Nurturing life Your reference in perinatal nutrition, from pregnancy to childhood

Which milk substitutes can non-breastfed children under 12 months consume if allergic to cow’s milk protein?

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By : Nurturing Life's Nutrition Team | Montreal Diet Dispensary
— Updated on :
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Before 12 months of age, commercial infant formulas are recommended rather than other kinds of milk or milk substitutes (goat, soy, almond…) if the child is not breastfed.

It should first be noted that exclusive breastfeeding of infants for the first six months of life is recommended.

In children who are not breastfed, commercial infant formulas (CIF) are recommended since they are enriched and adapted to the needs of the infant. They ensure adequate nutrition for infants. Special CIF are available for those with allergies. However, some of these CIF can be obtained only with a prescription. It is important to note that the type of commercial preparation, in case of allergy, will be chosen by the child’s doctor.

 Choosing a formula

Extensively hydrolyzed formulas: Average sensitivity to cow’s milk protein
Alimentum® Pregestimil®A+® Nutramigen®A+®
100% hydrolyzed formulas (amino acids): Severe Allergy to cow’s milk protein
NeocateMD PurAminoTMA+®
Partially hydrolyzed formulas: Not recommended 
Bon départ® Similac® protéines fractionnées Enfamil A+®Gentlease®
Soy-based formulas: Not recommended
Isomil® Bon départ Alsoy® Enfamil Soy®

Alimentum®, Pregestimil®A + ® and Nutramigen®A + ® are hypoallergenic commercial formulas that contain highly “predigested” cow’s milk proteins, that is to say highly hydrolyzed proteins. They may be suitable for children with an average sensitivity to cow’s milk protein. Note that the CIF labelled “partially hydrolyzed” are not recommended in case of allergy to cow’s milk protein, nor are the lactose-free CIF.

Neocate® and PurAminoTMA + ® are hypoallergenic commercial formulas that contain 100% hydrolyzed cow’s milk protein. Thus, the proteins are divided into amino acids (small blocks of proteins). Such preparations are absorbed without causing allergy. They are recommended in patients with severe allergy to cow’s milk.

Some commercial infant formula containing soy protein isolates (Enfamil Soy®, Isomil® and Jumpstart AlSoy®) are sometimes offered to infants with allergy to cow’s milk protein. However, many of these babies also react to soy and for this reason, these preparations are never recommended before 6 months of age. In children at high risk (children with multiple allergies or that have a family history of allergies), they should not be offered before 9 months of age.

These tailored commercial preparations are not always well tolerated by babies because of their flavor, different from breast milk or from normal commercial preparations. We must therefore be patient before the baby agrees to drink an adequate amount of milk. In cases where the mother can pump her milk or has a reserve of breast milk available, she can mix one part with the formula. The mixture is usually better accepted by the baby, allowing to gradually decrease the amount of breast milk and gradually increase the amount of commercial formula. If breast milk is not available, two kinds of commercial preparations can also be mixed together, including one that is more acceptable for the baby.