RepertoireClinical template workspaceFree Self-Assessment
LactoseintoleranceChronicdiarrheaInfantrefluxRectalbleedingCow milkproteinallergy

Gastroenterology

Cow milk protein allergy

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Lactose intolerance

Comes up in this visit

Chronic diarrheaInfant refluxRectal bleeding

Template

Cow milk protein allergy

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FeedingChoose oneFirst line

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ExamChoose one

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Milk protein can cause spitting up and fussiness in some babies, and removing it for a few weeks shows whether it helps. Recommended supportive care with an emphasis on keeping all cow milk protein out of the diet and reading labels for milk ingredients. Return precautions given including vomiting, blood in the stool, poor feeding or fewer wet diapers, poor weight gain, unusual sleepiness, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

CounselingNot in the note with these choices

Because weight gain is slow, we will check weight closely while milk is out of the diet. Recommended supportive care with an emphasis on frequent feeds and keeping all cow milk protein out of the diet. Return precautions given including more than streaks of blood, vomiting, poor feeding or fewer wet diapers, unusual sleepiness, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

Counseling

Blood in the stool from milk protein is common in young babies and is not dangerous in a baby who is growing well. It usually clears over 2-4 weeks after milk is removed, though small streaks can linger. Most babies outgrow it by around their first birthday, and milk can be reintroduced later as planned together. Recommended supportive care with an emphasis on keeping all cow milk protein out of the diet and reading labels for milk ingredients. Return precautions given including more than streaks of blood, vomiting, poor feeding or fewer wet diapers, poor weight gain, unusual sleepiness, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

  • Feeding type
  • Well vs poor growth
  • Hydrolyzed, amino acid, maternal elimination
  • Avoid soy; vitamin D; maternal calcium; GI; allergy

Return precautions in the template

vomitingblood in the stoolpoor feeding or fewer wet diaperspoor weight gainunusual sleepiness

Sources

Few formal guidelines cover this topic, so the template also leans on expert opinion.