Cow’s milk allergy in babies and children

Updated 30 October 2026

Author: Kathy Beck, APD, Paediatric Allergy Dietitian

Learning that your child may have cow’s milk allergy can feel overwhelming. Understanding the type of allergy, choosing suitable alternatives and knowing when to seek help can make feeding more manageable.

Cow’s milk allergy occurs when the immune system reacts to proteins in cow’s milk. It is one of the most common food allergies in early childhood, affecting more than 2% of infants in Australia and New Zealand. Some children remain allergic into adulthood.

Two main types of cow’s milk allergy

Cow’s milk allergy can cause immediate or delayed reactions. The timing and pattern of symptoms help guide diagnosis and management.

IgE-mediated cow’s milk allergy

IgE-mediated reactions usually occur within minutes to two hours of consuming milk or a food containing milk.

Symptoms may include:

Hives or welts.
Swelling of the lips, face or eyes.
Abdominal pain, vomiting or diarrhoea.

Some reactions progress to anaphylaxis, a severe allergic reaction. Signs include difficult or noisy breathing, wheezing, a persistent cough, tongue or throat swelling, collapse, or becoming pale and floppy.

If your child has signs of anaphylaxis, give adrenaline using an autoinjector if available and call 000. Follow their ASCIA Action Plan. Anaphylaxis can occur without hives or other skin symptoms.

Non-IgE-mediated cow’s milk allergy

Non-IgE-mediated reactions are delayed, usually developing over hours or days. They mainly affect the digestive system and commonly begin in infancy.

Depending on the condition, symptoms may include:

Persistent vomiting or diarrhoea.
Blood or mucus in stools.
Feeding difficulties.
Poor weight gain.

Some affected babies remain otherwise well and grow normally.

Reflux, crying, unsettled behaviour and eczema are common in babies and do not, on their own, confirm cow’s milk allergy. These symptoms need careful assessment before foods are removed.

Non-IgE-mediated allergy does not cause anaphylaxis. However, one form, food protein-induced enterocolitis syndrome (FPIES), can cause severe repetitive vomiting, pallor and lethargy, sometimes with dehydration or shock. These reactions need urgent medical care and a separate management plan.

How is cow’s milk allergy diagnosed?

Your GP, paediatrician or allergy specialist will consider your child’s symptoms, their timing, feeding history and growth.

For suspected IgE-mediated allergy, skin prick testing or blood tests for milk-specific IgE may help when interpreted alongside the reaction history. A medically supervised oral food challenge is sometimes needed.

Skin prick tests and IgE blood tests do not diagnose non-IgE-mediated allergy. Diagnosis usually involves a planned, time-limited exclusion of milk protein, followed by reintroduction to check whether symptoms return. Improvement during exclusion alone does not always prove allergy.

Your treating team should decide how and where reintroduction takes place. Children with immediate reactions or suspected FPIES need specialist advice before milk is offered again.

How is cow’s milk allergy managed?

Management usually involves avoiding cow’s milk proteins while providing suitable nutritional replacements.

Milk proteins occur in foods such as yoghurt, cheese, butter, cream and many packaged foods. Learning to read ingredient lists and allergen statements is an important part of management.

Lactose-free cow’s milk and standard lactose-free formula still contain milk proteins and are not suitable. A2 milk and goat’s or sheep’s milk are also unsuitable substitutes.

Some children tolerate milk baked into foods, but this should only be included according to an individual plan from their treating team.

Can I continue breastfeeding?

Yes. Breastfeeding can usually continue.

A breastfeeding mother does not automatically need to avoid dairy because her baby has cow’s milk allergy. Maternal exclusion may be recommended when a baby has symptoms related to milk proteins passing through breastmilk, particularly in some delayed allergies.

If exclusion is advised, it should have a clear purpose, review date and reintroduction plan. A paediatric allergy dietitian can help protect the mother’s nutritional intake and avoid unnecessary restrictions.

Do not remove soy, egg or other foods automatically. Further exclusions should be based on your baby’s assessment and response.

Which milk or formula can my child have?

Babies who need formula may require an extensively hydrolysed, hydrolysed rice or amino acid-based formula. The choice depends on their age, allergy type, reaction severity and tolerance. Soy formula is suitable for some babies, but not all.

Ordinary plant-based drinks, such as oat, almond or rice drinks, must not replace breastmilk or infant formula before 12 months.

After 12 months, a suitable milk alternative depends on your child’s overall diet and growth. Plant-based products vary considerably in protein, energy and added nutrients, so they are not all nutritionally equivalent. Some children continue to need specialised formula.

Will my child outgrow cow’s milk allergy?

Many children do, but the timing varies.

Common mild non-IgE-mediated conditions often resolve in infancy or early childhood. FPIES requires its own specialist review and reintroduction plan.

IgE-mediated milk allergy may resolve during childhood, but some children remain allergic beyond school age or into adulthood. Regular review helps identify when testing or a supervised food challenge may be appropriate.

What about a milk ladder?

A milk ladder introduces milk in stages, usually beginning with small amounts baked into food and progressing towards less-heated forms.

It may be suitable for selected children with mild non-IgE-mediated allergy once their treating team advises that reintroduction is appropriate. It is not suitable for every child and should not be started independently, particularly after immediate reactions or FPIES. Children with IgE-mediated allergy need an allergy specialist’s individual plan.

How a paediatric allergy dietitian can help

Removing dairy involves more than finding a different milk. Children need suitable replacements to support nutrition and growth.

At ChildD, we can help families:

Choose appropriate formula, milk alternatives and foods.
Meet calcium, protein, energy and other nutritional needs, including assessing vitamin D intake.
Understand food labels and practical meal substitutions.
Support maternal nutrition when breastfeeding exclusions are needed.
Monitor growth and feeding progress.
Follow an individual reintroduction plan in collaboration with the medical team.

Our aim is to help your child eat safely and grow well, while keeping their diet as varied and manageable as possible.

About the author

Kathy Beck is an Accredited Practising Dietitian and paediatric allergy dietitian at ChildD in South East Queensland. She has more than 30 years of dietetic experience, including extensive paediatric practice in Australia and England. Kathy contributes to ASCIA’s dietitian education and training activities and helps families manage food allergies with practical, individualised nutrition advice.