Almost all infants are fussy at times. But some are excessively
fussy because they have an allergy to the protein in cow's
milk, which is the basis for most commercial baby formulas.
A person of any age can have a milk allergy, but it's more
common among infants (about 2% to 3% of babies), though most
outgrow it.
If you think that your child has a milk allergy, talk with your
doctor about testing and alternatives to milk-based formulas and
dairy products.
About Milk Allergy
A milk allergy occurs when the immune system mistakenly sees the
milk protein as something the body should fight off. This starts an
allergic reaction, which can cause an infant to be fussy and
irritable, and cause an upset stomach and other symptoms. Most kids
who are allergic to cow's milk also react to goat's milk
and sheep's milk, and some of them are also allergic to the
protein in soy milk.
Infants who are breastfed have a lower risk of developing a milk
allergy than those who are formula fed. But researchers don't
fully understand why some develop a milk allergy and others
don't, though it's believed that in many cases, the allergy
is genetic.
Typically, a milk allergy goes away on its own by the time a
child is 3 to 5 years old, but some kids never outgrow it.
A milk allergy is not the same thing as
lactose intolerance
, the inability to digest the sugar lactose, which is rare in
infants and more common among older kids and adults.
Symptoms of a Milk Allergy
Symptoms of cow's milk protein allergy will generally appear
within the first few months of life. An infant can experience
symptoms either very quickly after feeding (rapid onset) or not
until 7 to 10 days after consuming the cow's milk protein
(slower onset).
The slower-onset reaction is more common. Symptoms may include
loose stools (possibly containing blood), vomiting, gagging,
refusing food, irritability or colic, and skin rashes. This type of
reaction is more difficult to diagnose because the same symptoms
may occur with other health conditions. Most children will outgrow
this form of allergy by 2 years of age.
Rapid-onset reactions come on suddenly with symptoms that can
include irritability, vomiting, wheezing, swelling, hives, other
itchy bumps on the skin, and bloody diarrhea. In rare cases, a
potentially severe allergic reaction (
anaphylaxis
) can occur and affect the baby's skin, stomach, breathing, and
blood pressure. Anaphylaxis is more common with other food
allergies than with milk allergy.
Diagnosing a Milk Allergy
If you suspect that your infant is allergic to milk, call your
doctor, who'll ask about any family history of allergies or
food intolerance and then do a physical exam. There's no single
lab test to accurately diagnose a milk allergy, so your doctor
might order several tests to make the diagnosis and rule out any
other health problems.
In addition to a stool test and a blood test, the doctor may
order an allergy skin test, in which a small amount of the milk
protein in inserted just under the surface of the child's skin
with a needle. If a raised spot called a
wheal
emerges, the child may have a milk allergy.
The doctor may also request an oral challenge test. After you
stop feeding your baby milk for about a week, the doctor will have
the infant consume milk, then wait for a few hours to watch for any
allergic reaction. Sometimes doctors repeat this test to reconfirm
the diagnosis.
Treating a Milk Allergy
If your infant has a milk allergy and you are breastfeeding,
it's important to restrict the amount of dairy products that
you ingest because the milk protein that's causing the allergic
reaction can cross into your breast milk. You may want to talk to a
dietician about finding alternative sources of calcium and other
vital nutrients to replace what you were getting from dairy
products.
All food makers must clearly state on package labels whether the
foods contain milk or milk-based products, indicating this in or
next to the ingredient list on the packaging. This law applies only
to foods packaged after the start of 2006, so some foods packaged
before then may not have any information about food allergens.
If you're formula-feeding, your doctor may advise you to
switch to a soy protein-based formula. If your infant can't
tolerate soy, the doctor may have you switch to a hypoallergenic
formula, one in which the proteins are broken down into particles
so that the formula is less likely to trigger an allergic
reaction.
Two major types of hypoallergenic formulas are available:
- Extensively hydrolyzed formulas have cow's milk proteins
that are broken down into small particles so they're less
allergenic than the whole proteins in regular formulas. Most
infants who have a milk allergy can tolerate these formulas, but
in some cases, they still provoke allergic reactions.
- Amino acid-based infant formulas, which contain protein in
its simplest form (amino acids are the building blocks of
proteins). This may be recommended if your baby's condition
doesn't improve even after a switch to a hydrolyzed
formula.
"Partially hydrolyzed" formulas also are on the
market, but aren't considered truly hypoallergenic and can
still provoke a significant allergic reaction.
The formulas available in the market today are approved by the
U.S. Food and Drug Administration (FDA) and created through a very
specialized process that cannot be duplicated at home. Goat's
milk, rice milk, or almond milks are
not
safe and are not recommended for infants.
Once you switch your baby to another formula, the symptoms of
the allergy should go away in 2 to 4 weeks. Your doctor will
probably recommend that you continue with a hypoallergenic formula
up until the baby's first birthday, then gradually introducing
cow's milk into his or her diet.
If you have any questions or concerns, talk with your
doctor.
Reviewed by:
Steven Dowshen, MD
Date reviewed: November 2008
Originally reviewed by:
Ramaan Sreedharan, MD, and Devendra Mehta,
MD, MBBS, MS, MRCP
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
© 1995-2009 The Nemours Foundation/KidsHealth. All rights reserved.