Your child has an allergy to cow's milk. If your child eats or drinks cow's milk or something with cow's milk in it, they may have a mild reaction and just have hives (red, itchy bumps) or a severe allergic reaction, called anaphylaxis.

Anaphylaxis can cause trouble breathing and other life-threatening symptoms. It is treated with a medicine called epinephrine.

Here's how to care for your child.

Medicines:

• Know what to do if your child has signs of an allergic reaction and how to use epinephrine if their symptoms are severe. Epinephrine is available to use as an injection (EpiPen ® or Auvi-Q®) or as a nasal spray (neffy®). Talk to your healthcare provider about which one is right for your child .
• Ask your healthcare provider for a written allergy action plan that includes when to use the epinephrine.
• Make sure your child always has epinephrine with them, including at school, childcare, and activities. Make sure the epinephrine has not expired, and don't leave it in cars or in other places where it could be exposed to too much heat, cold, or sunlight.
• Ask your healthcare provider what other medicines your child needs to keep with them (such as an antihistamine like Benadryl® (or a store brand) or an asthma inhaler).

Read food labels carefully before you give any foods or drinks to your child:

• Avoid all products with “milk” on the label or ingredient list. Your child should avoid every type of animal milk (such as sheep's milk and goat's milk) because they're similar to cow's milk and may also cause a reaction.
• Avoid foods and drinks labeled “may contain milk,” “processed in a facility that also processes milk,” or “manufactured on equipment also used for milk.” Not all companies use these labels, so if you're not sure, call or email the company.
• Ask your healthcare provider if your child can eat baked products that contain cow's milk.

When preparing food:

• Wash your hands with soap and water before touching food. Hand-sanitizing gel doesn't get rid of the allergens (substances that cause allergic reactions). If soap isn't available, hand-cleaning wipes can be used.
• Wash countertops, bowls, plates, spoons, and other utensils with dishwashing soap and hot water to remove any milk on them.
• If you keep foods that contain milk in the house, store and prepare them in a separate part of your kitchen so they don't accidentally touch your child's food.

At childcare and school:

• Tell caregivers, the school nurse, teachers, and coaches about your child's allergy. Share the written allergy action plan with them.
• Make sure to keep epinephrine (and any other medicines your healthcare provider recommends) for your child at childcare, daycare, or school.
• Your child should not share other kids' food. Be sure to have a plan so your child always has safe snacks and meals. This is important on regular days but also during special celebrations and field trips.
• Have your child sit at an allergen-free table if recommended by your healthcare provider.

General information:

• Take your child for any testing and to an allergist (allergy specialist) as recommended by your healthcare provider.
• If your child can read, help them learn to read food labels.
• Teach your child “when in doubt, leave it out.” This means if they don't know the ingredients of a food or drink, they should avoid it.
• If you are breastfeeding your child, ask your healthcare provider if you need to avoid foods and drinks that contain cow's milk.
• If your baby drinks formula, use the one your healthcare provider recommends.
• Talk to your healthcare provider or a dietitian to make sure your child is getting the nutrients and vitamins they need.
• If your child is going to a family member's house, another child's house, or to a party, tell a supervising adult about your child's milk allergy. Make sure your child has epinephrine (and any other medicines your healthcare provider recommends) with them. Be sure the adult has a way to contact you in case they have any concerns or your child has a reaction.
• When eating outside the home, make sure you tell the people preparing or serving your child's food about their allergy.
• Have your child wear a medical alert bracelet that says they have a milk allergy. You can buy one online or at a pharmacy without a prescription.

Your child has one of these signs of a mild allergic reaction:

• Hives
• Skin itching, redness, or swelling
• Sneezing
• A stuffy or runny nose
• Itchy, watery eyes
• Coughing

If your child has more than one of these mild signs, or a mild sign is getting worse, give epinephrine right away then call 911 (see below).

Your child has any signs of anaphylaxis (a severe allergic reaction), such as:

• More than one mild sign
• A mild sign that is getting worse
• Swelling of the mouth or tongue
• Trouble swallowing
• Trouble speaking or hoarseness
• Throat tightness, wheezing, or trouble breathing
• Belly pain, nausea (sick to the stomach), vomiting (throwing up), or diarrhea
• Dizziness or fainting
• A feeling like something bad is about to happen

Follow these steps:

• Have someone call 911 while you give the epinephrine. If you're alone, give epinephrine first, then immediately call 911.
• Lay your child down with their legs raised while you wait for the ambulance. Give epinephrine again if their symptoms don't go away, get worse, or go away and then come back. If your child stops breathing or doesn't have a pulse, start CPR (cardiopulmonary resuscitation).

Your child needs to go to the ER after getting epinephrine, even if they're feeling better. The symptoms can come back and get worse.

What causes cow's milk allergy? The body's immune system works to protect the body from germs and other harmful substances. When someone with an allergy comes into contact with what they are allergic to, their immune system mistakenly thinks it's harmful and fights against it. This causes the symptoms of an allergic reaction .

Will my child always be allergic to milk? Many children outgrow a cow's milk allergy. Your healthcare provider can do tests to see if it's likely your child will outgrow their allergy and to check if your child still has it.

If my child gets only mild symptoms from cow's milk, can they still get more serious symptoms? Yes, even a child who has had a mild reaction in the past can have anaphylaxis in the future. It's very important to always be ready to treat anaphylaxis with epinephrine.

Are there treatments for cow's milk allergy? There are some treatments that can help the immune system react less to cow's milk. Talk to your healthcare provider to see if these treatments are right for your child.