For a child with suspected cow's milk protein allergy, what is the initial recommended formula?

• A. Switch to a soy protein-based formula
• B. Switch to a high hydrolyzed protein formula
• C. Switch to a protein hydrolysate or free amino acid formula
• D. Switch to a lactose-free cow's milk-based formula

Answer: (C)

In suspected cow’s milk protein allergy, the goal is to minimize exposure to the allergenic protein. Intact cow’s milk proteins can trigger reactions, so the safest first step is a formula where the protein is already broken down. Protein hydrolysate formulas have proteins that are pre-digested into small peptides, making them much less likely to provoke an allergic response. Amino acid–based formulas go even further, providing free amino acids with no peptide chains, which virtually eliminates allergen exposure.

This approach helps most infants tolerate feeds and supports growth while the allergy is managed. Alternatives like soy-based formulas can still trigger reactions in some infants and aren’t reliably tolerated in CMPA, and lactose-free cow’s milk-based formulas still contain cow’s milk protein, so they don’t address the underlying allergy. Therefore, starting with a hydrolyzed protein formula or an amino acid formula is the recommended initial choice.