Cow’s Milk Intolerance in Children and Babies: Symptoms and Diagnosis

Cow’s milk intolerance is a difficult condition to diagnose, mainly affecting infants before 6 months. However, it can also occur in children and young adults. As its name suggests, the cause of these painful symptoms is the ingestion of cow’s milk. This is a difficult diagnosis for doctors, increasingly common, and the mechanism is poorly understood. In medical literature, an allergy of the intestinal wall to one or more components of cow’s milk is often cited as an explanation. This allergy would occur upon weaning from breastfeeding, or in an infant fed cow’s milk. It is the fourth most common cause of allergy in children after eggs, peanuts, and fish. It represents 12.6% of allergy causes in children under 15 years of age.

What are the signs of a cow’s milk allergy?

Four main families of symptoms can indicate a cow’s milk allergy: digestive, skin, respiratory, and/or neurological symptoms. These signs can be associated and coexist. Unfortunately, some signs are not always present, such as the appearance of hives (i.e., a skin allergy) immediately after the first intake of milk.

Most often, digestive symptoms (50 to 80% of cases) appear, with:

diarrhea,
regurgitation or vomiting,
colic with stomach ache (very common in infants and not expressed)

This is why you should consult your doctor if a baby presents with unexplained crying, often after feedings. As mentioned, there are also signs on the skin and sometimes respiratory signs. The child has “asthma-like symptoms,” which can indicate bronchitis or bronchiolitis. It’s the absence of fever that can make the difference!

Symptoms of cow’s milk intolerance in children and babies

Focus on digestive symptoms

These intolerance symptoms are found in infants, children, and young adults. In infants and very young children, oral expression is often difficult. Only crying indicates that “something is wrong.” Do not hesitate to consult a doctor if such symptoms appear after taking bottles of milk.

The most common are:

Diarrhea
Vomiting or regurgitation
Abdominal pain with crying after bottle feeding
Colic (which is common in infants)
A bloated stomach that has changed since stopping breastfeeding, or since the first bottle of milk

Older children and young adults may sometimes experience irritation in the mouth, throat, and/or anus. Occasionally, tongue swelling or even repeated mouth ulcers may occur.

Focus on symptoms at the skin level

We will mainly remember hives or recurrent eczema, which appear after breastfeeding. These signs can quickly lead parents and doctors to consider breastfeeding as the culprit.

Focus on respiratory symptoms

In medical literature, we find symptoms of intolerance that do not immediately suggest milk intolerance. These include:

Rhinitis
Rhinopharyngitis
Ear infections
Childhood asthma
Bronchitis

This shows us how difficult it is for parents and health professionals to establish a definitive diagnosis.

Focus on neurological symptoms

We will especially remember, at the neurological level:

sleep disorders,
agitation,
tears.

Although these signs of intolerance can be found in any child, their occurrence after taking milk should lead to consideration of their possible responsibility.

How long does it take for these symptoms to appear?

As with any allergy, there are three types of reaction times:

Very rapid (in less than 1 hour): often, the signs are very acute (especially at the skin level), and are sometimes respiratory. They should lead, like any serious allergy, to hospitalization.
Intermediate (between 2 and 3 hours after taking milk): the symptoms are mainly digestive.
Delayed (more than 24 hours): the different symptoms may coexist or follow one another, complicating the diagnosis.

How to establish a diagnosis?

It is necessary to mention “intolerance to cow’s milk proteins” in front of:

a digestive form: acute (diarrhea – vomiting) or prolonged
a general allergic form (generalized urticaria)
especially if the signs appear after breastfeeding

In this syndrome, the doctor’s suspicion and hypotheses are paramount. Note that the diagnosis of this disease remains rare beyond the 6th month.

The very rapid improvement in symptoms (and even the dramatic disappearance of signs) must occur after the exclusion of milk and the administration of a substitute product not containing cow’s milk proteins. This is medical proof of the problem of this intolerance.

The reintroduction of cow’s milk into the diet

This step should not be undertaken “lightly” and must often be supervised in a pediatric ward. Indeed, as we have seen previously, there may be serious forms of intolerance and allergy to cow’s milk that can lead to emergencies, sometimes life-threatening, requiring procedures in a pediatric intensive care unit.

On the other hand, this step will allow for a more or less formal diagnosis if there is a relapse. The absence of any immediate or delayed relapse leaves an incomplete diagnosis that risks delaying treatment. If the form remains benign, this can lead to leaving a child in good health, but who will regularly present digestive or other problems throughout his life, which will disrupt his nutritional balance and lifestyle.

Milk reintroduction tests must be carried out:

At the earliest, after 2 to 3 months of an exclusion diet
In principle, before the age of 1 year
If relapse: more than 6 months later
Then every 6 months
In specialized service, a fundamental parameter, to avoid any accident that could be serious.