Best Dairy Alternatives For Breastfed Babies Testing Tolerance

Around 0.5% of breastfed babies in the world have cow’s milk protein intolerance. The best dairy alternatives for your baby depend on age, health, and nutrition.

Always ask a healthcare professional before you make any changes. Breast milk or hypoallergenic formulas are usually the safest choice for babies with dairy intolerance or allergy. There are safe and complete options, and you can get help during this process.

Key Takeaways

• Breast milk is the safest food for babies under one year. It is best even if babies have dairy intolerance or allergy.
• Babies who cannot have dairy need special formulas. Hypoallergenic formulas are safest. These include extensively hydrolysed or amino acid based formulas.
• Plant based milks like oat, almond, coconut, or rice milk are not good main drinks for babies under one year. They do not have enough nutrition.
• Toddlers over one year can have fortified plant based milks. Soya, pea, or oat milk are good choices. Always pick unsweetened and fortified types.
• Cow’s milk protein allergy can cause serious reactions. Babies must avoid cow’s milk and other animal milks like goat or sheep milk.
• Lactose intolerance is not the same as allergy. It usually causes mild tummy problems. It is rare in babies under one year.
• Watch for allergy or intolerance signs. These include rash, vomiting, diarrhoea, fussiness, or breathing problems. Get medical help if symptoms are severe.
• Always talk to healthcare professionals before changing your baby’s milk or diet. This helps keep your baby safe and healthy.

Best dairy alternatives

When you pick the best dairy alternatives for your breastfed baby, you want them to be safe and healthy. The right choice depends on your baby’s age and health.

Babies need different things at different ages. You should always talk to a healthcare professional before you change your baby’s food.

Top choices for infants

Babies under 12 months have only a few safe choices. Breast milk is still the best food, even if your baby cannot have dairy.

If your baby reacts to dairy, you may need to stop eating cow’s milk and dairy foods. This can help your baby feel better. A dietitian can help you get enough calcium, vitamin D, and protein from other foods.

If you cannot breastfeed or need more milk, you can use special formulas. The best dairy alternatives for babies with cow’s milk protein allergy or intolerance are:

1. Extensively hydrolysed formula (eHF): This formula has broken down milk proteins. They are smaller and less likely to cause problems. Most babies with cow’s milk protein allergy can use eHF.
2. Amino acid formula (AAF): Doctors give this formula to babies who cannot use eHF or have strong symptoms. AAF has only amino acids, which are parts of protein.
3. Lactose free formula: This is good for babies with lactose intolerance. It does not help babies with cow’s milk protein allergy.
4. Soy formula: Some babies over six months can use soy formula if they cannot have eHF or AAF. Soy is not hypoallergenic and can cause problems for some babies.

Note: Plant based milks like oat, almond, coconut, or rice milk are not good main drinks for babies under one year. These drinks do not have enough protein, fat, or vitamins for babies to grow well.

Options for older babies

When your child turns one, you can try more dairy alternatives. You still need to pick foods that help your child grow.

The best dairy alternatives for toddlers are fortified plant based milks and some animal milks, but only if your child is not allergic.

Always pick pasteurised and fortified options. You should ask a health visitor or dietitian to make sure your child gets all the nutrients they need. You can keep breastfeeding as long as you and your child want.

You can find the best dairy alternatives by thinking about your child’s age, health, and what they need to grow. For babies, breast milk and hypoallergenic formulas are safest.

For older babies, fortified plant based milks like soy or pea milk can work, but you must check labels and ask for advice.

Why avoid dairy and mammalian milks

Cow’s milk protein allergy (CMPA)

Cow’s milk protein allergy (CMPA) is a common food allergy in young children. Babies often show symptoms in their first year.

CMPA happens when the immune system reacts to cow’s milk proteins. This can cause rashes, vomiting, diarrhoea, wheezing, or even serious allergic reactions like anaphylaxis. Many children stop having this allergy by age three to six.

About 2–3% of children worldwide have CMPA. It is a main cause of food allergy in young children. In Europe, the rate is between 0.5% and almost 2%. CMPA can affect your baby’s skin, tummy, and breathing. Because of the risk of bad reactions, you must avoid all cow’s milk proteins if your baby has this allergy.

Tip: Lactose free cow’s milk is not safe for babies with CMPA. It still has the same proteins that cause allergies.

Lactose intolerance

Lactose intolerance is not the same as CMPA. It does not involve the immune system. It happens when your baby cannot digest lactose, the sugar in milk.

This is because their body does not make enough lactase enzyme. Symptoms are bloating, wind, diarrhoea, and tummy pain. These problems are usually mild and only affect the tummy.

Lactose intolerance is rare in babies. Most babies can digest lactose well. It usually starts after age three. Unlike CMPA, lactose intolerance does not cause rashes, breathing trouble, or severe reactions.

You only need to avoid lactose if your baby has clear signs of intolerance, but this is not common in the first year.

Other mammalian milks

You might think about using goat’s, sheep’s, or buffalo milk instead. But these milks are not safe for babies with CMPA. The proteins in these milks are very close to those in cow’s milk. Your baby can react to them just like cow’s milk.

• Goat’s milk and sheep’s milk often cause allergies in children with CMPA.
• Buffalo milk has lots of fat and does not fix the allergy.
• Goat’s milk does not have enough folic acid, which babies need to grow.
• Lactose free milks still have the same proteins as normal cow’s milk.

Note: Plant based drinks like oat, almond, or rice milk do not have enough nutrients for babies under one year. Only use them if a healthcare professional says it is okay.

You should always ask your doctor or dietitian before trying new milk or formula for your baby. This helps keep your baby safe and healthy.

Signs of intolerance or allergy

Common symptoms

You might see different signs if your baby cannot handle dairy or has an allergy. These signs can show up soon after feeding or even days later. Babies do not all react the same way, but some signs are more common.

The most common symptoms of dairy intolerance or allergy in breastfed babies are:

• Fussiness or crying before, during, or after feeds
• Spitting up often or having reflux
• Blocked nose or stuffy nose
• Skin problems like rash, eczema, hives, or dry skin
• Not gaining weight or losing weight
• Vomiting again and again
• Waking up suddenly and feeling uncomfortable
• Runny stools, mucus in stools, or blood in stools
• Diarrhoea, bloating, or lots of gas
• Stomach pain signs like clenched fists, arching back, kicking, or lifting legs
• Crying or being upset when passing gas

These symptoms can start minutes or hours after feeding. Sometimes, they take a few days to appear. If you stop eating dairy, your baby’s symptoms may get better in a few days or weeks.

Lactose intolerance can look almost the same. Your baby might have diarrhoea, stomach pain, bloating, gas, and be cranky. Some babies spit up more or seem to hurt during feeds. Some do not gain weight as they should.

Note: Milk allergy can also cause wheezing, coughing, swelling, itching, watery eyes, and vomiting many times. These can be like intolerance but are sometimes worse.

When to seek help

Some signs mean you need to get help fast. You should know which signs mean your baby must see a doctor right away. Bad allergic reactions can be very dangerous and need quick care.

Look out for these danger signs:

• Trouble breathing or shortness of breath
• Wheezing or noisy breathing
• Swelling of lips, tongue, or throat
• Hives or rash all over the body
• Vomiting after every feed
• Blood in the stool
• Sudden mood changes, dizziness, or fainting
• Signs of shock like pale or sweaty skin

If your baby has any of these, get medical help right away. Anaphylaxis is a very bad allergic reaction. It can make it hard to breathe, cause a red face, or make your baby pass out. This is an emergency. Use an adrenaline auto injector if you have one and call an ambulance.

Tip: Always talk to your healthcare provider if you see ongoing symptoms, poor weight gain, or if you feel worried about your baby’s health. Getting help early keeps your baby safe and healthy.

Best dairy alternatives for different ages

Picking the best dairy alternatives depends on your baby’s age. Babies need different nutrients as they get older. You should choose foods that help them grow well. Here is what you should know for each age group.

Under 6 months

Babies younger than 6 months only need breast milk or formula. These give all the nutrients your baby needs. If your baby cannot have dairy, there are safe choices.

Breast milk is still the best choice. If you breastfeed, you can keep going even if your baby has a milk allergy. You might need to stop eating dairy yourself.

A dietitian can help you get enough nutrients. If you use formula, doctors often suggest extensively hydrolysed or amino acid based formulas. These break down proteins so your baby can digest them safely.

Note: Do not use plant based drinks like oat, rice, or soya milk as the main drink for babies under 6 months. These do not have enough nutrition for growth. Rice drinks should not be given to children under 5 years because of arsenic.

6 to 12 months

From 6 months, your baby starts eating some solid foods. Breast milk or formula should still be the main drink. You can add small amounts of dairy alternatives to foods, but not as a main drink.

• Cow’s milk and most milk alternatives are not good as drinks before 12 months. They should not replace breast milk or formula.
• You can mix a little fortified plant based milk, like soya, pea, or oat milk, into foods such as porridge or mashed potatoes.
• Pick unsweetened and fortified types to avoid extra sugar and to give calcium and vitamin D.
• Babies with cow’s milk protein allergy need breast milk from a parent on a dairy free diet or a special hypoallergenic formula.
• Soya formula may be used from 6 months, but only if a doctor says it is safe. Some babies with cow’s milk allergy also react to soya.
• Do not give too much milk alternative so your baby still eats other important foods.

Always talk to a dietitian before giving new milk alternatives. They can help you pick the best dairy alternatives for your baby.

Over 1 year

After your child turns one, you can give more dairy alternatives as drinks. You need to pick ones with enough protein, calcium, and vitamin D.

• Fortified soya milk is a popular choice. It has protein and added nutrients. Some children with cow’s milk allergy may also react to soya, so check with your doctor.
• Pea milk and oat milk are other options. Choose fortified, unsweetened types. These give calcium and vitamin D, but protein levels are different.
• Almond, cashew, and hemp milks are available. These have less protein, so make sure your child gets enough protein from other foods.
• Do not give rice milk to children under 5 years because of arsenic.
• Hypoallergenic formulas may still be needed for children with strong allergies or poor growth.
• Limit flavoured or sweetened milks. Added sugars are not good for young children.

Remember: Always pick fortified and unsweetened types. Talk to your doctor or dietitian to make sure your child gets all the nutrients needed for healthy growth.

The best dairy alternatives change as your baby grows. Under 6 months, breast milk or special formulas are safest.

Between 6 and 12 months, you can add a little fortified plant based milk to foods, but not as drinks. After 1 year, you can give fortified plant based milks as drinks, but always check labels and ask for advice.

Plant based and hypoallergenic options

Extensively hydrolysed formula (eHF)

Extensively hydrolysed formula, or eHF, is a main choice for babies who cannot have cow’s milk. You might use this if your baby has a cow’s milk protein allergy or intolerance.

In eHF, the milk proteins are broken into much smaller parts. This makes it less likely to cause an allergic reaction.

eHF is not the same as normal infant formula. Normal formulas use whole cow’s milk proteins. eHF has proteins broken into smaller peptides or amino acids. This helps your baby digest it more easily and lowers allergy risk. Some eHF products have more energy and protein than regular formulas.

For example, some give up to 100 kcal and 2.6 g protein per 100 ml. Standard formula gives about 67 kcal and 1.5 g protein per 100 ml. These formulas are good for babies who need extra nutrition, like those not growing well.

eHF can cost more than standard formula. Some studies say eHF helps with digestion and lowers allergy risk, but the proof is not always clear. Always talk to your healthcare provider before you start eHF.

Amino acid formula (AAF)

Amino acid formula, or AAF, is another choice for babies with strong allergies. You might use AAF if your baby cannot use eHF or still has symptoms after trying it. 

AAF has only free amino acids, which are the building blocks of protein. These formulas do not have any whole or part milk proteins, so they are safest for babies with very strong allergies.

You should think about AAF if your baby has:

• Severe cow’s milk protein allergy that does not get better with eHF
• Serious gut problems, like food protein induced enterocolitis syndrome (FPIES)
• Anaphylaxis after milk
• Eosinophilic oesophagitis that does not improve with diet changes
• Severe eczema or skin problems
• Poor growth or failure to thrive
• Many food allergies
• Symptoms in more than one part of the body

AAF usually costs more than eHF. Doctors and dietitians suggest AAF for babies with the worst allergies or when other formulas do not work.

Soya formula

Soya formula is a plant based choice you might use if your baby cannot have cow’s milk. Soya formulas have been used for over 100 years and support normal growth in healthy babies.

But soya formula is not the first choice for babies with cow’s milk protein allergy. Some babies who are allergic to cow’s milk protein can also react to soya protein.

Doctors usually suggest soya formula for babies with galactosaemia or hereditary lactase deficiency. Soya formula is not right for premature babies, as it does not help them grow as well as other formulas.

Soya formulas have more aluminium and phytates than breast milk or cow’s milk formula. These can affect brain and bone growth, especially in babies born early or with kidney problems.

You should not use soya formula to stop allergies, as it does not lower the risk of allergies. If you want to use soya formula for your baby, always talk to your healthcare professional first. Soya formula may be an option for vegan families, but you need to check with your doctor or dietitian to make sure your baby gets all the nutrients needed for healthy growth.

Always pick the best dairy alternatives for your baby’s needs. Your healthcare team can help you choose which formula is safest and most suitable.

Oat, pea, and other plant milks

You may see many plant based milks in shops, such as oat, pea, almond, coconut, and rice milk. These drinks look like milk, but they are very different from breast milk or infant formula. If your baby has a dairy intolerance or allergy, you might wonder if these are safe choices.

Most plant based milks do not give your baby the nutrition needed for healthy growth. They often have less protein, fat, and key vitamins than breast milk or formula. 

Only soya based formulas are designed to meet the needs of infants under two years. Other plant based drinks, like oat or pea milk, are not suitable as the main drink for babies under one year.

Always check with your healthcare provider before giving any plant based milk to your baby or toddler.

What makes oat, pea, and other plant milks different?

• Oat and pea milks come from plants, so they are naturally free from lactose.
• Oat milk has a mild taste and is easy to digest, but it has less protein than cow’s milk or formula.
• Pea milk has more protein than oat milk and is closer to dairy milk in this way.
• Almond, rice, coconut, hemp, and cashew milks have very low protein and fat. These are not good choices for young children.
• Most plant based milks need added nutrients, such as calcium, vitamin D, B2, and B12. The amount and quality of these added nutrients can change between brands.

You should always choose fortified, unsweetened plant based milks if your child is over one year and needs a dairy alternative.

Fortification helps add calcium, vitamin D, and B vitamins, but not all brands are the same. Some nutrients in plant based milks are harder for the body to use than those in cow’s milk.

Most plant based milks are not suitable as the main drink for babies under one year. They do not have enough protein, fat, or micronutrients. Using them as the main drink can lead to poor growth and nutrient deficiencies. For toddlers over one year, fortified pea or oat milk may be an option if your child eats a balanced diet with enough protein from other foods.

⚠️ Note: Always talk to your doctor or dietitian before starting any new milk alternative, especially if your child has multiple allergies or poor growth.

Oat and pea milks also have a lower impact on the environment than dairy milk. They use less water and create fewer greenhouse gases. This makes them a popular choice for families who want a more sustainable option.

Alternatives to avoid

Unsuitable milks for infants

Shops sell many types of milk, but not all are safe for babies. Some milks can be harmful if given as the main drink to infants under one year.

You should stay away from these choices:

• Unmodified cow’s milk has too much protein and salt for babies’ kidneys. It does not have enough iron, vitamin E, or healthy fats.
• Goat’s, sheep’s, and buffalo milk have proteins like those in cow’s milk. Babies with a cow’s milk allergy can react to these too. Goat’s milk does not have enough folic acid for growth.
• Plant based drinks (oat, almond, coconut, rice, hemp) do not give enough protein, fat, or vitamins. These are not good as the main drink for babies under one year.
• Unfortified rice milk can cause very low protein levels. Babies who only drink rice milk may get swelling, skin issues, and not grow well.
• Unfortified soya drinks can lead to low vitamin D and calcium. Babies may get weak bones or rickets if these are their main drink.
• Raw or unpasteurised milk can have dangerous bacteria. This milk is not safe for babies or young children.

Always use breast milk or a proper formula as your baby’s main drink. If you need a milk alternative, pick one that is fortified and made for babies.

Some babies need special formulas. For example, babies with cow’s milk protein induced enteropathy need lactose free extensively hydrolysed formula or amino acid based formula.

Babies with congenital lactase deficiency must not have any milk or formula with lactose. If you mix up lactose intolerance and cow’s milk allergy, you might give the wrong milk and harm your baby.

Nutritional risks

Giving the wrong milk can cause serious health problems for your baby. Many animal and plant based milks do not have the nutrients babies need to grow.

If you use the wrong milk, your baby may not get enough protein, vitamin D, calcium, vitamin B12, or folate. These nutrients are needed for strong bones, brain growth, and healthy development.

For example, a baby who only drinks unfortified rice milk can get kwashiorkor, a bad protein deficiency. Signs are swelling, skin changes, and poor growth.

Another baby who only drinks unfortified soya drinks may get rickets, which causes weak bones, slow growth, and bent bones.

You should always choose milk substitutes that are like cow’s milk and have added vitamin D, calcium, and protein. Breastfeeding is still the best choice.

If you cannot breastfeed, hypoallergenic formulas are safest for babies under two years. These formulas give all the nutrients your baby needs and help stop deficiencies.

⚠️ Picking the best dairy alternatives means avoiding unsafe milks and making sure your baby gets full nutrition. Always ask your healthcare provider before changing your baby’s milk.

Introducing alternatives safely

Step by step introduction

When you give your baby new dairy alternatives, you need to be careful. You want your baby to stay safe and get all the nutrients needed to grow.

Here is a simple way to do it:

1. Talk to your healthcare professional before starting any new milk or food. They will help you pick the right option for your baby’s age and health.
2. Choose a hypoallergenic or special formula, like extensively hydrolysed or amino acid based formula, if your baby is under one year old.
3. Give new foods or milk alternatives one at a time. Wait a few days before trying another new food. This helps you see if your baby reacts.
4. Always read food labels to check for hidden milk proteins like whey, casein, or lactose.
5. Do not use rice milk or nut milks as main drinks for babies under one year. These do not have enough nutrition.
6. If you breastfeed, you might need to stop eating dairy. Only do this with advice from a professional.
7. Follow a feeding plan made with your healthcare team. This plan will fit your baby’s needs and help you keep track of progress.

📝 Tip: Go slowly and watch your baby carefully. This helps you find the best dairy alternative for your baby.

Monitoring for reactions

You must watch your baby closely when you try new milk or food. Keep a diary of what your baby eats and any symptoms you see. This helps you and your doctor spot patterns and make safe choices.

Look for symptoms like rashes, tummy pain, vomiting, or changes in poo. If your baby has trouble breathing or swelling, get medical help straight away.

For mild symptoms, write down when they happen and tell your doctor. Watching your baby closely helps you know if the new milk is safe.

Professional support

Paediatricians and dietitians are important when you try new foods. They help you choose safe milk alternatives and make sure your baby gets enough nutrients.

Dietitians can make a feeding plan for your baby and help you read food labels to avoid hidden milk proteins. Paediatricians might suggest allergy tests or food challenges if needed.

You should always work with your healthcare team when changing your baby’s diet. Their help keeps your baby healthy and growing well. Regular check ups and advice from professionals give you confidence as you try new foods and drinks.

Picking the right dairy alternative for your breastfed baby is important. You need to choose safe options that have all the nutrients your baby needs.

Breast milk and hypoallergenic formulas help babies with dairy intolerance or allergy grow well and feel better. You should always ask healthcare professionals for advice and check ups.

Dietitians and feeding guides can help you with feeding problems and make sure your baby gets enough nutrients. With good planning and help from experts, you can feel sure your baby will get what they need as they grow.

FAQ

What is the safest milk alternative for a baby under one year?

Breast milk is the safest for babies under one. If you cannot breastfeed, use a hypoallergenic formula. Extensively hydrolysed or amino acid based formulas are best. Plant based milks are not safe as main drinks for babies under one.

What signs show my baby may have a dairy intolerance or allergy?

Your baby might get rashes or vomit after feeds. Diarrhoea, fussiness, or not gaining weight can happen. Some babies have trouble breathing or swelling. If you see these signs, talk to your doctor.

What plant based milks can toddlers drink?

Toddlers over one year can have fortified soya, pea, or oat milk. Pick unsweetened and fortified types for more nutrients. These milks give calcium and vitamin D. Do not give rice milk to children under five.

What should I do if my baby reacts to a new milk alternative?

Stop giving the new milk right away. Write down what symptoms you see and when they started. Speak to your healthcare professional for advice. They will help you find a safer milk.

What nutrients do I need to check in milk alternatives?

Look for calcium, vitamin D, vitamin B12, and protein. Fortified plant based milks often add these nutrients. Always check the label to make sure your child gets enough nutrition.

What is the difference between lactose intolerance and milk allergy?

Lactose intolerance means your baby cannot digest milk sugar. Milk allergy means the immune system reacts to milk proteins. The symptoms and treatment are not the same. Your doctor can help you find out which one your baby has.

What foods can help if I remove dairy from my diet while breastfeeding?

Eat green leafy vegetables, nuts, seeds, tofu, and fortified cereals. These foods give you calcium and other nutrients. A dietitian can help you plan a healthy diet.

What should I avoid when choosing a milk alternative?

Do not use unfortified plant based milks, raw milk, or animal milks like goat’s or sheep’s milk. These do not give enough nutrition or may cause allergies. Always pick fortified and pasteurised options.