doctor may have requested a cow’s milk protein allergy test to support the diagnosis of cow’s milk allergy — this will either have tested the skin or blood. Skin tests involve exposing a small area of your baby’s arm or back to cow’s milk protein, and then gently pricking the skin so the liquid is absorbed. If the site turned red or swelled in about 20 minutes while you were at the surgery or clinic, this would have indicated sensitisation. With a blood test, a sample of your baby’s blood would have been taken by your doctor and sent to a laboratory to measure the amount of antibodies that reacted to cow’s milk protein.
The final diagnosis of cow’s milk allergy will have depended on the interpretation of the results in the context of clinical history.
Is it easy to tell when a baby has cow’s milk allergy?
Not always. Reactions can vary greatly depending on your infant’s sensitivity to cow’s milk protein. Babies with cow’s milk allergy may experience colic due to cow’s milk allergy, reflux and skin rashes. However, babies who are not allergic to cow’s milk protein can also have these problems. Complicating matters is the fact that reactions brought on by cow’s milk allergy sometimes don’t appear until days after consuming routine formula or milk-containing products. So this means that the connection between dairy in your baby’s diet and their reactions might not be that obvious.
What types of reactions do children get to cow’s milk?
The type of reactions and their severity vary from baby to baby depending on the degree of individual sensitivity to cow’s milk protein. Most babies with cow’s milk allergy experience mild to moderate reactions such as colic due to cow’s milk allergy, reflux, diarrhoea, constipation, wind, skin rashes, persistent coughing, runny nose and wheezing. Severe problems may include breathing difficulties, rectal bleeding, hives or rashes, and anaphylaxis (severe abdominal pain, high-pitched breathing, irregular heartbeat and low blood pressure). Symptoms can appear within minutes or up to a few days after eating a food containing cow’s milk protein. Babies with cow’s milk allergy also may appear irritated or distressed at feeding time, sleep poorly or have trouble gaining weight.
Will my baby always be allergic to cow’s milk protein?
In general, most children outgrow cow's milk allergy naturally on average between 3-5 years of age.2 In some cases, often where the allergy is more severe, children may continue to be allergic to cow's milk. Talk to your healthcare professional for more advice if you suspect your child may have outgrown their allergy.
Is cow’s milk allergy common?
Approximately 2-7.5% of babies are allergic to cow's milk. It is the most common food allergy in children under 3 years of age.
Will my baby be allergic to foods other than dairy?
It’s possible. As many as 10-35% of babies with cow’s milk allergy are also allergic to soy. If you are worried, consult your doctor before introducing your baby to potentially allergy-inducing foods such as cow’s milk, soy, eggs, wheat, peanuts, tree nuts and fish
What is the difference between cow’s milk allergy and lactose intolerance?
Cow’s milk allergy is an immune-system response to milk proteins such as casein and whey. Lactose intolerance is when the body can’t digest a milk sugar called lactose. Children with lactose intolerance have insufficient amounts of the enzyme needed to digest this milk sugar. Cow’s milk allergy and lactose intolerance are both caused by milk and share a few symptoms, such as wind, tummy pain and diarrhoea. But unlike cow’s milk allergy, lactose intolerance doesn’t affect the immune system and doesn’t cause allergic reactions such as hives, skin rashes, wheezing or persistent runny noses and coughs.
How is cow’s milk allergy managed?
Now your baby has been diagnosed with cow’s milk allergy, your doctor or specialist will have probably recommended eliminating cow’s milk protein from your baby’s diet.
If you are breastfeeding: because cow’s milk protein can be passed from mum to baby through breast milk, nursing mums may have been advised to follow dairy-free diets until their babies are weaned. Don’t stop breastfeeding though, as breast milk provides the best nutrition for your baby.
If you are bottle-feeding: formula-fed infants may have been advised to switch to a formula that is specially formulated to not cause allergic reactions in babies with cow’s milk allergy. Around 90% of infants with cow’s milk allergy do well with an extensively hydrolysed formula such as Nutramigen with LGG®.
The cow’s milk protein in Nutramigen with LGG® has been broken down or hydrolysed into small pieces so that they are, in most cases, less likely to cause allergic reactions. Rarely, a small number of infants with cow’s milk allergy react severely to cow’s milk protein and may not tolerate an extensively hydrolysed formula. These infants need a hypoallergenic formula made from amino acids, the building blocks that form proteins.
Most children become tolerant to cow’s milk naturally between 3-5 years old. However, you should only introduce your child to foods made with cow’s milk under the supervision of a healthcare professional.
Will my baby always be allergic to cow’s milk protein?
Your doctor may refer you to a paediatric allergy specialist, a paediatric dietitian or a paediatric gastroenterologist (a doctor who specialises in children’s digestive problems). Because some processed foods like bread, cereals and biscuits may contain hidden dairy ingredients, it’s useful to see a dietitian before you start weaning. A dietitian can help ensure that your baby gets the nutrients needed for healthy growth and development while eating a dairy-free diet.