6 week old happy and thriving baby with CMPA?

[BiscuitsAreLife]

My 6 week old little girl is doing really well, ebf and growing beautifully. She has put on nearly 5lbs since birth. She’s very happy and sleeps in 5 hour stretches overnight. All great.

However last weekend her stools started getting darker, not very yellow and seedy like they used to be. More like dark yellow/green. Then on Sunday we spotted the tiniest amount of blood in her stool. Then again on Tuesday, the tiniest amount. We’re talking the size of an ant, if that. We took her to the doctor who has suggested CMPA and requested a stool sample to rule out infection. Then no more blood for the rest of the week until today there was an even smaller amount of blood in the stool. I would have missed it if I wasn’t inspecting every nappy.

Could this be CMPA? Or maybe more like just a sensitivity? Most other stories of CMPA that I’ve read have been of inconsolable babies who aren’t putting on much weight, can’t be put down, not sleeping etc.

Any input will be welcome. I’ll arrange to see the doctor again this week and discuss further but just wanted to thrash out my thoughts somewhere :)

@BiscuitsAreLife yes.

It sounds like what's referred to as "FPIAP" - food protein-induced allergic proctocolitis. There is a much nastier version, "FPIES" FPI enterocolitis syndrome, which is the version you've heard about in other children.
See for an overview of both FPIES and FPIAP.

The current advice on FPIAP is just push ahead with breastfeeding, continue your normal diet, wean as per the EAT study protocol because in a child with raised risk of allergy the best thing to do is introduce all allergens in tiny amounts early and often and the diarrhoea and blood will very likely clear up by itself at about 68 months (i.e. a bit after weaning). If the diarrhoea persists with food, probiotics may help - Bio-Kult Infantis is the most diverse and thus the best at this stage - comes in sachets, just sprinkle onto porridge. You can get it in Boots.

PM me if you want more details but your GP should be able to talk intelligently about FPIAP and weaning as per EAT study.

My child had CMPA and was putting on weight normally despite having diarrhea and bloody stools. So that in itself doesn’t rule out CMPA.
I think the previous poster is being a bit too optimistic in her expectations that a GP would know so much about this issue. We had a referral to a consultant but ultimately all he did is to check that the child is thriving...

To clarify, CMPA producing green bloody stools in a thriving infant is a subpopulation of FPIAP. FPIAP can be allergy to all sorts of things - eg my DS is allergic to both dairy and soy and other stuff we haven't determined yet. So cutting out dairy didn't help on its own in his case. However dairy is probably the commonest cause of FPIAP so worth thinking about. It is worth noting that dairy allergy is NOT the same thing as lactose intolerance. Allergy to dairy can be to one or more of numerous different proteins in cow's milk, some of which are present in many or all mammalian milks - and also can be found in beef or other meats (Bovine serum albumin is found in milk and beef. It's one of the known culprits but there are many others).

Allergy is broadly divided into 4 types of reaction. Type 1 is IgE-mediated histamine-based reactions like hives and anaphylaxis. Type 4 is stuff like eczema, coeliac disease, and FPIAP. The relevance of this distinction is that allergy testing is meaningless for FPIAP because it only works for IgE-mediated Type 1 reactions. So anyone telling you to get skin prick, RAST, spIgE testing done for FPIAP doesn't know what they're talking about. There may be some value in doing those tests later, around age 2 (when immune responses have matured a bit) to check your baby doesn't also have a type 1 allergy.

I guess there will be GPs who know this stuff and GPs who don't. Push for referral to a paediatrician at least, paed immunologist at best, if your GP looks lost when you mention the stuff above. Good luck. It will probably clear up just fine.

@EggplantsForever did you change your diet? I’ve been advised by her pediatrician to cut back on dairy rather than cut it out. As she is growing and happy etc so no need for such drastic measures. So I’ve swapped out milk for almond milk, vegan and soy free butter etc. I’ll see if that makes a difference.

Interesting @twaseverthus666 about not changing my diet. I can see the thinking behind it but everything I’m reading says I should be cutting out dairy completely. I looked through the links you provided but didn’t spot anything about maintaining my current diet.

Advice re diet is very recent so may not be in that one, sorry. There is a brief mention in the papers about the EAT study. I got the advice on maintaining normal diet from a highly research-active paediatric immunologist at a big public teaching hospital, 18 months ago. He sees hundreds of kids a year with FPIAP.

Try to get a referral from your GP to an immunologist and/or a paediatrician, I guess.

Completely cutting out dairy is quite hard because it's in all sorts of things like supermarket bread, biscuits, most processed foods. So while nut milk and marg are a good start, you'd need to go the full distance on complete removal of all possible sources from your diet and wait at least 6 weeks to see if you get a result. If not you then try cutting soy as well, then all the orher "big 8" allergens. By that time, the FPIAP may have cleared up anyway, and you may have given yourself nutritional deficiencies or lost so much weight you had to stop breastfeeding (I lost 10kg in a few weeks when trying to cut out allergens). And you miss the window for weaning as per EAT, and lack of allergens in the early diet contributes to development of subsequent type 1 allergy. Thus the reasoning is that FPIAP is unlikely to be a long term problem, while cutting things out of the diet can be a major long term issue in several ways.

I was completely milk-free until around the time my child turned 8 months - but this is because she had very frequent(and somewhat bloody) stools otherwise. Unfortunately, really I could eat something like a butter cookie and she would have blood in stool several hours after during the first few months of life.

At age 8 months I gradually reintroduced dairy in my diet, and it was OK. I introduced dairy in my child's diet at 1 year of age, and it was OK as well, so she stopped being allergic sometime in her first year of life.

In my experience stopping dairy wasn't a big deal...But I guess it is a very personal thing depending on your usual diet.

To see a difference you would have to be dairy free for around a week - two weeks at least, or at least this is what the literature tells us - to give her colon time to heal I suppose.

I have been prepared to go completely milk free and possibly more, soya, eggs, nuts, checking labels etc. I was going to start a true elimination diet. We are vegetarians and cook from scratch a lot, my biggest hardship would be finding appropriate snacks. However her pediatrician has only suggested cutting back on dairy rather than completely cutting it out to see how that goes. This is because the blood is so minimal and her only symptom. But as you said eggplant, surely her poor insides need a rest! We’ll see how the next couple of weeks go with the cut back dairy, we have her two month appointment coming up and they’ll do another stool test. I’m going to carry on looking into the research that twasever mentioned, it would be great to carry on my diet as normal but the bloody and green frothy stools are just so hard to ignore :(

@BiscuitsAreLife the advice to cut back rather than eliminate completely makes very little sense - it's an allergic reaction, not a dose-dependent intolerance. You either ignore the allergic reaction on the grounds it doesn't need treating, or you eliminate completely... cutting back won't do anything.

Blood in stools from immune causes in otherwise healthy babies