TOPLINE: 

Early growth deceleration in both weight and length was frequent in infants with gastrointestinal manifestations of cow’s milk allergy (CMA) even before a confirmed diagnosis, with parent‑initiated elimination diets before specialist referral likely contributing to growth deficits.

METHODOLOGY: 

• Researchers conducted a retrospective case series to evaluate growth deceleration in 60 infants aged up to 7 months (51.7% boys) who presented with gastrointestinal manifestations of CMA at a specialized clinic.
• Growth deceleration was defined as a decline in z scores for weight‑for‑age (weight deceleration) or length‑for‑age (length deceleration) indexes between birth and initial assessment, based on the World Health Organization growth standards; a reduction of more than 0.67 in either z score was considered to indicate failure to thrive.
• The clinical manifestations assessed were hematochezia (defined as bright red blood in the stool), diarrhea, vomiting, and atopic dermatitis.

TAKEAWAY: 

• A notable proportion of the study population exhibited weight (53.3%) and length (51.1%) deceleration at initial presentation. More than a quarter (26.6%) of infants showed failure to thrive based on weight, whereas 14.9% did so based on length.
• Weight deceleration was significantly associated with full term birth (P = .021) and a higher birth weight z score (P = .001), whereas length deceleration was associated with a higher birth length z score (P = .039).
• In infants who were breastfed at initial presentation, only 15.0% were exclusively breastfed, and 41.6% received a complementary specialized formula. In breastfeeding mothers, 73.1% reported eliminating milk and at least one other food from their diets.
• Hematochezia was the most frequent clinical manifestation (60.0%), followed by diarrhea (48.3%), vomiting (26.6%), and atopic dermatitis (20.0%).

IN PRACTICE:

“This scenario highlights that, in clinical practice, the focus should not only be on the formal diagnostic confirmation through an oral food challenge, but also on the immediate nutritional protection of the infant as soon as CMA is suspected,” the authors of the study wrote.

SOURCE:

Priscila Prazeres de Assis, with the Federal University of Pernambuco, Recife, Brazil, was the corresponding author of the study, which was published online on April 10 in Acta Paediatrica.

LIMITATIONS: 

The study did not use an oral food challenge to confirm the diagnosis. Because the study relied on existing medical records, daily energy intake, including exact volumes and caloric density of foods consumed before initial assessment, could not be assessed.

DISCLOSURES:

This study was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior and a doctoral scholarship by the Coordination for the Improvement of Higher Education Personnel, Brazil. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.