Yes, reflux and cow's milk protein allergy (CMPA) are often mistaken for each other in infants because they share similar symptoms like spitting up, crying, fussiness, feeding difficulties, and poor sleep. The key difference is that CMPA involves an immune reaction to milk proteins, while reflux is the backflow of stomach contents, but a milk allergy can actually trigger or worsen reflux, making differentiation challenging and requiring medical evaluation for an accurate diagnosis.
Reflux is when food or liquid comes back up from the stomach into the oesophagus and causes discomfort. Cow's milk protein allergy is an immune reaction to proteins found in cows' milk, and symptoms can range from mild (rash or vomiting) to severe (anaphylaxis).
One key difference between allergies and acid reflux is that the latter won't cause sneezing, itchy eyes or a runny nose. If you're experiencing symptoms and aren't sure whether you have allergies or LPR, make an appointment with your primary care doctor to get an accurate diagnosis.
There are a symptoms of baby reflux to look out for:
Lactose intolerance:
Symptoms include diarrhoea, vomiting, stomach (abdominal) pain and gas (wind or bloating). This condition is uncomfortable but not dangerous and does not cause rashes or anaphylaxis. Allergy tests to cow's milk are negative in people with lactose intolerance.
One or both of the following tests may be recommended:
Cow milk protein allergy (CMPA) is a prevalent food allergy in infancy. It often presents with symptoms that overlap with other conditions, such as gastroesophageal reflux disease, lactose intolerance, food protein-induced enterocolitis syndrome, and eosinophilic esophagitis.
A GP or specialist may want to check whether your baby has an allergy to cow's milk, because the symptoms can be very similar to reflux. If there's no sign of cow' milk allergy, they may recommend treatments for reflux.
catheter monitoring, in which a health care professional passes one end of a catheter—a thin, flexible tube—through the nose and into the esophagus to measure acid reflux. Health care professionals sometimes combine this test with an impedance monitoring test, which can detect nonacid reflux, during the same procedure.
Newborn reflux
Some babies will make gurgling or gulping sounds during or after feeds. Reflux can cause newborn fussiness, back arching and a lot of spit up.
Conditions That Feel Like Heartburn, But Aren't
Eosinophilic esophagitis (EoE): This condition is caused by an allergic reaction in the esophagus, leading to inflammation and symptoms that mimic GERD. Food triggers: Certain food allergies, particularly to dairy or gluten, can worsen reflux symptoms in some people.
How do doctors treat GER and GERD in children?
If your child is allergic to the protein in cow's milk, it may cause symptoms in multiple areas of the body, including: Skin: Hives (red, blotchy skin that can itch) and may include mild to severe swelling. Lungs: Difficulty breathing, shortness of breath, coughing or wheezing.
Evidence-Based Answer. Infants with Gastroesophageal reflux disease (GERD) who do not respond to Protein Pump Inhibitor (PPI) therapy may have resolution of symptoms following elimination of cow milk protein from breastfeeding mothers' diet (SOR: C, small cohort study).
Symptoms of GERD
Diagnostic Tests
GERD can cause repeated symptoms or damage to the lining of the esophagus. Having reflux two or more times a week may be a sign of GERD. Your child's health care provider may diagnose GERD if the reflux causes pain, feeding problems, or irritation of the esophagus.
GERD can cause a range of symptoms. Common ones include burning in the throat and upper stomach; sufferers can also experience a nagging cough, a sore throat and the feeling that food is stuck in the throat. Indeed, every part of the digestive tract above the LES is vulnerable to acid exposure.
Statistically speaking, there is a higher prevalence of formula-fed babies who experience reflux compared to exclusively breastfed babies2. One reason for this is likely the prevalence of cow's milk protein allergy (CMPA), and babies who are allergic to common milk protein in formula can experience reflux.
Sandifer syndrome is a condition characterized by unusual movements of your child's head, neck and back. The condition can cause temporary muscle spasms as a reaction to acid reflux. Symptoms are most common after your baby eats when the contents of their stomach don't settle.
Reflux and regurgitation can be symptoms of CMPA. However, babies with CMPA usually experience more than just one symptom and these symptoms can be very different from one baby to the next (Link to Symptoms). Therefore it is always best to discuss it with your baby's healthcare provider.
The symptoms and indictors of cow's milk protein allergy (CMPA) can be diverse and non-specific. This creates a challenge for parents and healthcare professionals, and often leads to misdiagnosis or delays in diagnosis.
Acrodermatitis Enteropathica (primary or secondary zinc deficiency) can also produce lesions in the skin and also gastro intestinal symptoms which can mimic milk protein allergy and differentiating between these two may be difficult.