Growth Deceleration in Infants With Gastrointestinal Manifestations of Cow's Milk Allergy: Case Series From Specialised Centre

AIM: To investigate growth deceleration and associations with clinical manifestations and dietary elimination in infants with gastrointestinal cow's milk allergy (CMA). METHODS: In this case series, infants at a specialised clinic had their clinical and anthropometric data analysed. Weight (WD) and length deceleration (WD and LD) were determined by z-scores, with reductions > 0.67 classified as failure to thrive (FTT). RESULTS: Sixty infants (1-7 months) were assessed. WD and LD were identified in 53.3% and 51.1%, respectively. FTT was observed in 26.6% (weight) and 14.9% (length). Only 15.0% were exclusively breastfed, and 41.6% received specialised formula. 73.1% of mothers reported multiple food eliminations. Hematochezia (60.0%) was the most frequent clinical manifestation. WD was associated with full-term birth (p = 0.021; effect size [ES] = 0.3) and higher birth weight z-score (p = 0.001; ES = 0.5). LD was associated with a higher birth length z-score (p = 0.039; ES = 0.3) and marginally associated with diarrhoea (p = 0.059; ES = 0.3). CONCLUSION: Growth deceleration was highly frequent among infants with CMA, even prior to confirmation. Clinically meaningful trajectory changes occur in the absence of overt undernutrition. Early nutritional assessment at the time of initial clinical suspicion is essential to prevent progressive nutritional impairment.