Cow's Milk Alternatives for Babies

Managing cow’s milk allergies in babies may pose some challenges. Infants usually rely on milk for sustenance, and when allergic symptoms develop, it may be difficult for parents and caregivers to support the child’s dietary requirements. Fortunately, with the advent of new medical research and technology, numerous cow’s milk alternatives are already available in the market.

Leg of sleeping child with redness on the skin, suffering from food allergies. Image Credit: Yaoinlove / Shutterstock
Leg of sleeping child with redness on the skin, suffering from food allergies. Image Credit: Yaoinlove / Shutterstock

The alternatives, however, should be selected in an age-appropriate manner and their use requires close monitoring before they can serve as the primary source of protein among babies. Because milk allergies usually subside after a few years, children are expected to eventually be weaned off such alternatives and begin to revert to natural milk products. Pediatricians should play an active role in determining appropriate cow’s milk alternatives for each infant, taking into consideration the child’s age, medical history, and symptomatology.

Infants less than 12 months old suffering from cow’s milk allergies are usually given any of four alternative options: amino acid-based formula, soy protein formula, extensively hydrolysed formula, and rice protein-based EHF.

Soy Protein Formula

With the main ingredient being soybeans, soy protein formula is a common alternative to cow’s milk. Over the years, there has been an abrupt rise in the number of caregivers who resort to the use of such as an alternative, with at least a fourth doing so in the US. Soy protein formula includes iron-fortified ingredients that are at par with the vitamin, mineral, and electrolyte requirements for feeding infants. It is particularly rich in lactose-free carbohydrate, carnitine, and taurine.

Extensively Hydrolysed Formula (EHF)

Extensively hydrolysed formula (EHF) is usually prescribed by doctors to infants with cow’s milk allergy. The EHF is formulated to specifically break down cow’s milk proteins through the use of enzymes. However, not all babies are able to ingest EHF. Infants who cannot adjust to EHF may be given other alternatives such as amino acid-based formulas or a partially-hydrolysed formula.

Rice Protein-Based EHF

Rice protein-based EHF are usually only given when cow’s milk allergy has not been yet diagnosed, that is, while waiting for laboratory results or for a second opinion from an immunologist. As such, this alternative is only used temporarily in most cases, but it may be continued upon the advice of a medical specialist.

Amino Acid-Based Formula (AAF)

Infants who are highly sensitive to cow’s milk alternatives may be given amino acid-based formulas (AAF). Studies suggest that 1 out of 10 infants are switched to AAF due to the severity and sensitivity of their allergic conditions. The formula is usually given for a 12-week period and requires intensive monitoring.

Babies more than 12 months old would require other milk alternatives, typically calcium-enriched oat, rice or nut milks, or soy milk; however, such milk substitutes may be insufficient to meet the nutrient requirement of these babies or may pose the risk of additional food allergies. Therefore, these alternatives should be given only upon consultation with a doctor.

In determining cow’s milk alternatives for babies, parents and caregivers should note other food allergies that may co-occur during healthcare management. The treatment for cow’s milk allergy and the planned intake of cow’s milk alternatives among babies is a long-term course of management.


  1. Allen et al (2009). Management of cow’s milk protein allergy in infants and young children: An expert panel perspective. Journal of Pediatrics and Child Health, 45, pp. 481-486.
  2. American Academy of Pediatrics (1998). Soy Protein-based Formulas: Recommendations for Use in Infant Feeding. Pediatrics, 101(1).
  3. Cow’s Milk Allergy (2017). Retrieved from  
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  6. Vanderhoof, J., Moore, N., & de Boisseui, D. (2016). Evaluation of an Amino Acid−Based Formula in Infants Not Responding to Extensively Hydrolyzed Protein Formula. Journal of Pediatric Gastroenterology and Nutrition, 63(5), 531-533.

Further Reading

Last Updated: Feb 26, 2019

Gaea Marelle Miranda

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Gaea Marelle Miranda

Gaea graduated from the University of the Philippines, Manila, with a degree in Behavioral Sciences, cum laude . Majoring in psychology, sociology, and anthropology, she approaches writing with a multidisciplinary perspective.


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