Cow milk intolerance in babies

What should I do if I think my baby is allergic or intolerant to cows' milk?

If you think your baby is having a reaction to cows' milk, see your GP or health visitor to discuss your concerns.

They will be able to assess if your baby's symptoms may be caused by a cows' milk allergy or something else. Make sure you get medical advice before taking cows' milk out of your child's diet as it contains important nutrients.

Cows' milk allergy in babies

Cows' milk allergy (CMA), also called cows' milk protein allergy, is one of the most common childhood food allergies. It is estimated to affect around 7% of babies under 1, though most children grow out of it.

CMA typically develops when cows' milk is first introduced into your baby's diet either in formula or when your baby starts eating solids.

More rarely, it can affect babies who are exclusively breastfed because of cows' milk from the mother's diet passing to the baby through breast milk.

There are 2 main types of CMA:

• immediate CMA – where symptoms typically begin within minutes of having cows' milk
• delayed CMA – where symptoms typically begin several hours, or even days, after having cows' milk

Symptoms of cows' milk allergy

Cows' milk allergy can cause a wide range of symptoms, including:

• skin reactions – such as an itchy rash or swelling of the lips, face and around the eyes
• digestive problems – such as stomach ache, vomiting, colic, diarrhoea or constipation
• hay fever-like symptoms – such as a runny or blocked nose
• eczema that does not improve with treatment

Occasionally CMA can cause severe allergic symptoms that come on suddenly, such as swelling in the mouth or throat, wheezing, cough, shortness of breath, and difficult, noisy breathing.

A severe allergic reaction (anaphylaxis) is a medical emergency. Call 999 for an ambulance immediately if you think your child has anaphylaxis (even if they start to feel better).

Treatment for CMA

If your baby is diagnosed with CMA, you'll be offered advice by your GP or an allergy specialist on how to manage their allergy. You may also be referred to a dietitian.

Treatment involves removing all cows' milk from your child's diet for a period of time. 

If your baby is formula-fed, your GP can prescribe special infant formula.

Do not give your child any other type of milk without first getting medical advice.

If your baby is exclusively breastfed, the mother will be advised to avoid all cows' milk products.

Your child should be assessed around every 6 to 18 months to see if they have grown out of their allergy.

Read more about cows' milk allergy in children on National Institute for Health and Care Excellence (NICE).

Could it be lactose intolerance?

Lactose intolerance is another type of reaction to milk, when the body cannot digest lactose, a natural sugar found in milk. However, this is not an allergy.

Lactose intolerance can be temporary – for example, it can come on for a few days or weeks after a tummy bug.

Symptoms of lactose intolerance include:

• diarrhoea
• vomiting
• stomach rumbling and pains
• wind

Treatment for lactose intolerance

Treatment depends on the extent of your child's intolerance. Some children with lactose intolerance may be able to have small amounts of dairy products without having symptoms.

Your child may be referred to a dietitian for specialist advice.

Read more about treatment for lactose intolerance.

Further information:

• Colic
• Food allergies in babies and children
• Reflux in babies
• How can I tell if my baby is seriously ill?
• Your baby's first solid foods
• National Institute for Health and Care Excellence (NICE): food allergy in children

Page last reviewed: 28 November 2022
Next review due: 28 November 2025

Milk intolerance in babies and children

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Some babies and children have a reaction when they drink cow's milk or formula made from cow's milk. This could be due to 2 things: a lactose intolerance or an allergy to milk. If your child has one of these conditions, you will have to alter their diet to cut down on milk or avoid it altogether.

Call triple zero (000) for an ambulance if your child has the following symptoms. They could be having a severe allergic reaction and will need urgent medical attention.

• wheezing or difficulty breathing
• a swollen tongue
• vomiting
• they are pale and floppy or unconscious

What is milk intolerance and milk allergy?

Around 1 in 10 young children has a reaction when they drink cow's milk. This could be because they have a lactose intolerance or a milk allergy. Milk allergy is much more common than lactose intolerance in children under 5.

Lactose intolerance is a problem with the digestive system – it means your child doesn't have the enzyme needed to digest lactose, which is the sugar in milk.

Milk allergy, however, is a problem with the immune system — the body reacts to the protein in milk. An allergy usually involves other parts of the body as well as the stomach, and may cause symptoms such as a skin rash or swelling of the face.

Your doctor can confirm whether your child is lactose-intolerant or has a milk allergy by doing some medical tests. Don't use unproven tests such as Vega, kinesiology, Alcat or allergy elimination tests for children. A milk intolerance is very unlikely to be the cause of mucus or coughing.

Many young children grow out of their intolerance or allergy. But don't start giving them cow's milk until your doctor tells you it's safe to do so.

Lactose intolerance

Causes

Lactose is the sugar found in the milk produced by all mammals, including humans. Sometimes people don't produce enough of the enzyme lactase in their gut to break down the lactose.

Very few babies have true lactose intolerance, a rare genetic condition where they're born without any lactase enzymes at all. (This is called primary lactose intolerance). However, many people develop lactose intolerance later in life, after the age of 5. It is more common in Aboriginal Australians and people from Asia, Africa, the Middle East and some Mediterranean countries.

Babies and young children can become intolerant to milk if the lining of their gut is damaged by an illness such as gastroenteritis, or an allergy or intolerance to another food. This is called secondary lactose intolerance and will go away once the gut heals, usually over a few months.

Symptoms and diagnosis

The symptoms of lactose intolerance in babies and children are:

• liquid, sometimes green, frothy stools
• being irritable
• stomach aches
• bloating
• passing a lot of gas
• not putting on weight
• nappy rash

All of these symptoms are common in babies and don't necessarily mean they have lactose intolerance. But if your child has diarrhoea and isn't putting on weight, see your doctor. Don't stop breastfeeding unless your doctor tells you to.

Tests include a breath test to measure the hydrogen in your child's breath, or cutting out dairy to see if their symptoms improve. This is known as an elimination diet.

Treatment

If the lactose intolerance is caused by a tummy upset, keep on breastfeeding. If your baby is formula fed, talk to your doctor or child and family health nurse before switching to low-lactose or lactose-free formula.

Older children will need to cut down on, but not eliminate, dairy foods from their diet. They can still have some cheeses, yogurt, calcium-fortified soy products, lactose-free milk, butter and cream. Your doctor or a dietitian will advise you on the best diet for your child.

Cow's milk allergy

Cow's milk allergy is one of the most common food allergies in young children. It usually disappears by the time they reach school age. It occurs when your child's immune system reacts to the protein in milk.

Symptoms and diagnosis

Reactions to milk can occur within minutes or not for several days.

Rapid reactions include:

• hives (urticaria)
• swelling of the lips, face or eyes
• stomach pain
• vomiting
• diarrhoea
• noisy breathing or wheezing
• a swollen tongue
• a swollen or tight throat
• a hoarse voice
• change in consciousness or floppiness in babies or young children

Delayed reactions include:

• an increase in eczema
• blood or mucus in stools
• vomiting and/or diarrhoea 2-24 hours after having milk

It is very important to see a doctor if your child has the symptoms of milk allergy. The condition is diagnosed using the history of symptoms or can sometimes be confirmed with an allergy test.

Treatment

If your child is allergic to milk, you need to completely remove dairy products from their diet. Follow your doctor's or allergy specialist's advice and read food labels carefully. You may also need to avoid milk from other animals, such as goats, as well as coconut milk products. Watch out for other words used to describe milk on food labels, such as butter, buttermilk, cream, curd, ghee, milk, cheese, dairy, milk solids, whey, yoghurt, casein and caseinates.

If your baby is formula-fed, you can use soy protein formula (unless they are also allergic to soy), extensively hydrolysed formula (EHF) or amino acid-based formula (AAF). Do not use formula made from cow's milk, goat's milk, sheep milk, HA, A2 milk or lactose-free.

If your child is over the age of one, they can be given soy milk, calcium-enriched rice, and oat or nut milks. It is important to make sure they are getting enough calcium.

You may be advised to carry an Epipen adrenaline autoinjector if your child is allergic to milk. Severe allergic reactions can sometimes lead to anaphylaxis, which is serious and can even be fatal. An adrenaline autoinjector can be used to give first aid in the event of anaphylaxis.

Breastfeeding a baby who can't tolerate milk

If your baby is lactose-intolerant, you don't need to change your diet. It doesn't matter how much dairy you consume, the amount of lactose in your milk will be the same.

However, if your baby is diagnosed with milk allergy, you will need to remove all dairy from your own diet too. You will need calcium and vitamin D supplements every day. Your doctor or allergy specialist will advise you.

Where to seek more help

Don't try to deal with milk intolerance yourself. You can get help from:

• your doctor
• Pregnancy, Birth and Baby on 1800 882 436
• Australasian Society of Clinical Immunology and Allergy
• Australian Breastfeeding Association on 1800 686 268

Sources:

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: July 2020

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Related pages

• Reactions to food
• How to introduce allergy foods
• Airborne allergies

Need more information?

Lactose intolerance - MyDr.com.au

Lactase deficient people do not have enough lactase, the enzyme that helps break down lactose and they suffer from lactose intolerance. The main symptoms of lactose intolerance are bloating and wind. 

Read more on myDr website