Diagnosing and managing infants with suspected cow’s milk allergy

Exclusive breastfeeding is the first choice recommendation until 6 months, and this should be actively encouraged and supported:^*1

• •If an exclusively breastfed infant is symptomatic, then a strict elimination of cow’s milk containing foods from the maternal diet with daily supplements of calcium and vitamin D is recommended (early support from a dietitian is advised to facilitate this)^1-3

If exclusive breastfeeding is not possible or the mother chooses a mixed feeding approach, then a trial of hypoallergenic formula should be initiated:^1-3

• •In most cases, an extensively hydrolysed formula (eHF) should be recommended, while amino acid-based formulas (AAF) are used if an eHF is not well tolerated and for the management of severe cases^1-3
• •If mixed feeding, the mother can continue to consume cow’s milk protein, but if her child’s symptoms persist, she should exclude it from her diet (with the support of a dietitian)^1,3
• If an eHF and/or AAF is not tolerated or not affordable, then a Soy formula, like Similac Isomil^®, should be used.⁴

Breast milk provides the nutrition and immune support infants need to face their first adventures.^5–8

If symptoms clearly improve in the elimination stage, it is very important to carry out the reintroduction step to confirm the diagnosis of mild-to-moderate CMA.^1–3

For infants presenting with non-IgE-mediated CMA, cow’s milk protein can be reintroduced at home with guidance from a healthcare professional.^1–3

If there are no clear signs of improvement following the elimination trial and CMA is still suspected, then consider initiating an AAF and refer the infant to the local paediatric service.^1,3