If your baby has been diagnosed with a milk allergy, you might be concerned about weaning. Read on to find out how to do it safely.

With thanks to Bahee Van de Bor, paediatric dietitian

Step One: How to start solids for your baby with a milk allergy

If your baby has a milk allergy, the first step is to identify the style of baby feeding that you wish to follow. Should you spoon feed or follow baby-led weaning? The choice is yours but check that your baby is ready. According to the NHS, a baby is ready around six months and when they are able to:

• sit upright and hold their head steady
• co-ordinate their eyes, hands and mouth so they can look at the food, pick it up and put it in their mouth by themselves
• swallow food, rather than spit it back out

Step Two: Before starting solids for your baby with milk allergy…

Continue to breastfeed or use your baby’s special infant formula recommended by your GP, paediatric dietitian or allergy doctor.   If you’re thinking about baby-led weaning, a recent research paper showed interesting results. The researchers found that babies who followed baby-led weaning were more likely to be offered vegetables and join in with family meals.  With a few tweaks to your family meals to ensure that foods available at the table are dairy free, there’s no reason why your baby with a milk allergy cannot join either. Baby led weaning is safe so if this is your preferred feeding style, then go for it! In fact, this UK paper showed that babies at increased risk of choking were those who were not given finger foods alongside their puree foods. Regardless of the type of feeding style you choose, always remain with your baby during meal times to minimise any potential risk of choking.

Step Three: Be familiar with the signs and symptoms of milk allergy

If your baby has been well since starting their special infant formula or whilst you’ve been following a strict milk free diet for breastfeeding, you may have forgotten the earlier signs and symptoms that your baby had when first diagnosed with a milk allergy. The first thing that you will notice if your baby is accidentally given food containing milk is an allergic reaction. Signs of a milk allergy usually show immediately or within 2 hours and include

• Swollen lips, face or eyes
• hives, urticaria
• abdominal pain, vomiting

Serious symptoms – these are rare

• swollen tongue, persistent cough, hoarse cry
• difficult or noisy breathing
• pale/floppy/unresponsive/unconscious

Symptoms for delayed cow’s milk protein allergy

• recurrent tummy pain, worsening reflux and vomiting
• food refusal
• loose frequent stools – around 6-8 per day
• or constipation 2 or less bowel motions per week
• skin reddening or itch
• worsening eczema

Step Four: when you are ready to start solids for your baby with a milk allergy

Start with a puree of vegetables and then fruit. Simply peel, chop and then cover with water to cook in a saucepan. Mash with a fork using the water in the pan, breast milk or your baby’s special infant formula.   When your baby is ready, offer finger foods. Use very soft pieces of steamed or cooked vegetables such as carrots, broccoli, root vegetables and then move onto fruit. During this phase of weaning, focus on the variety rather than the amount that baby eats. Focus on iron-rich foods.  From around 6 months of age, baby’s iron stores and the amount of iron present in breast milk starts to decline. If you are following a plant-based diet, then you can introduce lentils and beans which are good sources of iron. Recommended iron rich foods to give when starting solids for your baby with milk allergy include:

• Lentils
• Nut butter
• Meat, chicken, fish, eggs
• Green leafy vegetables
• Iron-fortified breakfast cereal

If you need to use milk in a recipe, substitute the whole milk in the recipe above with breast milk or your baby’s special infant formula. 

Introducing other high allergenic foods

Egg, nuts, fish and gluten may be causing you some worry and confusion. If your baby also has moderate to severe eczema your allergy doctor, GP or paediatric dietitian may recommend introducing cooked egg and peanuts to try to prevent your baby’s chances of developing an allergy to these foods. Wait at least a few days before introducing a new food and start with small amounts such as 1/4 to 1/2 teaspoon of cooked food.  Gradually increase the amounts offered. If your baby accepts these foods and doesn’t have a reaction then continue to offer these foods as part of their weekly menu plan. If your baby has an allergic reaction, then please stop giving your baby the food that they react to and speak to your family doctor for further advice.

Step six: Menu planning

Plan a daily menu with calcium for your baby with a milk allergy. Aim for 3 balanced mini meals per day. From around 9 months of age, you can start to use a plant milk to prepare porridge, dairy free pancakes or homemade bread for breakfast. Not all plant based milks are suitable and your dietitian may recommend using some types over others based on the source and amount of protein, the over all calories, presence of added calcium, vitamins and minerals.

Lunch and evening meals

It seems early to think about “meals” but you can start creating mini meals with texture.

• Use root vegetables or grains like quinoa, amaranth, oats, rice, cous cous
• Add iron-rich vegetables and green leafy choices
• Protein (meat, chicken, fish or lentils)
• Use infant formula or a calcium fortified plant drink to get the desired texture

Desserts or snacks

Your baby still needs breast milk or specialist infant formula and they can have dairy-free yoghurts (check that they are calcium fortified). For finger foods, cut up pieces of bread or toast dipped into hummus or calcium-fortified yoghurt based dips. You can even make custard using a dairy free custard powder and then mix with baby’s specialist formula. Other useful foods containing added or natural sources of calcium include:

• oat based creme fraiche and cream that is also calcium fortified
• tahini paste, a plant source of some calcium
• tinned fish with it’s bones to prepare sandwiches (excellent source of calcium)
• broccoli, kale
• beans and pulses

Step Seven: Read all food labels, including “Free From” ranges

There are many ways that milk can be labelled and it’s not always obvious. Never assume that foods from a “free from” range will be free from cow’s milk protein and remember that you are also avoiding milk and food products made from sheep, goat or buffalo as the protein is very similar to cow’s milk protein.

Bahee Van de Bor RD MBDA is a private paediatric dietitian and former Great Ormond Street Hospital for Children-trained specialist children’s nutritionist. Now based in Harley Street, you can find out more on her website. Follow her on Instagram @ukkidsnutrition or on Facebook @ukkidsnutrition. You can read more from Bahee about weaning babies with milk allergies here.   Disclaimer: The views and advice given in this article are those of the guest writer and do not necessarily reflect the opinions of Weaning Week or any other organisations represented on this platform