What to Do When Your Baby Can’t Tolerate Regular Formula

Frequently fussy or spitting up after feedings could signal an allergy
What to Do When Your Baby Can't Tolerate Regular Formula

Contributor: Kadakkal Radhakrishnan, MD

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During the first year of your child’s life, proper nutrition plays a significant role in supporting healthy development and immunity. Like many medical experts, I endorse breast-feeding as the best source of nourishment for babies after birth.

If you are unable to produce enough milk to breast-feed, baby formula is a safe alternative. The American Academy of Pediatrics recommends iron-fortified formulas made from cow’s milk.

Most babies can handle cow’s milk-based formulas very well. However, if your baby is frequently fussy or spitting up after feedings, this could be a sign of milk allergy.

When your baby has a milk allergy, his or her sensitive immune system perceives the protein in cow’s milk as a toxin and immediately produces germ-fighting antibodies, referred to as immunoglobulin E or IgE, to attack it. Each time your infant ingests cow’s milk thereafter, those antibodies and chemicals like histamine are released.

Milk allergy symptoms

Milk allergy is seen in about 2 percent to 4 percent of formula-fed babies. Your infant’s individual allergic reaction to cow’s milk protein can vary from mild to severe.

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Potential warning signs to watch out for:

For purposes of clarity, milk allergy can also occur in breast-fed babies when cow’s milk protein is transferred through breast milk. In most of these cases, allergy symptoms may not show up until after the first consumption of cow’s milk.

Milk allergy is not the same as lactose intolerance. Lactose intolerance is the inability to digest the sugar found in milk and other dairy products. This is rarely seen in infants or toddlers. Generally, children who are lactose intolerant start to see symptoms, including stomach bloating and watery diarrhea with gas, after age 5.

Diagnosing and treating milk allergy

Your doctor often can diagnose milk allergy in your child with the help of a detailed history of symptoms. From there, the best testing consists of removing the source of milk protein and reintroducing as symptoms improve. Reintroduction should only be done under the supervision of your pediatrician, allergist or gastroenterologist.

The simplest and most recommended treatment is eliminating cow’s milk from your baby’s diet and substituting with a hypoallergenic formula. Occasionally, a baby may need to be placed on a specialized formula containing amino acids — the basic building block of proteins. Some babies can switch to soy formula, but up to half of children with milk allergy also experience adverse reactions to soy proteins.

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As a rule of thumb, always seek the advice of your doctor before changing formulas. Enlisting the help of a pediatric dietitian can also be very helpful.

About 80 percent of infants with milk allergy can tolerate cow’s milk proteins by age 1 and almost all children grow out of their milk allergy by age 5.

This post is based on one of a series of articles produced by U.S. News & World Report in association with the medical experts at Cleveland Clinic. 

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