How might an infant be exposed to cow’s milk? Some breastfeeding moms drink it, and some baby formulas contain it. Babies differ in how sensitive they are to milk proteins. Some have very few symptoms, and others might experience blood in the stools if a nursing mother adds even a splash of milk to her coffee, according to Boston Children’s Hospital. Allergic colitis isn’t common — it’s thought to affect between 2 and 3 percent of infants. Why some babies develop the condition and others don’t is not fully understood. However, allergic colitis is thought to be caused by a combination of changes to the mother’s immune system during pregnancy, and the immaturity of a baby’s own immune system. Heredity may play a role as well. Infants born into families with a history of food allergies, asthma, or environmental allergies seem to have a slightly higher risk of developing the condition. The good news is that symptoms of allergic colitis usually disappear once the condition is detected and the offending food is removed from the baby’s diet. In addition, most infants become tolerant to milk proteins once milk is gradually reintroduced after age 1, according to a review article published in October 2020 in the World Allergy Organization Journal. A baby with allergic colitis may be extremely fussy, difficult to console, and develop flecks or streaks of blood in the stool. Some infants also have diarrhea and vomiting, and some may show other signs of allergies, such as nasal congestion or eczema. But the symptoms of allergic colitis aren’t always this obvious. Many babies with this condition look and act healthy and some have normal-looking bowel movements — blood and mucous can be invisible to the naked eye. As symptoms get worse, however, you’ll likely realize there’s a digestion problem. Allergic colitis can make eating uncomfortable for a baby. The resulting weight loss and protein loss will cause your baby a lot of distress. As soon as you’re aware that something’s wrong, call your pediatrician. Your doctor will let you know if you need to see a specialist. Once detected, allergic colitis is usually resolved relatively quickly, reassures Elizabeth Marcus, MD, a pediatric gastroenterologist and an assistant professor of pediatrics at The David Geffen School of Medicine at UCLA in Los Angeles. She advises parents to know the signs of allergy, but not to change an infant’s diet without first consulting a pediatrician or pediatric gastroenterologist.
How Allergic Colitis Is Diagnosed
There isn’t a single test that spots allergic colitis. Your doctor will likely examine your baby, take a history, and run a test to check for blood in your baby’s stool. This might be blood that can only be seen through a microscope or detected with biochemical tests. A diagnosis of allergic colitis is often not made, however, until the implementation of an allergen-free diet for baby and, if the baby is breastfed, the mother too. “[If we suspect allergic colitis,] what we do is empirically remove what the most likely sources of the allergy are,” says Eitan Rubinstein, MD, a pediatric gastroenterologist at Boston Children’s Hospital. “In the majority of infants, the allergy is to milk, and sometimes to soy, but any protein can be the trigger.” Most diagnoses of allergic colitis are made after the baby responds positively to the elimination of the suspected culprit, according the World Allergy Organization Journal review.
Treating Allergic Colitis in Infants
Treatment for allergic colitis is relatively straightforward and involves eliminating the offending proteins from your baby’s system. If you’re feeding your infant with formula, you’ll need to switch to one that’s hypoallergenic. If you’re breastfeeding, you’ll need to switch to a dairy-free diet. It takes up to 72 hours for a mother’s breast milk to become free of milk protein. During that time, you’ll need to give your baby a hypoallergenic formula. According to Boston Children’s Hospital, roughly 30 percent of babies who are allergic to cow’s milk protein are also allergic to soy protein. If your baby’s symptoms don’t clear up, it is recommended that a nursing mother avoid soy as well as dairy. Once you’ve altered your or the baby’s diet, you’ll usually see less bleeding within 72 to 96 hours. Sometimes, however, it can take longer for the colon to heal. Depending on the degree of irritation, it’s possible for rectal bleeding to continue for up to two weeks, says the report in World Allergy Organization Journal. You’ll know when your infant is feeling better — his or her irritability will lessen, resistance to feeding will go away, and your baby will gain weight. The condition also improves with passing time. At about 11 months, you can give your baby milk again to see if they have outgrown the allergy. Dr. Rubinstein notes that more than 95 percent of allergic colitis cases disappear by the time an infant is one year old. If that doesn’t happen, you should continue to consult your doctor and perhaps a specialist, and repeatedly introduce milk every three months until your child begins to tolerate it. “When you change everything and symptoms don’t go away and blood is still in the stool, further evaluation is needed,” says Rubinstein. Your doctor might suggest a test called a flexible sigmoidoscopy to check the intestines for infection, polyps, or abnormal blood vessels close to the surface that could be causing bleeding. It’s also possible, though not usual, that a baby has a rectal fissure or tear. During this time, it’s still important to introduce new foods into your child’s diet. Babies need to begin to get used to them. And solids, like cereals, contain new vitamins and minerals not found in breast milk or formula.
Tips for Managing Allergic Colitis in Infants
When your infant has allergic colitis, it’s important for you and the baby to adhere to the elimination diet and not reintroduce milk proteins too quickly. Here are some tips that may help you resolve your baby’s allergic colitis symptoms. Always read foods labels. During the elimination period, it’s important to make sure what you’re buying for yourself to eat or feed to your baby doesn’t contain cow’s milk or soy milk. Don’t assume you know what the contents of a product are. Ingredients and additives change all the time. Introduce new foods early in the day. It’s a good idea to introduce new foods into your baby’s diet first thing in the morning so that if an allergic reaction occurs you’ll know what caused it. For the same reason, new types of food shouldn’t be introduced more often than every three to five days. Keep your pediatrician in the loop. When you change and add foods, involve your pediatrician. See your pediatrician when you need to, but no less than twice after allergic colitis is diagnosed. Your doctor will want to keep track of your baby’s weight and be sure your child is getting all the necessary nutrients. Additional reporting by Jordan M. Davidson.
