Page 12 - Today's Dietitian (February 2020)

Children’s Nutrition By Diana K. Rice, RD, LD, CLEC

infant’s diet and symptoms resolve. This
requires either switching the infant to
a special formula or having the breast-
feeding mother eliminate the suspected
foods from her diet, as the milk and soy
proteins she consumes pass into her
breastmilk. Fortunately, MSPI generally
doesn’t last beyond a child’s third year of
life and often resolves as early as 10 or 12
months of age.
Since cow’s milk protein intolerance
alone is more common that the combined
milk and soy protein intolerance, parents
typically are advised to first eliminate
cow’s milk from the mother and/or baby’s
diet. If symptoms don’t fully resolve, the
family may need to eliminate soy protein
and other top allergens.
And although milk and soy are
among the “top 8” food allergens (the
others include wheat, eggs, fish, shell-
fish, peanuts, and tree nuts), and an
infant’s condition may be referred to
informally as an allergy, it’s important
to recognize that MSPI isn’t an immu-
noglobulin E–mediated food allergy. It
also differs from lactose intolerance.
The intolerance in MSPI is to the pro-
tein component of the offending food
(eg, casein in the case of milk), whereas
lactose intolerance is characterized
by a deficiency in lactase, the enzyme
required to break down milk sugar.
Chrissy Carroll, MPH, RD, is a
Massachusetts-based dietitian with
Milk Soy Protein firsthand experience managing MSPI
in her breast-fed infant. “Within a few
Intolerance weeks of my son’s birth, we started
noticing that he was very fussy and had
mucus in his stool.” Carroll says. “When
Dietitians are poised to help identify and treat our guaiac test came back positive, we
infants with this uncommon digestive disorder. were told to cut dairy [from my diet].
N ew moms certainly have plenty to manage. Between symptoms, we realized we also needed
After that didn’t completely alleviate
recovering from childbirth, sleep deprivation, and
to cut soy and eggs [from my diet].”
Carroll considered herself lucky
the overall adjustment to a new way of life, it’s fair
to say that having a new baby may be among the
who had knowledge of MSPI, because
most stressful times in a woman’s life. to be working with a pediatrician
But many women experience an additional stressor they many women have a much different
weren’t expecting: managing their baby’s food intolerance. experience.
Milk soy protein intolerance (MSPI) is a condition that affects “For my first child, my pediatrician
somewhere between 2% and 5% of infants, often presenting was not familiar with MSPI at all,” says
around the infant’s third or fourth week of life. 1 Ann Dunaway Teh, MS, RD, owner of
Symptoms of MSPI may include mucus and/or blood in the Dunaway Dietetics in Marietta, Geor-
infant’s stool, diarrhea, gas, reflux, and colic. Pediatricians gia. “I did all of my own research and
may run a guaiac test to confirm the presence of blood in an presented it to him as something to try
infant’s stool, but there’s no specific diagnostic test to con- rather than reflux medicine. He told me
firm the condition, so the diagnosis generally is believed to be to try it if I wanted to but didn’t seem to
determined once the suspected foods are removed from the be interested beyond that in the results.”

12 TODAY’S DIETITIAN • FEBRUARY 2020