Medical Column: Food Induced Nausea, Vomiting, and Diarrhea in Babies

By: Dr. Hyder Naqvi
Family Medicine Resident
Colquitt Regional Medical Center

If you’ve noticed that your infant is starting to suddenly have nausea, vomiting, and diarrhea, you might be surprised to find out that while the most common cause is related to stomach viruses, a small percentage of infants actually have a condition known as Food Protein Induced Enterocolitis Syndrome.  Food Protein Induced enterocolitis syndrome (FPIES) is a rare type of food sensitivity that presents as repetitive vomiting, watery diarrhea, and dehydration which can lead to weakness and lethargy. This is mainly seen in the infant population, but infants and children with it are often misdiagnosed with a stomach bug or a stomach infection. Fortunately, this condition is rare in the United States,  affecting only about one in 200 infants. However, despite being relatively uncommon, it is extremely important that parents don’t mistakenly assume that their infants diarrhea is just another stomach virus.

Classic FPIES usually starts in early infancy within one to four weeks of age and is usually associated with  the introduction of milk protein or soy protein based baby formulas. Classically symptoms will start with severe vomiting followed by severe diarrhea.

One of the most reliable ways to diagnose this condition is to eliminate suspected food triggers from the diet and then re-introduce foods that are most likely to be the cause, one at a time until symptoms return. Often referred to as doing a “food challenge”, some of the most common trigger foods includes cow’s milk (non-breast milk) and soy protein based baby formulas. Foods, which are becoming more common as well include rice and oat baby cereal, egg, and fish.

Once the doctor and parent find out what foods are triggering the symptoms, the next first step is to cut the food out of the baby’s diet, which for infants less than a year old may mean switching their formula.  Usually upon elimination of the trigger foods and introduction of new foods, the symptoms resolve within 3-10 days. In addition, some studies have shown that introducing foods such as green vegetables and certain fruits at 4-6 months of age instead of cereal, may be beneficial because 1/3 of infants who have milk or soy FPIES will also develop reactions to rice and other grains.

In some more severe presentations of this condition, the child may become dangerously dehydrated. So if your infant begins acting lethargic, stops making urine, or just can’t hold down any liquids, this is a reason to take the child to the emergency room as soon as possible

Usually FPES to cow’s milk and soy formula will go away by 3-5 years of age. However, FPIES to other solid food can occur as well, so if you suspect that your child may be experiencing symptoms of a food allergy, then make an appointment with your family medicine doctor right away.