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Nutrition and Breastfeeding Articles

‘It is hard to know what to believe with so much conflicting nutrition
information. ​I provide you with the latest evidence-based facts.’


Dairy allergy & lactose intolerance in children

Dairy is a common allergy in babies. In Australia and New Zealand, more than 2% of infants are allergic to cow’s milk protein. Mild or moderate signs of a dairy allergy include:
–    Swelling of lips, face, eyes
–    Hives or welts on the skin
–    Stomach pain
–    Vomiting
–    Diarrhoea

Severe rapid onset allergic reaction (anaphylaxis): This reaction is life threatening, and immediate medical attention should be sought by calling 000.
–    Noisy breathing
–    Wheezing
–    Swelling or tightness in throat
–    Young children may be pale and floppy

Delayed reactions to cow’s milk and other dairy foods can occur, and reactions usually occur hours or days after consuming dairy.
Symptoms may include:
– Eczema
– Delayed vomiting
– Diarrhoea
– Blood in the stool

Lactose intolerance is caused by the lack of the enzyme, lactase, which helps to digest the milk sugar, lactose. It commonly occurs after the age of 5 years.
Symptoms of a lactose intolerance include:
– Vomiting
– Diarrhoea
– Stomach pain
– Gas (wind or bloating)
These symptoms are uncomfortable but are not life threatening. Lactose-free dairy is the best alternative. Very rare lactase insufficiency in babies can present as very poor growth, severe diarrhoea and is a medical emergency.

Secondary lactose intolerance: may occur due to conditions such as gastroenteritis, which damages the gut lining and will resolve once the virus passes. Lactose intolerance can also present with a new diagnosis of coeliac disease; once treated, it will resolve.

Functional lactose overload: may occur in breastfed babies who are receiving large amounts of lactose-rich milk, often in a case of over-supply. This can be managed with the right breastfeeding support, there no need to stop breastfeeding or switch to a lactose-free formula.

If you notice any of the above symptoms in your child, it is important to speak to your doctor, dietitian or lactation consultant, so the appropriate action may be taken.

For up-to-date, evidenced based information on allergies, check out the Australasian Society of Clinical Immunology and Allergy (ASCIA) website:

By Emma McShane, Dietitian, edited by Nicole Bando (APD, IBCLC), November 2022

Dairy-free and/or soy-free foods: supermarket brands

By Emma McShane & Nicole Bando, March 2022

Some people need to remove dairy and soy products from their diet due to a food allergy or intolerance. As these foods contain vital nutrients, including protein and calcium; important for the health of our bones and muscles, dairy and soy should be replaced with nutritious substitutes. This easy to follow guide provides simple swaps to help you enjoy the foods you love and get the nutrients you need.

*Please note that this resource is a guide only. Always check the ingredient labels of foods, medications and supplements for allergens, as ingredients may change. This resource displays food products labelled as dairy-free (DF*) or soy-free (SF*) or both. Products ‘may contain traces’ of either soy or dairy, please consult with your allergist or dietitian for guidance. Please note that plant based milks may not meet the growth needs of young children, seek advice from a dietitian. Daily calcium requirements vary according to age and gender.

Are you breastfeeding and avoiding soy/dairy? See this article for more about how to meet your dietary needs.
See here for more about breastfeeding & nutrition.

For further label reading advice, see:
This does not substitute individual dietary and medical advice.


When a mother is breastfeeding a baby with an allergy or intolerance to dairy and/or soy proteins, these foods may need to be eliminated from the mother’s diet for 2-4 weeks, before possible reintroduction (under guidance of a health professional). These conditions include Cow’s Milk Allergy, Food Protein Induced Allergic Proctocolitis (FPIAP) and Food Protein-Induced Enteropathy (FPIES).

  • Both dairy and soy are common food sources of calcium, and many other important nutrients including Vitamin A, Vitamin B12, protein, zinc & magnesium.
  • Calcium is vital to ensure strong bones and teeth and reduce the risk of osteoporosis, therefore it is important to find other sources of this mineral within your diet.
  • A mother who cuts dairy and/or soy out of her diet may be at risk of developing weak bones and osteoporosis if she doesn’t replace these foods with alternatives.
  • Calcium in the breastmilk is constant and comes from the mother’s skeleton. A women’s dietary intake of calcium, or supplements does not affect the amount in breastmilk.
  • The calcium taken from the mother’s bones is restored within a few months of stopping breastfeeding. Studies show that women who breastfeeds are not at higher risk of osteoporosis than a woman who does not breastfeed.

Below is a table of dairy-free (DF) and/or soy-free (SF) food sources of calcium. Check food labels every time you buy a food, medication or supplement, as ingredients may change. Use this guide for label reading:

  • So how much calcium do we need? The average women needs 1,000 mg/day. See the sample meal plan below to demonstrate how to meet average calcium needs:

This sample meal plan provides 1319mg of calcium across the day, and meets nutritional requirements from the five core food groups, in line with the Australian Guide to Healthy Eating (AGTHE), for a breastfeeding woman. It is a guide only. 

Sometimes a calcium supplement is needed to ensure that you are getting the amount of calcium you need every day. Your dietitian or GP will help you decide if a supplement is necessary.


  1. UCSF Health (2021). Calcium content of foods. University of California. Accessed June 10th 2021. Available from:
  2. Nutrient Reference Values (2014). Calcium. NHMRC. Accessed June 10th 2021. Available from:
  3. Fishbein L. (2004). Multiple source of dietary calcium – some aspects of its essentiality. Regulatory Toxicology and Pharmacology. 39(2);67-80. Accessed June 10th 2021. Available from:
  4. Gueguen L., Pointillart A. (2013). The Bioavailability of Dietary Calclium. Journal of the American College of Nutrition. 19;sup2, 119-136. Accessed June 11th 2021. Available from: 10.1080/07315724.2000.10718083
  5. Australasian Society of Clinical Immunology and Allergy. Cow’s Milk (Dairy) Allergy. ASCIA, 2019. (Available from, accessed May 31st, 2021).
  6. Australian Guide to Healthy Eating Serve Sizes [Internet]. Eat for Health. Australia; 2015. Accessed June 23rd 2021. Available from:
Allergy-friendly party food

If you are planning a party for children who have food allergies, it can seem overwhelming to know where to start. Follow these steps for safe and yummy party food. A food allergy is when a person’s immune system reacts to the protein in a food, causing symptoms such as hives, rashes or in more severe cases swelling of the mouth and throat (anaphylaxis). Find out which allergens you need to exclude and take it from there. The key allergens are: peanuts, dairy, wheat, egg & fish.

  1. Have a plan: Find out the symptoms of the child’s food allergy. Who will be supervising them? What is their allergy/anaphylaxis plan? Make sure they have their epi-pen & you or a supervising adult knows how to use it. Call an ambulance if the child demonstrates signs of an allergic reaction.
  2. Know your key allergens and read the ingredients list. It is Australian law that processed foods must be clearly labelled to include allergens using their common names (e.g. egg or milk) so that they can be easily recognised. Allergens are often shown in bold
    in the ingredients list. There is also a ‘contains’ section that has a summary list of the allergens present in that food. Check food labels every time you buy the product, as ingredients and processes can change.
  3. What about ‘may contain traces of?’ This means that there is a potential cross-contamination risk. It may be best to avoid these foods for safety reasons.
  4. Food preparation and cross contamination: When the tiniest amount of an allergen comes into contact with another food (e.g. crumbs from wheat bread are on the bread board used to prepare gluten-free bread) it can be enough to cause an allergic reaction. Set up the food preparation area in a clean environment away from other foods being prepared. Use only clean (using hot, soapy water) equipment when preparing food. Make sure that your hands are cleaned prior to preparing and serving as well and that any products used haven’t been exposed to allergens (e.g. margarine previously used for wheat containing bread).
  5. So what party foods can I serve? Choose fresh over processed foods, it is easier to avoid multiple food allergens this way. Have fun with fruit, e.g. fruit skewers or try our simple allergy-friendly popsicle recipe: Blend 500ml of plant-based milk, 1 tb of maple syrup and your choice of 300g frozen fruit. Pour mixture into moulds, add an icy-pole stick & freeze until solid. Also try gluten-free pizza bases with vegetables (either without cheese or with vegan cheese), tofu and vegetable skewers, mini beef burgers with gluten free rolls, 100% corn chips & avocado dip, popcorn (over 3 years), rice crackers & dried fruit. Consider party bags that are food free and perhaps involve craft, such as colouring.
  6. What about the cake? Check out this allergy free birthday cake recipe! – if looking for a wheat/gluten free option, swap out the plain flour for gluten-free flour.


  1. What is allergy? – Australasian Society of Clinical Immunology and Allergy (ASCIA) [Internet]. 2022 [cited 9 July 2022]. Available from:
  2. Avoiding Cross-Contact [Internet]. 2022 [cited 9 July 2022]. Available from:
  3. [Internet]. 2022 [cited 9 July 2022]. Available from:

By Emma McShane, Dietitian, edited by Nicole Bando, Dietitian & LC, August 2022

Eczema and Dairy

Eczema is a disorder of the immune system caused by an abnormal skin barrier, dryness and inflammation.
30% of people with atopic dermatitis (eczema) also have an allergy. A food allergy may trigger eczema, but it is not the cause of the eczema. Some foods such as dairy may exacerbate eczema.

Eczema can be normally well managed by maintaining, protecting and treating the skin by:
–    Applying moisturiser (at least twice/day)
–    Use non-soap based wash or oil in the bath or shower
–    Avoiding soap and washes that produce bubbles or foam (as these may cause the skin to dry out)
–    Using anti-inflammatory creams and ointments, such as topical steroids
–    Treating bacterial skin infections with antibiotics
–    Use immune modulating treatments if prescribed by your doctor or dermatologist.

Food exclusion diets are only recommended to be tried in children with eczema when the above treatments don’t work. Food exclusion diets should be guided by a clinical immunologist or allergy specialist and dietitian. Only short term food exclusion is needed to determine if the food allergy is causing the eczema.

Dairy is often a common trigger for eczema, even if they are not allergic to dairy but to something else. Research has shown that more often than not food exclusion diets can be short-term. This is because eczema is an immune response, and in children, their immune system is not fully developed. It is predicted that as a child’s immune system develops, they are likely less sensitive to dairy causing eczema and can slowly introduce these foods back into their diet. It is important that this is done under close guidance of a paediatric dietitian.


  1. Eczema and food allergy. Fast facts. ASCIA. 2020. Available at:
  2. National eczema association. Everything you need to know about eczema and food allergies. 2018. Available at:
  3. Nikolovski A, Rallis S (2020) The Impact of Dairy Elimination on Pediatric Atopic Dermatitis. J Nutri Med Diet Care 6:044.