Dairy is always a hot topic in the nutrition world.
It has conflicting reputations depending on who you ask, yet most kids love it, and parents are constantly left wondering if it’s good or bad, how much is too much, and whether or not it should be a staple in their kids’ diets.
Hand in hand with the conversation about dairy is the one about alternative milks and whether they’re the same as cow’s milk, different, good, bad, etc. There have been trends to move away from dairy and trends to bring milk back.
I get it, it can be confusing- So confusing that I’ve actually written several different, specific posts on the topic. From what to do if your toddler won’t drink milk to best almond milk for baby to whether or not your toddler should drink raw milk or goat’s milk, the topics to explore around milk are endless.
In this particular post, I want to take a deeper dive into milk from a food allergy perspective. Many families deal with physical issues around dairy, and I want to help educate you on what those issues can be, how they can look, and some helpful ways to make swaps that are safe for your kids.
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Dairy allergy vs. lactose intolerance
After talking to tons of parents and families, I’ve found that there’s some confusion about why someone might need to avoid dairy.
There are a couple common reasons: lactose intolerance and dairy allergy. Those terms sometimes get used interchangeably, but they’re actually not the same.
Clinical lactose intolerance is described as the malabsorption of lactose. Lactose is the naturally occurring sugar in milk and milk products. This means the body lacks the enzyme lactase to break down and digest lactose.
(Little fun science fact, if you see the ending –ose, that means it’s a sugar, and if you see the ending –ase, that means it’s an enzyme. Those sugars need a corresponding enzyme to break them down, and if not, that’s when we see the uncomfortable symptoms.)
Lactose intolerance has nothing to do with the protein in milk (that’s a dairy allergy- we’ll talk about that in a minute). It’s technically not an allergic reaction, because it doesn’t involve the immune system- which is the hallmark of a true allergy.
That doesn’t mean it’s not serious or not a reason to avoid dairy- it definitely is!
It causes uncomfortable digestive symptoms like bloating, gas, diarrhea, and nausea, but it doesn’t really have the propensity to cause the more serious, potentially life-threatening symptoms like an allergy can.
Don’t worry, MOST allergic reactions are not life-threatening either, but true immune-system mediated allergies can be very serious.
Here’s a couple tidbits of good news:
- Congenital lactose intolerance (meaning they were born with it) is extremely rare in babies– especially, especially for babies born past 34 weeks of gestation. It is so exceedingly rare that it has only been observed in a few infants. Because full-term (and even less than full-term) babies develop enough lactase in utero to manage the lactose in breast milk and formula, we rarely see this lactose malabsorption at this age.
- In fact, lactose intolerance before the age of 5 is pretty rare. Even if some lactase deficiency is present, we often don’t see symptoms manifest until after age 4 or 5. Certain ethnicities are more likely to have lactase deficiency than others, but in populations that have a predominance of dairy in the diet, less than 2% of people are estimated to have primary lactase deficiency.
- Sometimes people grow out of lactose intolerance, OR they can still manage some dairy in the diet. They may be limited in the amount or types they can eat, but some dairy is virtually lactose-free (like some hard, aged cheeses that have a very low moisture content). Also, some people may find that if dairy is an ingredient in a baked good or dish, it doesn’t affect them in the same way as a glass of milk might.
- If 100% avoidance isn’t in the cards, you can also manage lactose intolerance with certain OTC medications like Lactaid. Lactaid can supply your body with the necessary lactase to be able to eat dairy and not experience the uncomfortable GI symptoms associated with lactose intolerance.
A dairy allergy is clinically known as a cow’s milk protein allergy (or CMPA). This name helps us understand what’s really going on: an immune-mediated response to the protein in cow’s milk. This is when the body recognizes the protein in cow’s milk as an antigen and responds accordingly.
If it’s going to appear, CMPA usually appears while a child is a baby- either from dairy itself or from dairy transferred through breast milk- BUT it is also not very common.
This immune-response can be IgE-mediated, non-IgE mediated, or mixed. This is a fancy way of saying it can involve certain immunoglobulins and not others, so it can present slightly differently, but it is an immune system trigger nonetheless.
The symptoms of CMPA can include vomiting, diarrhea, crying/colic in babies, skin rashes, constipation, and blood in stool. More severe allergies can manifest with difficulty breathing, or severe swelling. Always, always seek emergency medical attention if you suspect your child is having an allergic reaction.
Identifying a cow’s milk protein allergy can be tricky, because there can be a crossover of symptoms with a lot of other occurrences in infancy and childhood that can be unrelated to the diet- such as fussiness and baby acne. Parents often jump to assuming CMPA is the reason for any and all discomfort, but that’s not always the case.
Another couple tidbits of good news:
- Most children outgrow their CMPA by age 3, with most even displaying reduced symptoms after age 1.
- Less than 3% of babies will exhibit CMPA in infancy
- It is the exception, not the norm (read: really rare!), that CMPA is diagnosed in exclusively breastfed babies. And only then is a dietary change for the breastfeeding parent recommended.
So what do you do?
First of all, I recommend working with your pediatrician to determine a solution that works for your family. I don’t recommend freaking out, self-diagnosing, and taking action on your own, because sometimes symptoms of different conditions can look similar or be something else altogether!
If there is confirmed lactose intolerance or cow’s milk protein allergy, the first line protocol would be to avoid dairy. That means avoiding dairy, dairy derivatives, or it could mean breastfeeding parent modifying their diet to avoid dairy as well. Work with your doctor to determine which course of action is right for you.
If you are in the boat of having to modify your diet for your baby’s intolerance/allergy, remember THERE IS HOPE they will grow out of it! This likely won’t last forever!
Secondly, you’ll be tasked with finding alternative products. For infants, that might just be formula (which we will touch on in the next section), but for babies and children who are already eating solids, that could mean finding suitable alternatives for lots of dairy sources that might be in their diets: yogurt, milk, cheese, etc.
When you’re looking for alternatives, I want you to be mindful of checking out those nutritional labels. Some alternatives are closer to the nutritional profile of cow’s milk while some are pretty different. For example, almond milk is fine for your child to have, but it lacks a lot of the fat, protein, and vitamins and minerals in cow’s milk, so it’s not a straight swap. You’d also need to find other ways to replace those nutrients in their diet.
Fortified soy milk (unsweetened) and soy products are usually the closest alternatives to cow’s milk as their nutritional profiles match up pretty closely.
Baby formulas for a baby with milk allergy
If you are needing to switch out your baby’s formula due to a milk allergy, there are some great products out there. Again, I recommend working primarily with your pediatrician to determine what is best for your baby, as their needs will vary based on what is going on clinically.
“Cow’s milk protein allergy is treated by eliminating cow’s milk protein from the diet. Formula alternatives include hydrolyzed cow’s milk formula, rice-based formula, soy-based formula, and amino acid–based formula, which are all nutritionally adequate alternatives to cow’s milk formula. Symptom severity, patient preference, cost, and efficacy are factors to be considered when choosing an alternative.” (Check out this medical journal for more information!)
Kids with Food Allergies is a great resource for helping you determine what type of formula your child might need. But again, you’ll need to cross-reference these options with your child’s doctor to ensure they are suitable for your child’s specific needs.
I want to emphasize that swapping to a non-dairy formula is not “healthier” (or less healthy) per se, and should only be done if medically indicated.
I did a breakdown on ingredients in US vs EU infant formulas- many of which have alternative protein sources. Take a peek here!
Best milk for a toddler with dairy allergy
According to the American Academy of Pediatrics, fortified unsweetened soy milk is the best alternative to cow’s milk. I would agree, but I also want to mention that there are some newer products on the market that mimic the nutrition of cow’s milk very well, too.
Here’s a breakdown I did on alternative milks that shows you a side by side comparison of how certain milks stack up to cow’s milk.
If you are a parent wondering what milk to give your toddler, I encourage you to look at the nutrition facts labels and check out their similarities and differences.
Pay close attention to calories, fat, protein, vitamin D, and calcium. Also know that calcium is typically higher in non-dairy alternatives because it is not absorbed as well as the calcium in cow’s milk. So your child isn’t necessarily getting more calcium even though the number on the label is higher.
Your baby doesn’t actually HAVE to drink milk. Babies and toddlers have certain nutritional needs, and cow’s milk has a nutritional profile that meets a lot of those needs. Offering milk/dairy products is an easy way to ensure those goals are being met, but it is not the only way.
Rest assured that you can help them meet their needs in a variety of ways, even if you’re needing to avoid cow’s milk.
Reintroducing dairy to a baby with CMPA
When you go in for your 1 year pediatrician appointment, that’s a great time to talk to your doctor about a plan to potentially reintroduce dairy into your child’s diet. Like we’ve discussed, kids can and do often grow out of this allergy.
The plan you devise with your pediatrician depends largely on the severity of your child’s allergy.
What I usually see happen is that you’ll start with milk as an ingredient- baked into something/as an ingredient in a cooked dish, rather than a sip or cup of milk.
If your child is able to tolerate that without symptoms, you can move on to different presentations. Sometimes certain foods will trigger symptoms and others won’t.
I recommend starting slow and small, watching for symptoms, and keeping a log you can discuss with your child’s provider.
How to test for dairy allergy
Because these conditions and many other dietary (and non-dietary) conditions in childhood can look similar, I don’t recommend trying to self diagnose whether on Google, mom-forums, or a home-allergy testing kit.
If you suspect an allergy or intolerance to dairy or any food, it’s always a good idea to take action- especially before kids can communicate what they’re feeling. This would likely be done through an allergist, through a referral from your pediatrician.
If you are feeding a new eater and suspect a food/dairy allergy, or one runs in your family and you want to safely rule it out, there are a couple at-home products I recommend.
Spoonful One, Ready Set Food, and Lil Mixins all have products designed to introduce your baby to the top allergens- including dairy- in a controlled way so that you can determine what, if any, foods are causing your baby problems.
But I hope you can breathe just a little bit easier knowing that food allergies (and especially severe ones) are rare in the grand scheme of things, they can be managed with dietary interventions, and can even go away altogether!
Whether you’re working with a food allergy or not, I’d love for you to check out my Meal and Snack Survival Guide. I created this comprehensive guide so that parents could breathe a little easier around meal and snack times and its chock full of meal ideas that can be customized to your family’s needs/liking- including allergy-friendly ideas.