Summary of ESPGHAN's Medical Position Paper

Thursday, Feb 01, 2018

Diagnostic Approach and Management of Cow's-Milk Protein Allergy in Infants and Children


Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, Mearin ML, Papadopoulou A, Ruemmele FM, Staiano A, Schäppi MG, Vandenplas Y. Diagnostic Approach and Management of Cow's-Milk Protein Allergy in Infants and Children: ESPGHAN GI Committee Practical Guidelines. J Pediatr Gastroenterol Nutr. 2012 Aug;55(2):221-229. Link to PubMed

Cow's milk protein (CMP) is the leading cause of food allergy in infants and young children younger than 3 years. Correct diagnosis allows the appropriate diet to be given to affected infants, thus supporting normal growth and development.

ESPGHAN GI Committee Practical Guidelines:
Provide practical approach to managing children with predominantly GI symptoms, and recommendations for the diagnosis and management of suspected cow's milk protein allergy (CMPA) in Europe.


  1. Thorough medical history and physical examination;
  2. Suspected CMPA can be followed by CMP elimination;
  3. Improvement of clinical symptoms from CMP elimination from diet should be confirmed by a standardized oral challenge test performed under medical supervision.

Treatment for confirmed CMPA:

  • Breastfed infants:
    - Mothers are encouraged to continue breastfeeding while avoiding all milk and milk products from their own diet.
  • Non-breastfed infants:
    - Extensively hydrolyzed protein-based formula with proven efficacy in appropriate clinical trials.
    - Amino acids-based formula, an option for infants reacting to extensively hydrolyzed formula.
    - Soy protein formula, if tolerated, is an option for infants beyond 6 months of age.
  • Children with CMPA that continues beyond the first 12 months of age need individualized nutritional advice, with dietetic assessment on intakes of protein, calcium, vitamin D, and vitamin A.

Patients should be reevaluated every 6 to 12 months to assess whether they have developed tolerance to CMP, in which most cases outgrow CMPA by 6 years of age.



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