- Age: 0-10 months (usually presents 3 weeks - 3 months)
- Distal colon inflammatory reaction to Cow's Milk Protein
- Appears to not be IgE mediated
- Concomitant soy milk reaction in 30% of infants
- Early introduction of cow's milk
- Especially after Gastroenteritis
- Loose Bowel Movements
- Blood and mucus streaked stools
- Otherwise healthy infant with normal growth
- Vomiting
- Hives
- Swallowed maternal blood (during delivery, or from cracked nipples)
- Most common cause of infants with blood in stool
- Infectious Colitis causing bloody stool (Salmonella, Shigella)
- Enterocolitis due to Necrotizing Enterocolitis
- Anal Fissure
- Hirschsprung's Disease
-
Stool studies
- Leukocytes
- Stool Guaiac
- Stool Culture
- Wright's Stain for Eosinophils
- Complete Blood Count with differential
- RAST testing not useful
- Nursing Mothers
- Avoid milk and possibly soy products in maternal diet
- Formula fed
- May trial on Soy Formula first (previously not recommended)
- Casein Hydrolysate formula (e.g. Nutramigen)
- Elemental formula (Neocate) for refractory cases
- Re-challenge with cow's milk at 1 year
- Infants outgrow in 95% cases by age 1 year
- Mason and Woods in Herbert (2019) EM:Rap 19(2): 7-8