Milk Soy Protein Intolerance (MSPI)
MSPI is a temporary intolerance to the proteins in milk and soy. Both breast-fed and formula-fed babies can develop an intolerance to cow’s milk and / or soy proteins. “As many as 2-7% of babies under one year of age have intolerance to cow’s milk, and in our area, 60% of those babies will also develop intolerance to soy proteins”. (7) A food intolerance may often run in families, with more than one child or a parent needing a special diet.
It is unclear why MSPI is more frequently seen in the Midwest Regions of the United States. Other regions across the United States may possibly call it by another name like cow’s milk protein intolerance (CMPI), food protein induced colitis, or allergic colitis.
is sometimes difficult, as there is not a definite test. Diagnosis is mainly by reviewing the history of the baby’s symptoms and a dietary trial without milk and / or soy products. Your baby’s physician may check for blood in the baby’s stool. Symptoms
vary from infant to infant and can include:
- Fussiness (before, during, and after a feeding)
- Stools may be infrequent, watery, mucous, or bloody
- Spitting up
- Nasal congestion
- Skin rash, eczema
- Weight loss
- Repeated vomiting
The baby’s symptoms should improve within as little as 3 to 7 days after removing the food intolerant. It may take up to 2 weeks for the baby’s stomach / intestines to heal from any irritation caused by the intolerance. Cow’s milk protein can stay in mom’s body for 1 ½ to 2 weeks, and then it may be another 1 ½ to 2 weeks for the protein to get out of the baby’s system.
Fussiness is one of the most common symptoms of a food sensitivity or intolerance. Fussiness before eating because of hunger, during the feeding and then more fussy as they become more uncomfortable can be common. “Children with MSPI may cry 18 hours or more a day and may develop weight loss, congestion, repeated vomiting, reflux, and certain kinds of skin rashes. They also may have changes in appetite, including refusing food or wanting to eat all the time, irritability / fussiness, and blood or mucous in their stools.” (7) Some babies frequently “grunt” as if they are having a hard time passing stool, but stools are soft. This may be a sign of intestinal inflammation.
: There is no medication to treat MSPI. As a treatment, the breastfeeding mom removes the food intolerances from her diet. Committing to a strict, time-consuming diet is challenging but worthwhile. Continuing to breastfeed is still the best nutrition for your baby and the immunities breastfeeding provides will assist in the healing process for your baby. A variety of foods are available by making recipes from scratch, substituting milk and soy free products. “Babies with MSPI also do better if solid foods are not introduced until around 6 months of age. At that time, solid foods can be introduced in a slightly different order than for babies without MSPI.” (7)
Ask your healthcare provider in what order to introduce solid foods. Support
: Talking with a dietician early on or prior to starting a food-restricted diet is very beneficial. The dietician can direct you to certain food items and brands that are milk and soy free, and help find hidden sources of dairy and soy in foods and drinks. The dietician will also make sure you are getting the nutrients that you need while breastfeeding and suggest non-dairy food sources of calcium. Bring a family member or friend with you to your visit to make sure all your questions and concerns are answered, and to educate them as well, on what foods you can eat.
Keeping a food log will also help the dietician locate hidden sources. It is very important to keep a food log of everything you eat and drink along with fussiness and symptoms the baby has. In some babies, it may take 3 to 4 days for the symptoms of intolerance to a food to show up. You can then look back for any new item you ate or drank to locate the cause of the symptoms.
Some new moms find a strict food diet is very overwhelming. If you are feeling anxious, overwhelmed or struggling emotionally, please talk with your physician. Joining a MSPI support group is very beneficial as you receive emotional support and helpful hints about food, recipes, and restaurants.
Formula fed babies must switch to an expensive dairy and soy free formula. “These formulas are made up of broken down proteins and are able to be digested without an immune reaction. These formulas will work in 90% of patients with a cow milk protein intolerance.” (3)
“Most infants that are started on cow’s milk-free formulas or breastfed by a mother on a cow’s milk-free diet will need to remain on the diet for about 6-12 months. At that point, the child can be challenged with cow’s milk, and if they have no reactions, milk can be put back into the child’s diet.” (7) Check with your baby’s doctor about when to introduce milk and soy into their diet. If breastfeeding, introduce the milk or soy product to the baby to see if there is a reaction. If you eat the milk or soy product, it will be in your breast milk for a longer period of time.
Eating out at a restaurant is a challenge while on a food sensitivity diet. Plan ahead. Before you go out:
- Check the restaurant website for a list of allergy contents;
- Call the restaurant (avoid busy meal times) and speak to the manager or chef to inquire about how they prepare dishes and the oils they cook with. Some meat products are cooked in butter. Ask to see/check the labels of their prepackaged food;
- Be specific when ordering about how you want your items prepared, and tell them about the food sensitivities of your baby;
- Ask if you may bring your own salad dressing in;
- Check all foods. If you order a sandwich like a hamburger, the hamburger patty may be ok to eat but the bun may not.
Food and Food products are constantly changing, manufacturers may change their products without notice. Always read the label. Check medication and vitamin labels as well, as they may contain milk or soy ingredients. Some of your own favorite recipes can be made milk and soy free, by using milk and soy free products. See the following sites for food related items and recipes that are safe to eat.
Find more information at Resouces
Please direct question and/or comments to Jackie Moline, BSN, RN
Phone: 402-471-0165, Cell: 402-326-6415, or firstname.lastname@example.org
Documents used in the development of this page:
- ABM Clinical Protocol #24: Allergic Proctocolitis in the Exclusively Breastfed Infant. Medicine, The Academy of Breastfeeding. 2011, Breastfeeding Medicine, pp. 435-440.
- What is MSPI? Complete Children's Health. [Online] August 21, 2014.
- Recognizing Cow's Milk Protein Allergy in Infants - Evidence Shows Eliminating Milk and Soy Can Help. Judith C. Thalheimer, RD, LDN. 2012, Today's Dietitian, p. 14 (Vol. 14 No. 3 P. 14).
- Diagnosis and management of cow's milk protein allergy in infants. Elisabeth De Greef, Bruno Hauser, Thierry Devreker, Gigi Veereman-Wauters, Yvan Vandeplas. 1, Brussels, Belgium : World Journal of Pediatrics, 2012, Vol. 8.
- Gastrointestinal Food Allergy in Infants. Hideaki Morita, Ichiro Nomura, Akio Matsuda, Hirohisa Saito, and Kenji Matsumoto. 3, s.l. : Allergology International, 2013, Vol. 62.
- Infant Food Allergy: Where Are We Now. Joneja, Janice M. 49S, s.l. : Journal of Parenteral and Enteral Nutrition, 2012, Vol. 36.
- A Review on the Diagnosis and Management of Food-induced Gastrointestinal Allergies. R. Meyer, C. Schwarz, N. Shah. 1, s.l. : Current Allergy & Clinical Immunology, 2012, Vol. 25.