Substituting Milk for Allergic Toddler

in Substitutions
Published: July 2, 2010

Q: Our 18-month-old daughter is allergic to cow’s milk. I’m somewhat confused about what to use in its place. Does it depend on her age? Can you help?

Alisa Bar-Dayan, RD: It’s common for parents to be concerned about a child’s nutrition with an allergy to cow’s milk, since it’s a source of calcium, vitamin D and fat. These are important nutrients for growth and development, and to keep bones strong. However, many children thrive without consuming cow’s milk.

If you are breastfeeding your 18-month-old, you may continue to do so. In some cases, mothers who consume milk can pass allergenic proteins through their breast milk. If this is suspected, you may need to avoid milk products. In other cases, cow’s milk proteins are not passed through. Always consult your doctor or a dietitian before altering your diet while breastfeeding. Removing milk from your diet won’t be recommended unless absolutely necessary.

If you are not breastfeeding your daughter, she should drink soy formula until the age of 2. Soy formula is a complete source of nutrition and will provide enough calcium, fat and protein. Your doctor or dietitian can advise you on how much formula to give based on your child’s age, height and weight.

Some children don’t tolerate soy formula and require a hypoallergenic formula that contains extensively hydrolyzed proteins. Since the proteins are broken down, the body no longer recognizes them as allergenic. This formula should only be used on the advice of a doctor or dietitian.

While soy formula is a good alternative at your daughter’s age, soy, rice and other dairy-free milk substitutes should not be used in place of infant formula as a main source of liquid nutrition. These beverages do not contain the amount of protein, fat or iron needed and may lead to poor weight gain and brain development.

Young children who cannot eat or drink cow’s milk products must continue on soy formula or extensively hydrolyzed formula until age 2. (Children without milk allergy are able to drink homogenized milk starting at the age of 1.) Goat’s milk is also not a suitable alternative for a child allergic to cow’s milk, as those with this allergy may also react to goat’s milk.

By 2, your daughter can be reassessed to determine if she is ready to transition to a fortified soy beverage with vitamins and minerals, such as vitamin A, vitamin D, vitamin B12, riboflavin, calcium, zinc and others. Children allergic to cow’s milk should eat non-dairy, calcium-rich foods as well as foods with lots of vitamin D. With the right modifications to her diet, your daughter will receive all the nutrients she needs even without cow’s milk in her diet.

Non-dairy foods for an 18-month-old

Rich in Calcium
• Broccoli
• Bok choy
• Tahini
• White beans
• Calcium-fortified orange juice

Rich in Vitamin D
• Egg yolks
• Fish
• Liver
• Fortified margarines
• Soy beverages

See question and answer on substituting eggs.

Alisa Bar-Dayan, RD, is the Marketing Dietitian at the Specialty Food Shop in Toronto’s Hospital for Sick Children, First published in Allergic Living magazine, Winter 2008.

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