Vomiting in Infancy: Is It FPIES?

Elizabeth Feuille, MD; Anna H. Nowak-Wegrzyn, MD, PhD


January 02, 2019

Answers: Appropriate Substitutes for Cow's Milk-based Formula

Amino acid-based formula, extensively hydrolyzed formula, and soy formula (introduced under physician supervision) are appropriate for patients with cow's milk FPIES.

Addressing Nutritional Concerns

The current guidelines recommend that clinicians consider referring parents of infants with FPIES to a nutritional counselor, who can discuss dietary avoidance measures and ensure that patients receive adequate nutrition.[1]

Infants reacting to cow's milk or soy in infancy require alternative formula options. Most patients will tolerate an extensively hydrolyzed cow's milk-based formula, but 10%-20% may require an amino acid-based formula.[4] Because of the potential co-reactivity of cow's milk and soy, a clinically supervised food challenge is the appropriate setting for introduction of soy for a patient with cow's milk FPIES, and vice versa.[1] Breastfeeding is also an appropriate option, and maternal avoidance of cow's milk and/or soy is typically unnecessary.

Parents of young infants who had an FPIES reaction to their first foods often need encouragement and reassurance as they continue to introduce new foods to their infant and expand his or her diet. The guidelines offer a chart of low-, medium-, and high-risk foods for FPIES to help practitioners provide specific recommendations on introduction of complementary foods.[1]


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