What does the American Academy of Pediatrics recommend in infants with acute diarrhea associated with gastroenteritis? Why?

• A. Switch to soy or lactose-free formula due to soy intolerance
• B. Continue with routine cow's milk-based formula
• C. Hydrolyzed or free amino acid-containing formula since a high percentage of children who are allergic to cow milk protein will also be allergic to soy protein
• D. Use lactose-free formula only

Answer: (C)

When an infant with gastroenteritis presents with diarrhea and cow milk protein allergy is a possibility, the feeding plan aims to minimize exposure to cow milk proteins. Many infants with CMPA also react to soy protein, so simply switching to a soy-based formula is not reliable. Extensively hydrolyzed formulas break down cow milk proteins into small peptides, greatly reducing allergenicity and are typically tolerated by infants with CMPA. If reactions persist or the allergy is more severe, amino acid–based formulas provide proteins in their simplest form with no intact cow milk or soy proteins. Lactose-free formulas address lactose intolerance but do not remove the allergen, so they aren’t the preferred choice for CMPA alone. This approach explains why using hydrolyzed or amino acid–based formula is recommended.