Following a cow’s milk free diet whilst breastfeeding
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You have been asked to trial your baby on a strict cow’s milk free diet to help your doctor decide if your baby’s symptoms are caused by a reaction to cow’s milk protein. As your baby is breastfeeding, you will need to make sure that your own diet is completely free from cow’s milk to stop any proteins from the dairy products passing through to your baby in your breastmilk. This fact sheet will help you to follow a strict cow’s milk free diet that is healthy and balanced.
What foods should you avoid?
You will need to avoid cow’s milk and all foods and drinks made with cow’s milk. You should also avoid all mammal milks (e.g. goat’s milk, sheep’s milk, mare’s milk, buffalo milk) as these contain similar proteins to cows milk which your baby may also react to.
Always check food labels
Cow’s milk is often an ingredient in pre-packaged foods and drinks, for example, bread, biscuits, baked goods, processed meat and fish, crisps, breakfast cereals, sweets and ready meals.
Under current labelling laws, if cow’s milk (or any common allergen) is an ingredient in a pre-packaged food or drink, it must be highlighted or emphasised in bold.
Ingredients list example
Water, Vegetable Oils (37%) [Rapeseed Oil, Palm Oil], Olive Oil (22%), Whey Powder (from Milk),
Salt (1.1%), Emulsifier (Mono- and Diglycerides of Fatty Acids), Stabiliser (Sodium Alginate), Preservative (Potassium Sorbate), Colour (Carotenes), Flouring, Vitamin A, Vitamin D
Check all labels for these ingredients:
- cheese – all varieties
- condensed milk
- cow’s milk & all animal milks
- crème fraiche
- evaporated milk
- fromage frais
- casein (curds)
- calcium or
- sodium caseinate
- hydrolysed casein
- hydrolysed whey protein
- milk powder
- skimmed milk powder
- milk protein
- milk sugar
- milk solids
- non-fat milk solids
- modified milk
- whey solids
- hydrolysed whey
- whey protein
- whey syrup sweetener
Foods sold without packaging don’t need to be labelled BUT you can ask someone behind the counter for allergen information, to see whether these products contain milk.
Some manufacturers and supermarkets compile their own lists of products that are free from cow’s milk. These can often be downloaded from their websites or requested from customer services. These lists are useful to help you identify foods that are safe to eat. Foods labelled ‘may contain milk’ will not have milk within the ingredients but may contain traces of milk due to being manufactured on the same equipment. Usually only severe allergy sufferers will need to avoid these products.
Lactose-free foods and drinks still contain cow’s milk protein and are not recommended as alternatives.
Your daily calcium requirements
While breastfeeding your body needs approximately 1250mg of calcium daily. Dairy foods are one of our main sources of calcium, but there are lots of dairy free alternatives available. The table below shows some foods that are free from cow’s milk and their calcium content per typical serving. Choose dairy alternatives that are calcium & iodine fortified. NB: organic options will not be fortified.
|Fruit and vegetables||Serving size||Calcium (mg)|
|Orange||1 small (120g)||56|
|Dried figs||1 (20g)||50|
|Dried apricots||4 (32g)||23|
|Okra – stir fried||60g||132|
|Cooked spinach||1 tablespoon (40g)||64|
|Cow’s milk free alternatives||Serving size||Calcium (mg)|
|Oat milk (fortified)||280mls (1/2 pint)||335|
|Coconut milk (fortified)||280mls (1/2 pint)||336|
|Soya milk (fortified)||280mls (1/2 pint)||370|
|Almond milk (fortified)||280mls (1/2 pint)||336|
|Rice milk (fortified)||280mls (1/2 pint)||335|
|Soya yogurt (fortified)||100g||120|
|Soya cheese (fortified)||30g||400|
|Coconut yogurt (fortified)||100g||128|
|Fish||Serving size||Calcium (mg)|
||60g (1/2 can)||300|
|Breaded scampi||5 pieces||150|
|Salmon in tin (edible)||100g||91|
|Bread and Cereals||Serving size||Calcium (mg)|
|Calcium fortified cereals
|White bread||1 slice (30g)||47|
|Wholemeal bread||1 slice||32|
|Half and half||1 slice||79|
|Fortified bread||1 slice||150|
|Nuts, seeds and legumes||Serving size||Calcium (mg)|
||1 tablespoon (35g)||56|
|Baked beans||1 tablespoon (80g)||42|
Example meal plan to meet your daily calcium requirements
Breakfast cereal (fortified) 30g or 2 biscuits)
Fortified oat milk (250mls or half a pint)
Orange Juice (150mls/small glass)
Sandwich – 2 slices of fortified bread, dairy free
With tinned salmon (edible bones) & cucumber slices
Fortified oat milk (250mls or half a pint)
Apple (1 medium)
Chicken, grilled (60-90g, size of a pack of cards)
Mashed potato made with fortified milk (50ml)
Sweetcorn (2 heaped tablespoons)
Broccoli (2 spears)
Pudding: Tinned peaches with Soya dessert (125g)
Almonds (small handful, approx.15)
If you are unable to meet your calcium requirements of 1250mg a day through diet alone, you can take a calcium supplement to make up the difference. See below for suggestions available in your pharmacy or supermarket.
|Ove the counter||Form||Calcium per dose|
|Vitabiotics Pregnacare: Breast-feeding||Tablet||700mg calcium (+ 10ug Vit D)|
|Osteocare liquid calcium (+magnesium, Vit D, zinc)||Liquid/syrup||300mg calcium (+ 10ug Vit D)|
|Osteocare original (+magnesium, Vit D, zinc)||Tablet||800mg calcium (+ 25ug Vit D)|
|Tesco calcium + vitamin D||Tablet||400mg (+2.5ug Vit D)|
|Boots or Sainsbury’s calcium + Vitamin D||Chewable tablet||800mg (+ 5ug Vit D)|
|Vitabiotics ultra calcium + Vitamin D||Tablet||1000mg (+20ug Vit D)|
|Boots effervescent calcium + Vit D & Vit K||Tablet||800mg (+ 10ug Vit D)|
Vitamin D is needed for healthy bones, teeth and muscles. Our main source of vitamin D is sunlight on our skin, however, the sun in the UK is not strong enough to produce Vitamin D in winter and autumn, therefore we need to obtain Vitamin D through diet. Vitamin D has limited dietary sources (oily fish, red meat, liver, egg yolks & fortified foods) and it is difficult to meet the recommended vitamin D intake from food alone. The Department of Health recommends adults (including breastfeeding women) consider taking a daily supplement containing 10ug of vitamin D, particularly during winter and autumn.
How long should I follow a cow’s milk free diet?
Many infants will grow out of their cow’s milk protein allergy or intolerance, often by 5 years of age. Your dietitian or doctor will discuss with you how to safely reintroduce cow’s milk into your baby’s diet, usually when your baby is around 1 year old. It can be a slow process and many babies will only gradually be able to take increasing amounts of cow’s milk protein without symptoms. Your Dietitian or doctor will tell you if this will be done by you at home or under medical supervision in hospital. Some babies who are allergic or intolerant to cow’s milk protein also react to other foods. Speak to your dietitian or doctor if you suspect this with your baby