Dairy-free babies and toddlers

Allergy, intolerance or choice

Families go dairy-free for different reasons, and the reason changes what your child can have:

• Cow’s milk allergy: the immune system reacts to milk protein, so all foods made from milk are out. That includes lactose-free milk, which still contains milk protein (NHS Forth Valley), and other animal milks such as goat’s and sheep’s milk, which have similar proteins (NHS Cambridgeshire). See cow’s milk allergy.
• Lactose intolerance: trouble digesting milk sugar, not an allergy. The AAP says children who can’t drink cow’s milk can often still meet their dairy needs with yogurt and cheese.
• Family choice, such as a vegan diet: see vegetarian and vegan babies.

Ask before you cut it out. The NHS says not to experiment by cutting out a major food such as milk, because your child could miss out on the nutrients they need. Talk to your health visitor or GP, who may refer you to a registered dietitian.

Milk feeds under 12 months

Up to 12 months, breast milk or infant formula stays your baby’s main drink (NHS).

• Breastfeeding: keep going. The AAP says there isn’t enough evidence for breastfeeding parents to avoid milk routinely. If your baby is diagnosed with a milk allergy, your doctor may suggest you cut dairy from your own diet, and the AAP says it can take several weeks for milk protein to disappear from breast milk. Ask about your own calcium and vitamin D if you do.
• Formula for a milk allergy: your GP or pediatrician will prescribe a hypoallergenic formula (NHS, AAP). Comfort (partially hydrolysed) formula and goat’s milk formula are not suitable for babies with a cow’s milk allergy (NHS).
• Soy formula: the NHS says it’s suitable from 6 months, and only under medical supervision. The AAP says up to half of babies with a cow’s milk protein allergy may also react to soy.
• Vegan families: first infant formula is usually based on cow’s milk (NHS), so ask your health visitor or pediatrician about the options.

Plant drinks: when and which

• In cooking from 6 months. NHS dietitians say plant drinks such as oat, soy, hemp or pea can be used in cooking and on cereal from 6 months, for example in porridge or sauces (NHS Cambridgeshire, NHS Forth Valley). With a milk allergy, soy drink waits until soy foods have gone well, and a drink your baby has reacted to isn’t tried again (NHS Cambridgeshire). Breast milk or formula stays the main drink.
• As a main drink from 12 months. The NHS says unsweetened, calcium-fortified plant drinks such as soy, almond and oat can be given from age 1 as part of a healthy, balanced diet.
• Choose fortified, unsweetened versions. NHS dietitians suggest at least 40 calories and 1 g of protein per 100 ml (NHS Cambridgeshire) and about 120 mg of calcium per 100 ml, and warn that organic plant drinks usually aren’t fortified (NHS Forth Valley).
• Soy is closest to cow’s milk. The AAP says soy milk is nutritionally equivalent to cow’s milk and that other plant milks aren’t recommended in place of dairy milk.
• Nut drinks aren’t the first choice with a milk allergy because of possible reactions (NHS Forth Valley).
• No rice drinks under 5. The NHS says young children shouldn’t have rice drinks because of the arsenic they contain. See rice and arsenic.

For a full comparison of soy, pea, oat, almond and coconut drinks, see plant milks for toddlers.

Calcium

Babies need 260 mg of calcium a day at 7 to 12 months and toddlers 700 mg a day at 1 to 3 years (NIH). Without dairy, include calcium foods often from 12 months. Good options (NIH, NHS):

• calcium-fortified soy drink, soy yogurts and other fortified plant yogurts (check the label)
• tofu made with calcium (some brands have it added)
• green vegetables such as kale, broccoli, bok choy and okra, cooked soft and chopped
• canned sardines or salmon with their soft bones mashed completely flat
• calcium-fortified cereals and, in the UK, bread made with fortified flour

Spinach is not a good source: it has calcium, but the body can’t absorb all of it (NHS). See calcium for toddlers for amounts and a sample day.

Vitamin D

The AAP says a child who doesn’t drink cow’s milk may need a vitamin D supplement, so ask your pediatrician. In the UK, the NHS already advises daily vitamin D drops for breastfed babies and for every child aged 1 to 4. Many fortified plant drinks have vitamin D added; check the label. See vitamin D for babies.

Iodine

The NHS lists cow’s milk and dairy foods first among good sources of iodine, so a dairy-free diet can run short. Eggs, sea fish and shellfish are other sources. Only some plant drinks, such as some soy and oat drinks, are fortified with iodine, so check the label (NHS). Ask your doctor or dietitian whether your child needs more, and don’t use seaweed or kelp to fill the gap. See iodine for babies.

Protein and energy

• Protein: the NHS suggests at least 2 portions a day of protein from plant sources (beans, chickpeas, lentils, tofu) or 1 from animal sources (meat, fish, eggs) for young children. The AAP says plant drinks other than soy may be low in protein. See protein for babies.
• Energy and fat: dairy-free diets can be lower in calories and fat. For children under 2, NHS dietitians suggest cooking with olive, vegetable or rapeseed oil and using dairy-free spreads generously (NHS Forth Valley). See healthy fats for babies.

Reading labels

Milk turns up in bread, biscuits, crisps, processed meats, breakfast cereals and ready meals (NHS Cambridgeshire). On UK labels, milk must be emphasized in the ingredients list, often in bold. Look for words such as casein, caseinate, whey and milk protein (NHS Cambridgeshire). One NHS dietitian page says children with a milk allergy don’t need to avoid foods labelled “may contain milk” (NHS Cambridgeshire), but ask your own dietitian or doctor. See the 14 allergens for US and UK labeling rules.

If your baby reacts

The NHS says most allergic reactions happen within minutes and up to 2 hours, but with cow’s milk allergy symptoms can take up to 3 days. A few hives, mild swelling around the eyes or a flare of eczema: stop the food and call your pediatrician, GP or health visitor.

Signs of anaphylaxis are trouble breathing, wheezing or a cough that won’t stop, swelling of the tongue or throat, lips or mouth that suddenly swell, a hoarse cry, turning pale or floppy, becoming very sleepy or unresponsive, or signs in more than one part of the body at once. If you see any of these and your baby has an epinephrine (adrenaline) auto-injector, use it right away, then call for an ambulance. Call 911.Call 999.Call your local emergency number (such as 112 in Europe or 000 in Australia). If you don’t have an auto-injector, call straight away. If you’re alone with your baby, use the auto-injector first if they have one, then call on speaker straight away. Don’t leave your baby to find a phone. Keep your baby lying down, never standing or walking (on their side if they’re vomiting, head and shoulders a little raised if breathing is hard). See signs of anaphylaxis.

A delayed type of milk allergy called FPIES causes repeated vomiting a few hours after milk and can make a baby pale and floppy. If your baby vomits once or twice a few hours after milk and is alert and like themselves, call your pediatrician or GP. Call 911 or go to the emergency room if your baby is vomiting again and again, or is pale, floppy, very sleepy or hard to wake.Call 999 or go to A&E if your baby is vomiting again and again, or is pale, floppy, very sleepy or hard to wake.Call your local emergency number (such as 112 in Europe or 000 in Australia) or go to the emergency department if your baby is vomiting again and again, or is pale, floppy, very sleepy or hard to wake. See FPIES.

Working with a dietitian

Many children outgrow a milk allergy (NHS). When it’s time to test, your dietitian may use a milk ladder, reintroducing milk in steps at home. Don’t start one without their advice.

Where US and UK advice differs

• Plant drinks. The AAP says only soy milk is nutritionally equivalent to cow’s milk. The NHS says unsweetened, calcium-fortified soy, almond or oat drinks can be given from age 1.
• Plant drinks in cooking under 12 months. NHS dietitian pages allow them in food from 6 months. We found no US guidance on this, so ask your pediatrician.
• Rice drinks. The NHS says none under 5. This site follows that everywhere.