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Home milk challenge

To confirm Cow's Milk Allergy in children with MILD to MODERATE delayed symptoms

It is potentially harmful to remove cow’s milk from your child’s diet if they don’t need to. It is therefore important to confirm the diagnosis to make sure that any improvement in symptoms is due to cutting out milk (and they have a cow’s milk allergy) rather than for any other reason.

Aim to start the challenge when they have been following a cow’s milk free diet for 4 weeks Challenge early on in the day, not in the evening, so that you can monitor for any symptoms.

  • Do NOT start this challenge if your child has a positive blood or skin test (specific IgE or Skin Prick Test) to cow's milk. (the paediatrician should give you individualised advice to follow instead)
  • Do NOT start this challenge if your child is unwell e.g.
    • Has a cold or any other lung infections or breathing problems
    • Any tummy/bowel problems e.g. tummy ache or loose nappies
    • Any 'teething' signs that are upsetting your child
    • Atopic dermatitis (eczema) has flared up
  • Do NOT start this challenge if your child is having any medication which may upset their tummy, e.g. antibiotics
  • Do NOT try any other new foods during this challenge

Write down what your child eats and drinks during the challenge. Also note any symptoms e.g. sickness, loose nappies, rashes or any other changes in their atop dermatitis.

Home challenge for a formula fed baby (those taking formula with or without some breastfeeds):

Follow the advice in the table below: each day, increase the amount of cow's milk formula given in baby's FIRST bottle of the day - (use the scoop provided in each).

Day Volume boiled water Cow's milk formula
No. of scoops		 Hypoallergenic formula
No. of scoops
1 150mls 1 in the 1st bottle of the day 4 in the 1st bottle of the day
2 150mls 2 in the 1st bottle of the day 3 in the 1st bottle of the day
3 150mls 3 in the 1st bottle of the day 2 in the 1st bottle of the day
4 150mls 4 in the 1st bottle of the day 1 in the 1st bottle of the day
5 150mls 5 in the 1st bottle of the day 0 in the 1st bottle of the day

If you have not seen any symptoms in your child by day 5 (when you have completely replaced one bottle a day with cow's milk formula) you can try giving cow's milk formula for each feed they would usually have from a bottle.

Home challenge for an exclusively breastfed baby:

Over a one-week period, mum should reintroduce cow’s milk to the same levels she used before she started having a milk free diet.

All babies:

If you see any obvious symptoms e.g. sickness, tummy pains, a rash, itching, STOP the challenge. Go back to the previous formula your baby was taking or to a milk free diet if you are breastfeeding, and inform your GP.

If you do not see any symptoms within 2 weeks of your baby having more than 150mls cow's milk formula per day, or you having resumed your normal diet containing milk, then your baby does not have a cow's milk protein allergy and should return to a normal diet/formula containing cow’s milk.