(Note that formulas labeled as partially hydrolyzed protein formulas are not considered hypoallergenic.)

It is possible that your doctor may suggest switching from cow's milk-based formula to exclusive breastfeeding. Breastfeeding a milk-allergic infant should be done under the close supervision of a registered dietitian because a strict diet must be followed to ensure adequate intake of nutrients while eliminating cow's milk protein. Because the cow's milk protein in the dairy products in a mother's diet can cross over to breast milk, all dairy products must be eliminated from her diet. Working with a dietitian can help a nursing mother find alternative sources of calcium and other vital nutrients found in dairy products.

Feeding a Milk-Allergic Older Child

Once a child is beyond the formula stage and is eating and drinking real foods and liquids, avoiding milk and milk products can become a real challenge.

A registered dietitian or nutritionist can recommend and monitor a milk-free diet that is nutritionally sound. He or she will provide a list of alternative foods that will substitute the nutrients — such as calcium, riboflavin, and vitamin D — your child needs.

In addition to not drinking milk, people who are allergic to it have to be diligent about reading labels on — and asking questions about — everything they want to eat. Beginning in 2006, food makers are required to clearly state on labels whether a food contains milk or milk products. But the new law only applies to foods labeled after the start of 2006, so there may still be products on the shelves that don't say whether the food contains the allergen.

Milk may be hidden in many foods, even those you'd never dream of, such as processed meats, brown sugar flavoring, canned tuna, and chocolate. The long list of other foods and ingredients to avoid includes:

• butter and related products (including artificial butter flavor, butter fat, butter solids, butter oil, buttermilk, and natural butter flavor)
• caramel color or caramel flavoring
• casein products and caseinates (including ammonium, calcium, iron, magnesium, potassium, rennet, sodium, and zinc caseinates)
• cheese
• cottage cheese
• cream and cream curds
• custard
• fat replacers such as Opta and Simplesse
• flavorings and natural flavorings (including Bavarian cream flavoring, brown sugar flavoring, caramel flavoring, coconut cream flavoring, some seasonings and natural flavors for meat and poultry, binding agents, fillers, natural egg flavor, canned fish, seasoned and ranch-style potato and tortilla chips, and seasoned french fries)
• goat's milk (contains proteins similar to those in cow's milk)
• half-and-half
• high-protein flour and other types of added protein (particularly the kind found in "high-energy" foods, which often contain milk protein)
• hydrolysates (including hydrolyzed casein and milk protein)
• lactose (and other products that begin with lact including lactalbumin, lactalbumin phosphate, lactate, lactic acid starter culture, lactoferrin, lactoglobulin, and lactulose)
• margarine
• milk in all forms (including condensed milk, dry milk, dry milk solids, evaporated milk, low-fat milk, nonfat or skim milk, milk derivative, milk fat, milk powder, milk protein, milk solids, malted milk, and powdered milk)
• sour cream, sour cream solids, and sour milk solids
• whey and whey products (including delactosed whey, demineralized whey, whey powder, whey protein concentrate, and whey protein hydrolysate)
• yogurt

Many nondairy foods can be substituted for milk or milk products. Be aware, however, that just because a food is labeled "nondairy," it does not necessarily mean that it is milk free. Even a "milk-free" label can be misleading. For example, some soy cheeses claim to be milk free but may still contain milk protein. That's why it's always important to read all food labels when you have a milk-allergic child.

When dining out, encourage your child to order the simplest foods, and ask the waitstaff detailed questions about menu items. Fried and battered foods should be avoided; even if the batter doesn't contain milk products, the oil used to fry the foods may have been used to fry something that did contain milk. Cross-contamination can especially be a problem at buffets, where spoons often go in and out of various bowls that may contain milk or milk products.

Cross-contamination can easily occur at home too. Make sure you use separate knives for spreading butter and making sandwiches, and use separate bowls for chips, crackers, or other foods that people might touch after touching a piece of cheese, dip, or other milk product.

Some good alternatives to milk and milk products include:

• for baking: milk substitutes work as well as milk, and some come out better. Fruit juice also works in baking, but you should then reduce the amount of added sugar. For milk used simply as a liquid, substitute water or rice milk. Dairy-free margarine, vegetable shortening, or soy butter (if your child tolerates soy) can be substituted for real butter. Pureed tofu works well as a thickener.
• for breakfast: calcium-enriched rice or soy milk (if soy is tolerated)
• for sandwiches and snacks: vegan products, such as vegan cheese, are sold at health food stores and made without eggs or milk
• for treats: soy-based (again, if soy is tolerated) or rice-based frozen desserts, sorbets, puddings, and ice pops

Teachers, school nurses, and childcare providers also should be told about your child's milk allergy. Try to get lunch menus in advance to help your child choose wisely or pack a homemade lunch if cross- contamination cannot be avoided.

Having a milk allergy doesn't mean your child can't enjoy eating. In fact, some people think some of the milk substitutes — like vanilla soy milk — taste better than regular cow's milk. In fact, your child will probably find that avoiding milk offers the opportunity to discover some great foods he or she would never have found otherwise.