Skip to content
Diet-Related Conditions

Cows Milk Difficulties

Cow’s Milk Allergy a
Spectrum Condition

Cow’s Milk Allergy affects 1 in 20 infants in their first year of life. It is a spectrum condition, with a wide range of presentations, sometimes difficult to distinguish from other common problems in infancy such as colic, regurgitation or loose stools. Both immediate and delayed reactions to cow’s milk are more common in atopic families; those with asthma, eczema or hayfever. Delayed reactions typically show up in gastrointestinal tract and skin.

Lower abdominal symptoms eg. loose, smelly, bloody or mucus pooh, constipation and painful wind. Upper abdominal symptoms include vomiting, reflux, pain after feeding and feeding aversion or milk refusal. All gastrointestinal features can impact an infants’ enjoyment and willingness to feed well. At least two persistent symptoms with delayed reactions are needed to consider a diagnosis alongside an allergy focussed history.

The difference between Lactose
Intolerance and Cow’s Milk Allergy

Symptoms are resolved by the complete exclusion of cow’s milk and its products, for at least 6 months for delayed reactions and up to 2 years for immediate reactions. A maternal exclusion for breast-feeding babies is an effective dietary treatment, and I will nutritionally treat infant/parent dyads in this scenario.

Care should always be taken to ensure mums are getting enough nutrition including calcium, Vitamin D, iodine and essential fats to meet their own needs.

Lactose intolerance is caused by too much undigested lactose in the large bowel, resulting from lack of the digestive enzyme lactase in the small bowel.

Symptoms arise, with loose, explosive stools, sore bottom, bloating and discomfort; very similar presentations to cow’s milk allergy, but a physiological response rather than an immune response; easy to spot with a trained eye!

Lactose is a found in all mammalian breast milk, as well as standard formula. Breast fed babies who snack at the breast and get lots of high-volume, lactose-rich fore milk, can readily get symptoms of lactose intolerance.

Feeding observation and advice on how to avoid this, whilst supporting babies to feed well at the breast will be helpful. Cow’s Milk Allergy and lactose intolerance can co-exist, particularly when there is severe and persistent diarrhoea and gut inflammation.

The importance of lactose
intolerance presentation

Dietary treatment will vary depending on the presentation of lactose intolerance. Lactase enzyme activity reduces with age, and with ethnicity. Peoples of Asian, African and Indian origin, and children as young as 2 – 3 years can lose lactose activity permanently, but this is not normally seen in the UK.

Older children and young teens, can also loose enzyme activity, which can be responsible for tummy symptoms and loose stools.

Temporary lactose intolerance the more common in the Northern Hemisphere, and is usually related to small bowel lining inflammation eg. after infection or surgery. A lactose free diet allows the intestine time to repair and for readiness of a gradual reintroduction of dietary lactose.

Get in Touch with
Paediatric Nutrition

For any general enquiries, please fill in the form with the necessary information. Any information about booking treatments or assessments can be found below.

Contact Us

Online Workshops for
Happier, Healthier Mealtimes!

Carine offers accessible online workshops on a variety of topics, designed to provide a space alongside others to listen, learn, share, practice and develop tools and strategies for nutritional health.

From Kitchen to Clinic – My Latest Blogs


making mealtimes better

Making Mealtimes Better : Structure, Nurture & Boundaries Accessible and full of sensible evidence-based information to support feeding young children well, Making Mealtimes Better is on-line workshop series is designed...


Iron Deficiency Anaemia in infancy

Iron deficiency anaemia (IDA) is the most common nutritional problem affecting infants with 60% of 6-12 month old babies in the UK having low dietary iron intake, a key risk...


Izzy’s Overnight Almond Oats

I really do get it - it's hard to make time on a school morning to prepare a nutritious breakfast. My teenage daughter Izzy and I teamed up to produce...


what’s the difference between lactose intolerance and cow’s milk allergy?

Many people are confused about the difference between lactose intolerance and cow's milk allergy. Misunderstood as same condition; the terms lactose intolerance and cow's milk allergy are used interchangeably and...


reintroducing lactose back into the diet

Following a 2 - 6 week low lactose diet to treat lactose intolerance, your child should now be well on their way to recovery from symptoms.  Reintroducing lactose back into...


good sources of calcium

Infants and children need good sources of calcium in their diets on a daily basis. Calcium absorption in the gut is variable and ranges from 25-50%, increasing when intake is...