What to Feed Your Infant or Toddler If They Have Food Allergies

Infants can develop food intolerances or allergies. A small subset of infants fed human milk (either by breast or bottle) can show symptoms due to food proteins the mother or lactating person eats passing through into the human milk. Formula-fed infants can show symptoms due to not tolerating the food proteins (milk or soy) in infant formula. Babies should ideally drink human milk or formula for at least the first year of life.

Food Allergy

A food allergy occurs when the body’s immune system sees a certain food as harmful and reacts by causing one or more symptoms. This is known as an allergic reaction.

Foods that cause allergic reactions are called allergens. Even a small amount of an allergen can cause a reaction. Allergic reactions usually occur after your child eats a food they are allergic to.

There are two types of food allergies: IgE mediated and non-IgE mediated.

Symptoms from IgE mediated food allergies usually occur within two hours of feeding and can present as:

• Rash
• Hives
• Vomiting
• Severe allergic reaction (anaphylaxis)

This is the “classic” type of food allergy that causes symptoms like hives and swelling. An IgE-mediated food allergy can get worse over time. Some food allergies are more likely than others to be outgrown as children age. When a child is diagnosed with this type of allergy, your health care provider should provide you with an epinephrine auto-injector to treat severe allergic reactions.

Symptoms from non-IgE mediated food allergies are usually delayed after feeding and may present as:

• Bloody, mucousy stools
• Colic, reflux, more severe spitting up
• Vomiting
• Diarrhea

Most symptoms of non-IgE mediated food allergies involve the digestive tract. Types of non-IgE mediated food allergies include:

• Eosinophilic [EE-oh-sin-oh-FILL-ick] esophagitis (EoE) – an allergic swallowing disorder caused by an inflamed esophagus (part of the throat)
• Food protein-induced enterocolitis syndrome (FPIES) [eff-PIES] – inflammation in the small intestine and colon (large intestine)
• Allergic proctocolitis [prahk-toe-koh-LIE-tis] – inflammation in the lower intestine caused by an allergy to cow’s milk or soy proteins found in formula or breast milk

The symptoms of non-IgE mediated food allergies usually go away when the food allergen is removed from the infant’s diet.

Human Milk Is Beneficial

Human (breast) milk provides optimal nutrition for an infant. Even babies with food allergies can benefit from human milk. Very rarely, the food proteins pass through the milk and can cause symptoms in an infant or toddler. If this happens, the doctor may recommend the lactating parent avoid eating the foods their child is allergic to (sometimes known as an “elimination diet”). Most often nursing/breastfeeding/pumping can continue if the foods that trigger their child’s symptoms are removed from the from the breastfeeding mother’s or lactating parent’s diet. It is important to make sure you eat a healthy variety of foods. Seeing a registered dietitian can be helpful to plan how to replace nutrition that may be lost from avoiding specific foods.

Formula Options for Infants and Children with Food Allergies

If human milk isn’t an option, what formula should you introduce to your baby who is showing signs of allergy or intolerance? The formula you give your baby will depend on the condition they have.

Here are different types of formula available you can discuss with your child’s doctor.

Milk-Based Formulas

Milk-based formulas offer complete nutrition. But babies sometimes develop an allergy or intolerance to the cow’s milk in these formulas. These formulas are not recommended for children diagnosed with cow’s milk allergy. Cow’s milk allergy is one of the most common types of infant food allergy.  (e.g., Similac® Advance®, Pro-Advance or Enfamil® NeuroPro®)