Distinguishing what's normal from potentially abnormal in babies is challenging for all parents. Pediatricians commonly hear questions about frequent crying or spitting up, as well as noisy breathing. While these behaviors can be normal, they sometimes indicate an underlying problem -- such as formula intolerance or allergy. Formula intolerance is a reaction to formula ingredients that irritate the baby's digestive tract and may cause inflammation throughout the body. A formula allergy is an immune system reaction to proteins in the formula. Although formula allergy and intolerance are different, the symptoms are often similar, and the terms are frequently used interchangeably.
Spitting Up and Vomiting
Many babies have harmless episodes of spitting up small amounts after feeding. If your baby has spitting up that is not painful or forceful and he is gaining weight well, this is probably not a cause for concern. Vomiting, however, may be a sign of formula intolerance or other serious disorders when it is persistent, accompanied by irritability, poor weight gain and abdominal bloating. Cow's milk protein and soy protein are the most common causes of these reactions.
Parents sometimes have a hard time distinguishing normal baby stools from diarrhea. Infant stools are normally slightly loose and frequent compared to adults. Some newborns have up to 8 stools per day. But if your baby is having watery stools, excessively frequent stools or there is mucus in the stool, he may be experiencing a formula intolerance. Bloody stools can also occur with a formula allergy, or they may point to something more serious.
Atopic dermatitis is an itchy, scaly rash that frequently accompanies food allergies. An August 2012 medical position paper published in the Journal of Pediatric Gastroenterology and Nutrition notes that 50 percent of babies with an allergy to cow's milk formula also have atopic dermatitis. The rash primarily appears on the face, scalp, arms and legs in infants. Hives can also occur with a formula allergy.
Bouts of Colic
Colic is defined as fussiness for several hours per day, usually occurring between 3 weeks and 3 months of age. Colic occurs in about 20 percent of infants and is characterized by inconsolable crying, often in the evening hours, abdominal distention, gas and signs of abdominal pain -- such as drawing up the legs. While colic frequently goes unexplained, on rare occasions it is caused by an intolerance to the baby's formula.
Wheezing and Other Respiratory Symptoms
Wheezing -- a high-pitched noise during breathing caused by inflammation and narrowing of the airways -- occurs in approximately 20 percent to 25 percent of babies with food allergy reactions. Other possible respiratory symptoms include chronic coughing, nasal congestion and a runny nose. Respiratory symptoms from a food allergy are usually seen in association with skin rashes and digestive system symptoms.
If you suspect your baby has a formula intolerance, talk with your pediatrician. Symptoms such as wheezing and poor weight gain can indicate a serious problem, so it's important to have your baby properly evaluated to identify formula intolerance or other possible causes. Seek immediate medical attention if your baby is having trouble breathing. Fortunately, symptoms caused by a formula intolerance usually diminish quickly once the offending formula is replaced by one that is well tolerated.
- Caring for Your Baby and Young Child, 5th Edition: Birth to Age 5; American Academy of Pediatrics
- Journal of Pediatric Gastroenterology and Nutrition: Diagnostic Approach and Management of Cow’s-Milk Protein Allergy in Infants and Children
- Nelson Textbook of Pediatrics, 19th Edition; Robert M. Kliegman, M.D., et al.