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Why does my child need to follow a cowÎÚÑ»´«Ã½ milk free and soya free diet?

A cowÎÚÑ»´«Ã½ milk free and soya free diet is necessary if your child has, or is suspected to have, a cowÎÚÑ»´«Ã½ milk protein allergy and a soya allergy.

Which foods does my child need to avoid?

The table below lists suitable and unsuitable foods on a cowÎÚÑ»´«Ã½ milk-free and soya-free diet. Although there are obvious sources of cowÎÚÑ»´«Ã½ milk and soya which should be avoided, derivatives of both are also found in manufactured foods. Avoid any foods with the following ingredients:

Ingredients containing cowÎÚÑ»´«Ã½ milk (avoid):

• CowÎÚÑ»´«Ã½ milk/ evaporated milk/ condensed milk/ milk drinks
• Cream, cheese, yoghurt, ice cream
• Butter/ margarine/ ghee
• Butter oil/ butterfat/ buttermilk
• Lactose
• Casein/ caseinates/ milk protein/ hydrolysed casein
• Non-fat milk solids/ milk sugar solids/ milk solids
• Milk powder
• Whey/ whey syrup sweetener

Ingredients containing soya and soya derivatives (avoid):

• Soya milk, soya yoghurts and desserts
• Hydrolysed vegetable protein
• Soya lecithin E322
• Soya protein products – for example, miso, tofu, edamame, tamari, teriyaki, natto, tempeh, Worcestershire sauce, oyster sauce, vegetable broth, vegetable starch
• Textured vegetable protein (ie soya meat)
• Soybean paste/ soya flour
• Bean curd

Please note: A product labelled ‘free from soya or soya derivatives’ may contain soya oil and/or soya shortening. Soya oil, as used in manufactured products, is refined and contains no protein and is considered soya free. Cold pressed soya oil, available from health food shops, may contain soya protein and should be avoided.

Pre-packed foods within the UK containing milk and soya are required by EU law to be highlighted in the ingredients list. In the UK if a food or drink product has two or more ingredients (including any additives), they must all be listed in the ingredients list on the label. Any allergens including milk and soya must be highlighted. This is required under EU law. However, please remember that foods sold outside the EU do not have to comply with these laws. From 1 October 2021 pre-packed foods for direct sale (eg sandwiches made in a café and packaged for direct sale on site) must also be labelled with the full allergen information.

Labels that say ‘may contain...’ are not covered by labelling laws. They are used to indicate that the food is produced in the same area as foods containing allergens, and there may be a risk of cross-contamination. It is very difficult to tell how much milk or soya is in these foods. Please talk to your dietitian about the safest approach to these foods.

Under EU food labelling regulations there must also be a list of product ingredients available for all foods that may not be labelled, as they are sold loose such as those sold in a delicatessen or bakery. This may be written down or explained to you verbally.

Please note: All branded products are cowÎÚÑ»´«Ã½ milk free and soya free at the time of printing; however, ingredients may change over time, so please continue to check the labels.

Also note that this is not an exhaustive list; products can change frequently, so please check your local supermarkets for additional suitable products. Detailed information on manufactured products can be obtained from the customer services department of most supermarkets.

Which milk substitutes can I give my child?

Infants and children under two years of age should be given a suitable cowÎÚÑ»´«Ã½ milk-free formula to ensure adequate intakes of vitamins and calcium. Your dietitian will advise you as to the most suitable formula for your child.

In instances where a specialist formula is not indicated, or where a child is more than two years of age, other cowÎÚÑ»´«Ã½ milk substitutes can be used such oat milk, coconut milk, almond milk, pea milk (check that this does not contain soya). Rice milk is a suitable cowÎÚÑ»´«Ã½ milk substitute for children over the age of 4½ years. It is recommended that you choose a cowÎÚÑ»´«Ã½ milk substitute which is calcium and vitamin enriched.

Does my child need a vitamin and mineral supplement?

If a calcium and/or vitamin supplement is required your dietitian will advise you on an appropriate product and dose for your child.

The Department of Health recommends that all children under the age of five take a supplement containing vitamin D (8.5 to 10mcg vitamin D for babies under one year; 10mcg vitamin D for children aged one to four years). Many suitable preparations are available over the counter at pharmacies and supermarkets.

However, if your child is taking more than 500ml of formula milk per day, then they will not require a vitamin D supplement as the formula milk provides enough vitamin D. Please ask your dietitian or local pharmacist if you have any questions.

Who can I contact for further information?

Paediatric dietitians: 01223 216655