What is the initial step recommended by the AAP for an infant showing signs of intolerance on an exclusively cow's milk-based formula?

• A. Switch to a hydrolyzed formula
• B. Continue current formula
• C. Switch to a high MCT oil formula
• D. Switch to a soy-based formula

Answer: (A)

When an infant shows signs of intolerance to a cow’s milk–based formula, the first step is to switch to an extensively hydrolyzed formula. Breaking the cow milk proteins into small, less allergenic pieces often reduces reaction symptoms and improves tolerance, addressing the underlying issue rather than just masking it. If symptoms persist despite using a hydrolyzed formula, an amino acid–based formula may be considered next, since it contains no intact cow milk protein.

Continuing the current formula won’t address the suspected protein intolerance. A high MCT oil formula isn’t targeted to reduce allergenicity and won’t necessarily resolve inflammatory or allergic reactions. Soy-based formulas are not reliable first-line for cow milk protein intolerance due to limited tolerance and potential cross-reactivity in many infants.