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 for cows’ milk allergy 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 website (nhs.uk) 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 an intolerance? And how does the treatment and advice differ accordingly?

Dr Emma Derbyshire, independent nutrition consultant, founder of Nutritional Insight Ltd and co-founder of LittleFoodie.org, says: “An allergy is an immunological response to a food or substance. In these instances a child’s immune system reacts by producing more immunoglobulin E, or IgE, so body levels rise. To have an allergy officially diagnosed, IgE levels need to be measured and these would be elevated in cases of a food allergy. The radioallergosorbent (RAST) test is one way of measuring the amount of IgE antibody in the blood stream made against a specific allergen. These are highly regarded, though can be expensive.

“An intolerance, sometimes known as a sensitivity, is when a food or substance disagrees with children. So for example, certain high-fibre foods could cause excess bloating or gas – tummy troubles are normally signs of an intolerance.

“The number of food intolerances is rising but it can be difficult to establish whether symptoms could be caused by something else. Unlike allergies there are no diagnostic tests for food intolerances. One way forward, however, is to keep a food diary and log foods that young children eat and drink, along with their symptoms. The two can then be crosslinked. Another option is to eliminate potential culprit foods one at a time over two to six weeks to see if symptoms improve or return when foods are reintroduced.”