Special Dietary Needs

Allergies to Milk and Soy—Implications for Practice

Milk is an important requirement in the Child and Adult Care Food Program (CACFP) meal pattern that provides a significant amount of protein to a child’s diet as well as many vitamins and minerals including calcium, phosphorus, vitamin D, vitamin A, riboflavin, vitamin B-12, potassium and magnesium. Unfortunately according to the Center for Disease Control (CDC), food allergies are on the rise with a reported 18 percent increase and children are becoming increasingly allergic to more foods compared to a few decades ago (1, 4). Cow milk allergies are in fact the most common food allergy in infants and young children. In this situation a parent should consult their pediatrician to find the best option that will allow their child to receive the most nutritious diet possible and still consume foods that do not cause adverse effects.

The CACFP guidelines have approved fluid milk substitutions that are nutritionally equivalent to cow’s milk. At this time soymilk is the only option but there are several brands available that can be found on Minnesota Department of Education’s (MDE) website. View the list of Approved Fluid Milk Substitutions.

However, according to research roughly 10-14 percent of children with cow milk allergies also have soy protein allergies (2). Luckily this seems to decrease with age (36.8 percent in the first year of life, 16.4 percent in the second year, and 13.7 percent in the third year) (3). According to other studies, most food allergies decrease with age (with the exception of peanuts). As many as 5.5 percent of infants have a clinically diagnosed food hypersensitivity (includes both allergy and severe intolerance) compared to 2.5 percent of 6 year olds and 2.3 percent of 11 and 15 year olds.

An alternative for a child with a soy and cow milk allergy could be for a parent to consult their pediatrician and determine if goat milk would be a viable option for this child. Typically, the use of goat’s milk is not recommended to patients with cow milk allergies without investigation of possible tolerance by a specialist. According to research, goat’s milk is tolerated by about 25-40 percent of children who are allergic to cow’s milk. This is a result of specific proteins (mainly lactalbumin) that are specific between different species (5, 6). One brand of goat’s milk, Meyenberg**, offers both whole (only creditable for children under two) and low-fat (one percent) versions that meets CACFP fluid milk requirements. Since goat milk is not a fluid milk substitute it does not need a parent’s written request or physician signed special diet statement. However, remember all milk (with the exception of human breast milk) needs to be Grade A pasteurized from a state permitted plant and fortified with vitamins A and D according to federal regulations.

Typically infants who are allergic to milk and soy will require an extensively-hydrolyzed formula such as Alimentum® or Nutramigen® where the protein molecules are broken down enough so the infant will not recognize the cow’s milk protein. View the list of FDA exempt formulas which require a special diet statement from a recognized medical authority.

**MDE does not endorse any specific brands or food manufacturers. Manufacturers can change ingredients and recipe formulations at any time.

(1) Branum, A.M., Lukacs, S. L. Food Allergy among U.S. Children: Trends in Prevalence and Hospitalizations. NCHS Data Brief No.10. 2008. Available at: http://www.cdc.gov/nchs/data/databriefs/db10.htm.

(2) Kattan, JD, Cocco, RR, Jarvinen, KM. Milk and Soy Allergy. Pediatric Clinical North American. 2011; 407-426. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070118/.

(3) Ahn KM, Han YS, Nam SY, Park HY, Shim MY, Lee SI. Prevalence of Soy Protein Hypersensitivity in Cow’s Milk Protein-sensitive Children in Korea. Journal of Korean Medical Science. 2003; 473-477. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12923320.

(4) Hadley, C. Food Allergies on the Rise? Determining the Prevalence of Food Allergies, and How Quickly it is Increasing, is the First Step in Tackling the Problem. EMBO Reports. 2006; 1080-1083. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1679775/.

(5) Jandal, J.M. Comparative Aspects of Goat and Sheep Milk. Small Ruminant Research. 1996; 177-185. Available at: http://www.dieteticai.ufba.br/Temas/LEITEDERIVADOS/cabra%20e%20ovelha.pdf.

(6) Pina, I.D, Carnice. T.R., Zandueta, C.M. (2003). Use of Goat’s Milk in Patients with Cow’s Milk Allergy. Anales de pediatria. 2003; 138-142. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12882742.