Managing Cow's Milk Protein Allergy (CMPA) and Faltering Growth

Case Study: Managing Cow's Milk Protein Allergy (CMPA) and Growth Faltering in an Infant

Patient Profile

• Patient: Miss PJ, 9.5 months old

• Primary Concern: Growth faltering and suspected Cow’s Milk Protein Allergy (CMPA) or lactose intolerance

Background

• 2-Month Weight: Between the 25th and 50th centiles

• 8-Month Weight: Just above the 9th centile, indicating significant growth faltering

Upon referral, CMPA was suspected based on symptoms of poor weight gain and gastrointestinal discomfort, likely linked to an intolerance to cow's milk protein or lactose. The goal was to address the nutritional deficits and ensure healthy growth and development.

Dietary Intervention

• Hydrolysed Formula: Initiated Aptamil Pepti 2, a hydrolyzed formula specifically designed for infants with CMPA, to address growth faltering and ensure appropriate nutritional intake.

• Weaning Advice: Provided tailored advice on safe and appropriate foods to introduce at 8-9 months, ensuring the diet was balanced while avoiding allergens.

Monitoring and Progress

• 9.5-Month Weight: Miss PJ’s weight had improved, returning closer to the 25th centile, showing a positive response to the dietary changes and formula adaptation.

• Weaning Success: The infant tolerated the hydrolysed formula well and was progressing with weaning, accepting new foods without adverse reactions.

Goal Indicators

• Consistent Growth: Weight stabilized within the 25th centile, showing steady growth and addressing concerns of growth faltering.

• Formula Tolerance: The hydrolysed formula was well-tolerated, with no signs of distress or intolerance.

• Weaning Progress: The infant was weaning well with appropriate foods, building towards a diverse diet.

• Symptom Resolution: Symptoms related to CMPA, or lactose intolerance were resolved, with no signs of discomfort or gastrointestinal upset.

Next Steps

• Milk Ladder: Plans were made to introduce the milk ladder at 12 months under dietetic supervision to safely reintroduce cow's milk and monitor for potential tolerance.

Conclusion
‍

This case highlights the importance of early intervention in cases of growth faltering and suspected CMPA. By introducing a hydrolysed formula and providing appropriate weaning guidance, Miss PJ showed significant improvement in weight and tolerance to the formula. The continued monitoring and gradual reintroduction of cow’s milk through the milk ladder will support the child’s long-term nutritional health.