Failure to Thrive and Recurrent Diarrhea in an Infant

Two weeks  ago a young mother brought in a seven-month old baby who looked alert and active and constantly smiling, however, she was small and light for her age. The presenting complaint was that she had been having recurrent diarrhea since the introduction of an infant formula feeding at the age of four months.

According to the mother the child was born within the normal birth weight of 3.1 kg and was fully breast fed till the age of three months and gaining weight well. The problem started when the mother gave her cereals and cow milk-based infant formula. The baby started having loose foul-smelling stools,passing lots of wind,bloated abdomen,appears constantly hungry and always crying. As expected she has not gained any weight for the last three months.She weighs at six kg, well below her weight for age which should been about eight kg .

The mother who is young and only received primary education, is at her wit's end trying to grapple with the problem. She has changed the infant formula brand once but the problem has not resolved. I noted down the name of the brands. Interestingly her first child also has suffered from the same condition, namely "intolerance" to infant formula. As a result the elder child is rather growth-stunted and slow in her milestones. I cannot help but feeling sad despite trying to be professionally detached. I wonder about the child's brain development. this condition is so preventable that it is a dereliction of duty on any health staff who look after these children  and  yet missed the signs,symptoms and most importantly the history!

The tragedy is the mother has been bringing both children to the local Mother and Child Services and has been told time and again to prepare the milk "properly". Without specific help and advice how does this lowly-educated woman know what to do? She doesn't have enough milk so she claims and the child needs to be fed.

Having listened to her history and description of the signs and symptoms and on physical examination of the child, I immediately made a diagnosis of cow's milk allergy in this infant. She cannot tolerate cow's milk due to possible genetic abnormalities in her gut. Looks like her elder sibling also has the same condition. The two infant formulas that she mentioned are cow's milk-based. She is subsequently advised to switch to  a soy protein-based infant formula.

Cow's milk products- A good source of protein

The mother comes today with a broad smile on her face holding her contented baby who has finally recovered from the diarrheal condition. The weight should start to pick up soon. Unfortunately the woman is from a different state and will return home at the end of the week and so I would not be able to get the joy of following her infant up.

The family came here for the school holidays and decided to try our clinic. They are very grateful to have come to us.  I advised her to continue attending regularly the Child Health Clinic in her State to monitor her child's growth. Moreover her child might outgrow the cow's milk allergy by the age of two or three. After which cow's milk products could be gradually reintroduced.

I feel  relieved  for the family.Imagine their months of anxiety and stress! Helping them to solve the problem  is yet another invaluable feeling of satisfaction for me.