What To Do if you Suspect your Baby has Cow’s Milk Allergy (CMA)

What To Do if you Suspect your Baby has Cow’s Milk Allergy (CMA) will focus on food protein-induced allergic proctocolitis: FPIAP. Cow’s Milk Protein Allergy (CMPA) is the most common allergy seen in infancy. CMA occurs when the body does not tolerate or overreacts to one or more proteins found in cow milk. These proteins can be ingested through formula or may be present in the breast milk with maternal ingestion of cow’s, goat’s or sheep’s milk (2). If you suspect CMA in your baby, CDHF recommends consulting with your family doctor or pediatrician and/or allergist. Either of these healthcare providers can diagnose, rule out and give you advice on CMA management.

If you are interested in learning more about CMA, the symptoms, diagnosis and solutions – read on!

Suspecting CMA

There are three types of CMA – this article will focus on a type of non-IgE mediated CMA – Food protein-induced allergic proctocolitis (FPIAP). 

Typically, symptoms of non-IgE mediated CMA begin to occur within the first few months of life. The classic CMA presentation is blood in the stool. It can be associated with increased frequency of stool, looser consistency of stool and/or mucus in the stool. The blood is generally flecked or streaked and appears red in colour (rather than maroon or brown). It is important to note that another common cause of blood in the stool at this age is constipation, which can happen from small tears at the anus from hard stool. However, with CMA, you’ll notice the stool is most often soft or looser rather than hard.

Other common signs of CMA may include:

• Increased frequency of poops
• Looser stool
• Mucus in the stool
• Gas or abdominal pain
• Feeding refusal
• Reflux or regurgitation

Not all symptoms will occur immediately after feeding. Some symptoms may take anywhere between two days to one week to show up. If your baby is experiencing lethargy, dehydration, a high fever, or paleness of the skin, visit the emergency room for assistance.  If possible, take a picture of the baby’s stool, especially if it contains blood or mucus, to show your doctor to help them confirm a diagnosis.

Nutricia has established a CMA allergy symptom checker to help serve as a starting point to help identify infants who may have CMA. Always check with your doctor or dietitian before modifying your baby’s diet.

Is there a cure for CMA?

As of now, there is no cure for CMA. However, there are ways to manage it and many babies outgrow their CMA as they get older and typically resolves by one year of age (4). Removing milk from the mother and baby’s diet and/or switching to extensively hydrolyzed formulas for babies who are formula-fed can help alleviate symptoms. Your doctor may recommend an oral food challenge to confirm a CMA diagnosis, where cow’s milk protein is removed for a minimum of two weeks with symptom improvement/resolution, followed by reintroduction of cow’s milk with symptom deterioration (4).

What Happens After a Diagnosis?

Babies and children that have been diagnosed with CMA require a milk-free diet. If the infant is being breastfed, the mother should talk with her healthcare provider about eliminating milk and potentially soy, from her diet. Hypoallergenic formula is needed with extensively hydrolyzed milk proteins if the baby is formula fed. Once a child has been diagnosed, a healthcare professional can help create a management plan.

Remember to look at food labels carefully to avoid any possible allergens. When preparing food at home, be sure to clean surfaces that have been exposed to foods with an allergen to avoid cross-contamination.

While CMA symptoms can be scary and cause alarm, it is important to note that once the cow milk is removed from the diet, babies otherwise continue to grow and thrive; they gain weight and continue to reach their developmental milestones!

Unless otherwise indicated, the information in this article is from our CDHF Talks with pediatric gastroenterologist, Dr. Lara Hart here.

---

What To Do if you Suspect your Baby has Cow’s Milk Allergy (CMA) – Food protein-induced allergic proctocolitis: FPIAP was reviewed by Amy Chow, RD,2022

Amy Chow is a Registered Dietitian based in Langley, BC. Amy is your go to Registered Dietitian if you’re looking for support with gut health, food allergies, diabetes, eating disorders and pediatric nutrition. With a decade of experience, she is passionate about inspiring you to feel confident about nutrition and bringing joy back to eating. When she’s not working, Amy enjoys spending time outdoors with her family and in the kitchen trying out new recipes! www.chowdownnutrition.com

---

References:

1. CDHF. (2021, December). CDHF Talks: Cow’s Milk Allergy. Canadian Digestive Health Foundation. Retrieved July 30, 2022, from https://cdhf.ca/digestive-disorders/cows-milk-allergy/cdhf-talks-cows-milk-allergy/#part3cows
2. Caffarelli, C., Baldi, F., Bendandi, B., Calzone, L., Marani, M., Pasquinelli, P., & EWGPAG (2010). Cow’s milk protein allergy in children: a practical guide. Italian journal of pediatrics, 36, 5. https://doi.org/10.1186/1824-7288-36-5
3. Fiocchi, A., Brozek, J., Schünemann, H., Bahna, S. L., von Berg, A., Beyer, K., Bozzola, M., Bradsher, J., Compalati, E., Ebisawa, M., Guzman, M. A., Li, H., Heine, R. G., Keith, P., Lack, G., Landi, M., Martelli, A., Rancé, F., Sampson, H., . . . Vieths, S. (2010). World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines. World Allergy Organization Journal, 3(4), 57–161. https://onlinelibrary.wiley.com/doi/10.1111/j.1399-3038.2010.01068.x
4. Society, C. P. (2021, April 27). Non-ige-mediated food allergy: Evaluation and Management: Canadian Paediatric Society. Non-IgE-mediated food allergy: Evaluation and management | Canadian Paediatric Society. Retrieved July 30, 2022, from https://cps.ca/en/documents/position/non-ige-mediated-food-allergy-evaluation-and-management