COWS MILK PROTEIN INTOLERANCE IN BABIES

What is Cow's Milk Protein Intolerance (CMPI)?

Cow's Milk Protein Intolerance (CMPI) is a condition in which a baby’s immune system reacts to the proteins found in cow’s milk. This can happen even if the baby is not allergic to the milk itself but has difficulty digesting the proteins, often resulting in gastrointestinal or skin-related symptoms. CMPI is different from a milk allergy. While both conditions involve the body’s immune system reacting to cow's milk proteins, a milk allergy involves an immediate allergic reaction, which may be severe, while CMPI tends to involve a delayed reaction, which can take hours or even days to develop.

Signs and symptoms:

CMPI symptoms can vary and may affect the digestive system, skin, and even the respiratory system. For some baby’s they may have all the symptoms and others only a select few. The most common symptoms in babies include:

Digestive issues:

Frequent vomiting or spitting up

Green/mucousy stools - for severe cases, there may even be blood specs present.

Abdominal pain or bloating

Skin symptoms:

Eczema or red pimply rash that isn't going away

Thick cradle cap

Hives or welts

Other possible symptoms:

Poor weight gain.

Irritability or fussiness

Discomfort after feeding

Congestion

Wheeze or persistent cough

It is important to note that symptoms can range from mild to severe. In some cases, CMPI can be mistaken for other conditions, so it’s important to work closely with your healthcare provider for proper diagnosis.

Diagnosis:

Unfortunately when it comes to diagnosing CMPI there is no test. It relies heavily on working with a trained health practitioner to identify and review your baby’s symptoms and medical history. Once a probable diagnosis has been identified then you will be encouraged to commence an elimination diet. 

Elimination diet: If you are breastfeeding, you will need to eliminate all cow's milk proteins from your diet. This means avoiding foods like milk, cheese, yogurt, butter, and any products that contain cow’s milk proteins (such as some processed foods). It is important to read all labels in order to ensure they are free from dairy as even small amounts of this protein can have an affect on your baby. It's important to note, it will often take around 2 weeks for the proteins to clear from your baby’s body and hence, for you to notice any difference. 

Consider consulting a Dietitian: Since eliminating dairy can impact your nutrition, especially calcium and vitamin D intake, it’s important to work with a healthcare provider or dietitian to ensure you’re getting enough nutrients.

For formula fed babies: It may be recommended to switch to a hypoallergenic formula, which contains broken-down proteins that are less likely to cause a reaction. Ensure you are working with the correct health professional to receive the correct advice for you. 

In some severe cases, or if symptoms do not improve with dietary changes, a doctor may refer you to an allergy specialist. Further testing may be needed, and your child may require additional treatments or close monitoring.

CMPI often resolves as babies grow older. By 12 months of age, most babies have started growing out of this intolerance, and by the age of 2-3 almost all babies have grown out of it completely. However, in some cases, CMPI can persist into childhood. Your pediatrician will monitor your baby’s progress and may reintroduce small amounts of cow’s milk to assess whether your baby’s system has matured and can tolerate the protein.

When to seek medical help:

Contact your healthcare provider if your baby shows any of the following:

Persistent symptoms (such as diarrhea or vomiting) despite dietary changes

Severe reactions such as blood in stools or skin reactions

Failure to thrive or poor weight gain

Your doctor will help assess your baby’s condition and guide you in managing the symptoms.

Tips for parents

Be patient: Dietary changes may take time to show results. It can take anywhere from a few days to a few weeks for symptoms to improve.

Read labels carefully: Many foods contain hidden sources of cow’s milk, so always check ingredient labels on packaged foods.

Monitor your baby’s growth: Keep track of your baby’s weight and feeding habits with your MCHN to ensure they are getting enough nutrition.

Dietitian recommendations when dealing with CMPI: 

Frances Walker - https://www.thefoodintolerancedietitian.com.au/

Kathleen Halliday (also IBCLC) - https://www.feedingfoundations.com.au/