Nutrition Tips for Dealing with Cow’s Milk Protein Allergy (CMPA)


One of the most common childhood food allergies is Cow’s Milk Protein Allergy (CMPA). Children who have this have an adverse immune system reaction to the proteins found in cow’s milk. Casein is the main protein in cow’s milk. There are 2 parts to milk — curd is the solid part of the milk you see when it curdles. Whey, on the other hand, is the watery liquid when the curd is removed. A child allergic to cow’s milk can be allergic to any one of these components of cow’s milk.

Globally, CMPA affects about 5 to 15% of young children in the first 3 years of their life. Majority of the children may grow out of the allergy by the time they are 3 or 4 years old. However, 30% of children with CMPA don’t outgrow it — causing the condition to plague them throughout their teens and young adulthood.

The allergic reaction can manifest in inflammation of the gastrointestinal tract, skin and respiratory tract. Symptoms of the allergy manifest in colic, runny nose, loose stools, constipation, bloody stools, vomiting, eczema and more.

The best way to avoid an allergic flare-up if your child has been diagnosed as having CMPA is to totally exclude foods that contain milk and dairy. Unfortunately, many parents sometimes are unaware that milk and dairy are commonly found in a lot of favourite children’s foods such as milk, ice cream, cookies, cakes, pizza, chocolates, snack foods, breads, buns and more. This can also make it difficult to control as children grow up and start making food choices of their own but aren’t armed with the right knowledge to know which foods are suitable for them or not. It’s common for them to get tempted and eventually eat something that contains dairy, only to end up with an allergy reaction. This can be frustrating then, in having to now deal with recovering from the allergic symptoms all over again.

It’s natural for parents of children with CMPA to be concerned about their child getting sufficient calories as their variety of foods get smaller since many of their favourite foods contain milk and dairy. Some children become rather picky in their food choices as well. Moreover, they have a high risk of missing out on important nutrition especially if their meals are not well balanced and their constantly fighting off symptoms of their allergy due to a lack of strictly adhering to a milk-free diet. For children that are growing, going to school and also eating out can be somewhat challenging as they learn to make food choices of their own.

Children 1 to 3 need to have 3 to 4 servings of milk and dairy in a day; whereas older children require 2 to 3 servings.

Here are some tips I’d like to share with you to help empower parents with children with CMPA:

Do talk to your paediatrician about suitable alternatives to cow’s milk. In the market, there are fortified soya formulas.

  • Contain soya bean protein and is fortified with vitamins and minerals
  • Switching to fortified soya formulas help some children with CMPA. However 30-40% of children with CMPA are also found to be allergic to soy, therefore soy is not a suitable alternative in these children. Always do consult your paediatrician to get the best recommended alternative for your child.


Specialized hypoallergenic formulas :

  • Extensively hydrolyzed formula– protein are broken down to be easily digested
  • Elemental formula – Proteins are in the simplest form for ease of absorption

Read ingredients lists to find hidden milk and dairy ingredients:

  • Milk (cows and other animals)
  • Hydrolyzed milk
  • Yogurt, cheese, cottage cheese
  • Half & half, cream, sour cream
  • Casein and whey products
  • Butter, butterfat, butter oil, natural butter flavours, butter solids
  • Ghee & Artificial butter flavouring
  • Lactose, lactate, lactalbumin & lactic acid
  • Chocolate
  • Custard (pudding), nougat, caramel


When substituting milk in recipes, this is what you can use:

1 cup (250 ml) milk =

  • 1 cup fruit juice (use light coloured fruit juice)
  • 1 cup soya bean milk
  • 1 cup milk-free growing up milk
  • 1 cup rice, oat or other grain milk
  • 1 cup almond or other nut milk
  • 1 cup water
  • TO SUBSTITUTE BUTTER = use oil or milk-free margarine


Tips to avoid cross contamination:

  • Avoid batter deep fried foods as the same oil may be used again
  • Educate family members, caregivers & teachers
  • Explain the condition to waiters/restaurant managers for special orders
  • Separate utensils, knives, cutting boards and dishes to prepare foods for your child

Empowering Your Child When They Start School:

  • Teach your child how to make choices
  • Go to the school to look at the canteen menu to assist your child to make choices
  • Inform the teachers of the condition
  • Parties? Asked to be informed early so you can pack some treats for your child
  • Make a card listing foods & ingredients your child should avoid


Take home message:

  • Think positive & know more about CMPA
  • Familiarize yourself with foods and ingredients with milk
  • Empower & teach your child to identify these foods
  • Ask your doctor or dietitian for suitable substitutes for milk & dairy
  • Think positive & know more about CMPA
  • Familiarize yourself with foods and ingredients with milk
  • Empower & teach your child to identify these foods
  • Ask your doctor or dietitian for suitable substitutes for milk & dairy


Written by Indra Balaratnam (Consultant Dietitian) 


Indra Balaratnam is our guest writer. She is the founder of Indra Balaratnam Nutrition – The Food Expert Clinic and she has 18 years of experience in the field of foods, nutrition. 

She runs her own private practice, where she conducts one-on-one dietary counseling and group workshops for clients who want to eat better for good health. Her area of dietetic interests are chronic illnesses such as diabetes, coronary heart disease, post surgery recovery, weight management, pregnancy, childhood nutrition and nutrition for fitness.

Indra’s keen interest in the profession also sees her invited as an expert speaker and trusted key opinion leader for professional conferences, corporate wellness programmes, workshops, television and radio talkshows. Indra is the co-author of the nutrition cookbook “Healthy Eating – Recipes for the Asian Palate” (Times Edition Marshall Cavendish 2004) and “Healthy Family Meals” (Marshall Cavendish Cuisine 2008) in which she collaborated with Chef Nicholas Pillai. 


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