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Pediatr Integral 2025; XXIX (8): 633
I. Fernández Castiella, L. Navarro Montilla
Residentes de Pediatría del Hospital Universitario La Paz. Madrid
45. Food Protein-Induced Allergic Proctocolitis
Doctor: Isabel Fernández Castiella. Residente de Pediatría del Hospital Universitario La Paz. Madrid
Mother: Laura Navarro Montilla. Residente de Pediatría del Hospital Universitario La Paz. Madrid
Doctor: Good morning, I am Dr. Smith, how can I be of service to this little princess?
Mother: Hi Dr., this is Lilly, and I’m Astrid, her mother. Well, you see, Lilly is 2 months old and her father and I have been noticing some blood in her stools for over a week now.
Doctor: I see. Has she had any fever? Did she vomit? Have you noticed any other symptoms? Are you or any relatives that have been taking care of her ill? Does she have any past medical history? Has she had any surgery or previous hospitalization? Does she have any allergies?
Mother: No, she hasn’t had a fever. No vomiting or diarrhea and apart from little strands of blood, her stools are normal. Otherwise, she’s been asymptomatic. No one close to her has been ill that I know of. She is a healthy baby with no medical history or allergies.
Doctor: Are you breastfeeding Lilly or is she taking formula?
Mother: I am exclusively breastfeeding.
Doctor: And is she feeding properly? Have you noticed any loss of appetite?
Mother: She has always had a good appetite and I haven’t noticed any changes.
Doctor: Okay then, let’s have a look at Lilly.
PHYSICAL EXAMINATION
Weight: 5.320 kg. Axilar Temp: 36.5ºC. Pulse: 130 bpm. BP: 100/50 mmHg. SpO2: 98%. Good general condition. Well-nourished and hydrated. Capillary refill time: 2 seconds. No skin lesions. No respiratory distress. Cardiac auscultation: regular, no heart murmur. Pulmonary auscultation: general good bilateral ventilation, no pathological breath sounds. HEENT: no pharyngeal exudates; normal bilateral otoscopy. Abdomen: soft, nontender to palpation, mild hepatosplenomegaly (1-2 cm).
Doctor: Okay, the physical exam is fairly normal. She doesn’t have any signs of infection. I would like to run a stool exam to rule out bacterial gastroenteritis. If these results come back negative, it would look like Lilly might have what we call Cow’s Milk Protein Allergy in a form that is called Food-Protein-Induced Allergic proctocolitis.
Mother: But she isn’t drinking cow´s milk.
Doctor: Since you are having dairy products, through the breastmilk she receives cow’s milk proteins.
Mother: So, does that mean she can never have milk or anything that contains it?
Doctor: No, it doesn’t. For now, we are not even going to put you on a free cow’s milk diet. The last recommendations say we don’t need to do so if no other symptoms are present, like Lilly’s case. Treatment is only indicated if the symptoms continue after 4 weeks. And this treatment would be to put you on a free cow’s milk diet or to give Lilly hydrolyzed formula if you stop breastfeeding at some point. If these measures were necessary, it would be for about 6 months, and then we would try to give her dairy products with cow’s milk to see if the symptoms come back. Usually, these allergies are overcome with age.
Mother: Okay, that’s great. Thank you very much for the explanation.
Doctor: Do bring her back if she starts to vomit, you find her sleepy, has abundant diarrhea or if the blood in the stools persists for three weeks more.
KEY WORDS
Vomit: vómito.
Diarrhea: diarrea.
Strand: hebra.
Blood: sangre.
Breastfeeding: lactancia maternal.
Cow’s Milk Protein Allergy: alergia a la proteína de leche de vaca.
Food-Protein-Induced Allergic proctocolitis: proctocolitis alérgica.
Hydrolyzed formula: fórmula hidrolizada.
Dairy products: lácteos.
Overcome with age: superar con la edad.
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