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Discovering your newborn is sensitive to their baby formula can be a very stressful time, with you struggling to get them to keep any milk down.

Cow's milk allergy (CMA), an adverse immune reaction to the proteins contained in milk from animals such as cows and goats, affects about 2.5% of children under age 3, according to the U.S.-based Food Allergy Research & Education organization.

It will often affect the skin and digestive tract, exhibited in symptoms such as a rash or eczema, vomiting, diarrhea, reflux or excessive crying.

The good news is that it’s fairly easy to find a substitute formula, with brands producing specialized options for sensitive stomachs.

Partially Hydrolyzed Formula (HA)

Most infant formula is a modified version of cow's milk, which contains whey and casein proteins.

But some babies can struggle to digest these protein chains, which are larger than those found in breast milk. This can manifest as CMA or the condition called reflux.


Finding the right formula to make your baby happy can be trial and error

Partially hydrolyzed formula (often seen on tins as HA for hypoallergenic) breaks down the complex protein molecules with water, so the curds that usually form in the stomach with casein proteins don’t appear.

Hydrolyzing proteins brings them closer to the size of breast milk proteins, which means they may be more easily digested. 

What is reflux? 

Also known as GER (gastroesophageal reflux), reflux is a condition that causes the milk and acid in your baby’s stomach to come back up. 

This could be a sign that they’re allergic to cow's milk, or that their digestive system is simply still maturing.

Extensively Hydrolyzed Formula (EHF)

More specialized formulas can break proteins down into even smaller chains—extensively hydrolyzing them so they are often better tolerated.

Your health professional will probably recommend one of these hypoallergenic formulas if your baby is having severe allergic reactions or inexplicable digestion problems. Studies have shown, however, that there was no evidence that switching to an HA or EHF formula reduces the risk of eczema or CMA in infants.

Did you know?

Breastfed babies can still be allergic to cow's milk protein, as it transfers through the mother’s milk.

In this case, a doctor may recommend the mom remove the allergen from her diet.

Amino Acid-Based Formula (AAF)

If your baby has a severe digestive tract reaction to milk proteins (i.e., acute gastroenteritis), or multiple food allergies, amino acid-based formulations are a hypoallergenic alternative.

These formulas contain amino acids, which are the building blocks of pure protein, but no actual proteins.

Amino acid-based formula that contains a blend of prebiotics, including fructo-oligosaccharides, and probiotics, such as Bifidobacterium breve M-16V, can improve the gut microbiota of infants with CMA, pediatric research shows.

Differences in the gut’s microbiome may be to blame for food allergies such as CMA, increasing evidence shows.

Children with CMA who displayed a lower diversity of microorganisms in the intestines saw improvement after six months on a hypoallergenic formula, a Shanghai study revealed.

Anti-Reflux Formula (AR)

If your baby isn’t suffering from a cow's milk allergy but has regurgitation issues, then your doctor may recommend an anti-reflux or thickened formula.

With these powders, some of the lactose has been replaced with starch to make the feed heavier—the idea being to keep it from rising back up the esophagus.

AR formulas, however, are not considered effective at reducing the acid levels that could be causing your baby's reflux in the first place. So it's best to consult a pediatrician, who in many cases is required to write a prescription for these and other specialized formulas, and who can recommend a complete course of action.  

A range of specialized formulas are on hand to help your little one

Could It Be Lactose Intolerance?

Although they share similar symptoms, lactose intolerance is different to CMA.

Lactose intolerance is the body’s lactase deficiency, resulting in the inability to break down lactose: the sugar in milk. It is not classed as an allergy as the immune system is not involved.

Symptoms include bloating, abdominal pain, gas or diarrhea and can be managed with a lactose-free diet. Something like a soy-based formula may help in this case.

Real lactose intolerance, according to the American Academy of Pediatrics, is more common after age 2. That means symptoms such as those listed above may simply be a temporary reaction to a newly introduced formula.

In most cases, infants will actually outgrow CMA and lactose intolerance. Elimination diets and testing for cow's milk antibodies can help determine the likelihood that the allergy or reaction will continue.

In the meantime, having a baby who is struggling to eat is heartbreaking. Please take comfort in knowing that there are many solutions nowadays to help relieve—if not eliminate—any symptoms.

If you have experience with CMA, please share your insights with other parents in the comments section below.

June is committed to supporting the best possible outcome for moms and babies—whether that is through breastfeeding or formula feeding. We are here to provide evidence-backed information to allow each family to make the choices that are right for them.