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Replacements for Cow’s Milk

Specialised infant formula - hypoallergenic formula
In some cases, it may be necessary to consider a specialised infant formula.

Extensively hydrolysed formula (EHF): The cow’s milk proteins have been broken down by enzymes into very small particles called peptides e.g. Pepti-Junior (SHS Nutricia). Some infants who are very sensitive to the cow’s milk protein may still react to Pepti-Junior and require an amino acid formula.

Amino acid formula (AAF): Amino acids are the simplest form of protein and very easy for the body to digest. Amino acids form the building blocks for protein e.g. Neocate (SHS Nutricia).

An allergy specialist or paediatrician can apply for a Special Authority Number for these hypoallergenic formulae. The formula can then be obtained on prescription with a partial subsidy; a small part charge payment is required by the family (and is similar to the cost of ordinary infant formula).

Soy milk formula: Soy-based formula is not generally recommended for infants under six months of age with cow’s milk allergy as there is a risk they may become sensitised to soy or will react to the soy protein. Soy formula may be considered for infants over six months of age who are not sensitised to soy and who have refused the hypoallergenic formula.

Partially hydrolysed formula (PHF): Partially hydrolysed formula is not suitable for the treatment of cow’s milk allergy as the cow’s milk protein has been only partially broken down, e.g. Karicare HA, Nan HA Gold Protect.

Goat’s milk, sheep’s milk, mare’s milk
These animal milks are not suitable for children or adults with cow’s milk allergy as the proteins are very similar to those in cow’s milk and most people will react to these too.

Milk replacements over one year of age
Some children may require continuation of a hypoallergenic formula, e.g. those allergic to both cow’s milk and soy milk. Review with a registered dietitan is important to assess nutrient and, particularly, calcium requirements.

Soy milk
Look for a soy milk that is fortified with calcium, vitamins B12 and B2 (Riboflavin), as these replace the nutrients found in cow’ milk. The fat and energy (calorie) content of soy milks vary. Some older children and adults may prefer lower fat milks.

Rice milk, oat milk, nut milk/ beverages
Rice milk / beverages are lower in energy, protein and fat, some may be fortified with calcium and B vitamins. Rice milks are not recommended for children under five years of age as the sole milk replacement.

Oat milk, nut milk /beverages have differing amounts of energy, protein, fat, added calcium and vitamins. These milks can be an alternative for adults; however a calcium supplement may be required.