Ask the experts

If a baby requires a specialist milk, parents may have more questions than usual. Here’s what our experts advise for these common queries

Which specialist milks are available on prescription? 

Geraldine Goodman, community dietitian, Dietetic Department, Cumberland Infirmary, says: “For babies with cows’ milk protein allergy there is a range of alternative hypoallergenic formulas available on prescription. Extensively hydrolysed formulas contain proteins that have been broken down into smaller segments and these formulas are suitable for many babies with an allergy.

“For babies who do not tolerate these, it may be necessary to use an amino acid formula. Soya based formulas are not suitable as a first-line choice in babies with cows’ milk protein allergy.”

If a parent wants additional information about specialist milks, what sources of help can I signpost them to?  

Registered nutritionist Charlotte Stirling-Reed BSc (Hons) MSc, says: “NHS Choices website ( is the best source of information for mums on this topic. This includes information on different formula milks and on cows’ milk intolerance. The First Steps Nutrition Trust has also produced a document for HCPs on infant feeding milks in the UK.”

Tanya Thomas, BSc (Hons) RD freelance paediatric dietitian, adds: “There is a wealth of information on the internet. Many baby milk manufacturers provide information on their products and the British Dietetic Association provides impartial advice on printable fact sheets.”

Soya based formulas are not suitable as a first-line choice in babies with cows’ milk protein allergy

What are the main differences between an allergy and intolerance? And how does the treatment and advice differ accordingly?

Registered nutritionist Dr Glenys Jones says: “Food allergies are thankfully rare, but occur when the body produces an immune response to a food or ingredient. Therefore the offending food or foods need to be avoided. These can produce symptoms from itchy skin through to severe breathing problems and anaphylaxis.

“Food intolerances are more common, and arise due to factors such as insufficient enzyme production or reactions to compounds, such as histamine, that are naturally present in foods. The response can take several hours or days to develop, with symptoms including headaches, diarrhoea and stomach pains. In many cases people can continue to consume the food in reduced amounts before symptoms occur.

“The advice I would give in both cases is, in the first instance, to get the parent to speak to the doctor to determine whether a food allergy or intolerance exists. Then, moving forward, get a referral or support from a dietitian to help with ensuring that the parents have the correct advice to make sure the child has a well-balanced diet that meets the needs of growth and development. Remember, if an allergy or intolerance is diagnosed and alternative milks/formulas are needed, it can take a little while for infants and children to get used to these, so do give these time. A dietitian can support parents on encouraging take up or suggesting alternatives.” [Information correct as of May 2017.]

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