A breastfed baby with cow's milk allergy is identified. What is the most appropriate management for the mother to adopt?

• A. Continue breastfeeding but exclude all cow's milk protein from her diet and take calcium and vitamin D supplements.
• B. Switch to a soy-based formula for the infant.
• C. Stop breastfeeding and switch to a hypoallergenic formula for the infant.
• D. Continue breastfeeding without any dietary changes

Answer: (B)

When a breastfed baby has cow’s milk allergy, the aim is to remove cow’s milk protein from the infant’s intake to prevent reactions. Switching the infant to a soy-based formula provides a cow’s-milk-protein–free source of nutrition, so the baby no longer receives the triggering protein through formula. This approach directly removes the offending protein from the infant’s diet and can help alleviate allergic symptoms, especially if maternal dietary elimination is not adequately controlling symptoms. Soy-based formula is a common alternative in CMA, but if soy intolerance or allergy is a concern, or symptoms persist, other hypoallergenic options such as extensively hydrolyzed or amino acid–based formulas may be used instead.