Cow’s Milk Protein Allergy in Babies: Identification and Treatment
Food allergies. Every parent’s nightmare, which is fair. Every allergy comes with an array of difficulties for kids and their parents. Some of these allergies present themselves really early in life and resolve out, others, can occur later in childhood and last a lifetime. I am so thankful my kids have not struggled with this personally, but I have many friends whose kids do or have struggled with multiple food allergies.
Despite the fact that it only affects about 1-3% of infants, it is something I saw fairly regularly in practice. That is cow’s milk protein allergy, also known as CMPA. This one in particular can be really distressing for families as it can cause some significant symptoms in infants who are unable to verbalize they are struggling. This can show up as constant crying, mimicking colic, frequent spitting up, projectile vomiting and alarming stools. It can also show up as significant eczema in kids, which is a dry, red, very irritating rash.
Let’s break it down and discuss when you should suspect there is a problem and seek help from your primary care provider.
Signs & Symptoms of CMPA
Again, very few kids have a true cow’s milk protein allergy and colic is a very real issue in infants from the ages of 2 weeks through 3 months. But, if you have a baby who is very fussy and seems like they are in pain after feedings, they may very well be in pain related to an allergy. I typically recommend parents start to track the timing of these fussy spells in their infant and write down what they are seeing. The symptoms can closely mimic both colic and infantile reflux, so there is further testing that can be done by your provider to flush out what is going on.
Beyond fussiness in an infant, babies can be very spitty or have episodes of true vomiting. Now, as I said, reflux is something a fair amount of babies deal with at baseline because they have an immature GI tract (more on that to come another day), but if your baby isn’t tolerating feeds without becoming exceptionally fussy, and spitting then you probably need to be seen by your primary care provider.
Eczema can be another sign of milk protein allergy. Dry, red, itchy skin can cause a lot of discomfort in infants. If parents are treating eczema symptoms with a good moisturizer and it is not improving, it may be an allergic reaction rearing it’s head due to an inflammatory process in the body related to allergy.
Additionally, the thing I was always looking for in primary care in my fussy babies was blood in the stool. Babies with milk protein allergy can have blood or mucous in their stool. There is a test your primary care can run on a stool to see if there is microscopic blood in the stool that may not be seen to the naked eye.
Weight loss: If your baby is spitting up so much they are losing weight or not gaining appropriately, milk protein allergy should be ruled out.
Management of CMPA
So, you suspect a milk protein allergy in your baby. What do you do next? That answer differs depending on how your baby is fed. If exclusively breastfed, the recommendation is an elimination diet for mom. Mom should eliminate all dairy from her diet, which is difficult! It takes up to 2 weeks for the dairy already in mom’s system/milk to clear so a trial of an elimination diet for 2-8 weeks is recommended. If symptoms drastically improve, a diagnosis of milk protein allergy can be made. If no improvement is seen, gradually adding dairy back into mom’s diet can be done with careful observation of symptoms.
If your baby is formula fed, switching to a hydrolyzed formula or amino-acid based formula is recommended. These formulas essentially don’t contain milk protein or are so broken down that the body doesn’t have to work to break down the protein which improves allergy symptoms.
Have you known anyone whose baby had a milk protein allergy? Was it stressful on the parents? Did it take multiple visits to get to the bottom of the baby’s symptoms? Unfortunately, it is an intricate diagnosis with a lot of moving pieces.
The good thing is, most kids outgrow this diagnosis! As the gut matures, it is more able to break down the milk protein without a reaction! So, if you are dealing with this, thankfully there is hope it will improve with time!
Check out my page @nuanced_newborns for more information and videos of what CMPA can look like in littles.
