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What is cow’s milk protein intolerance in infants?
This happens when the body thinks the protein in the cow’s milk is a foreign invader, so the immune system goes on attack.
This can happen with both breastfed and formula fed babies.
This occurs in about 2% of babies.
What causes cow’s milk protein intolerance in infants?
This is caused by an abnormal response of your baby’s immune system to cow’s milk protein.
This response causes inflammation in the gastrointestinal tract (the belly) as the immune system reacts when your infant consumes cow’s milk protein in formula.
The exposure can come from formula or from breastmilk when a mother is consuming foods made with cow’s milk.
If there is a family history of cow’s milk protein intolerance, your infant may be at a higher risk of developing it.
How is cow’s milk protein intolerance in infants diagnosed?
Your child’s healthcare provider will examine your infant and ask you questions.
Your child’s healthcare provider may ask for a stool sample.
Sometimes blood or mucus can be seen in the stool.
The stool can also be tested for blood that is not easy to see.
If your infant improves as cow’s milk products are eliminated, then the diagnosis is confirmed.
If your infant’s healthcare provider has any additional concerns about your infant’s diagnosis, they may refer them to a gastroenterologist or allergist.
What are the symptoms of cow’s milk protein intolerance in infants?
Your infant may be fussy before, during, and after feeding.
Your infant may have a hard time napping, or take awhile to settle and fall asleep.
Your infant may have loose, slimy stools.
You may notice mucus or blood in the stools.
Some babies may have vomiting.
The symptoms usually start within the first two months of life.
Symptoms can be present within a week of exposure to cow’s milk in breastfeeding and formula fed babies.
Usually the symptoms are more obvious between three to five weeks after birth.
Images of emotional infants:
Below is an image of a crying infant who is being comforted:
Below is an image of an image of a baby expressing discomfort who is being consoled:
Below is an image of a crying infant:
How is cow’s milk protein intolerance prevented?
There is no specific way to prevent your infant from developing this.
The best prevention once your child is diagnosed is avoidance of any irritating formula for formula fed babies, and avoidance of any dairy products in the mother’s diet for all breastmilk fed babies.
This is discussed below.
How is cow’s milk protein intolerance treated?
If your infant is on a cow’s milk formula, you will need to switch formulas.
Your infant’s healthcare provider can recommend different formulas.
Your infant’s healthcare provider may recommend a formula in which the protein is broken down, and easier to digest. Examples include Nutramigen and Alimentum.
If your infant consumes breastmilk, make sure that the mother sticks to a dairy free diet.
It is important to avoid products that have any of these listed as an ingredient:
milk, cream, butter, whey, casein, lactose or milk powder.
Some infants may also have an intolerance for soy protein. Your infant’s healthcare provider may recommend avoiding soy products as well.
If your infant’s healthcare provider has any additional concerns about your infant’s symptoms, they may refer them to a gastroenterologist or allergist.
The infant’s symptoms usually start to improve a few days after eliminating cow’s milk protein, though it may take 1-2 weeks to see improvement.
Cow’s milk protein intolerance is usually temporary, with most infants outgrowing it by the age of 1 to 2 years.
Your child’s healthcare provider will help you determine when would be a good time to try reintroducing cow’s milk protein, to see if your child has outgrown the intolerance.
When to contact your infant’s healthcare provider team:
You have noticed blood or mucus in your infant’s stool.
Your infant has been fussier or harder to console.
You think your infant has cow’s milk intolerance.
You have any other questions or concerns.
You would like to have your infant seen.
📚 References
This content was adapted from Orlando Health, Children’s Hospital of Philadelphia, The National Library of Medicine, Children’s National, . Images from https://www.babycenter.com/baby/crying-colic/is-it-normal-that-my-baby-doesnt-like-being-held-or-cuddled_13460, healthychildren.org, https://thechildrensclinicms.com/soothe-a-fussy-newborn/.
Reviewed by TT DO, JW MD, Patient Education Committee.