“No rash, not CMPA.”
That is what a pediatrician told me at my baby’s 8-week urgent appointment — an appointment made because something clearly wasn’t right.
My baby was in pain daily.
None of the typical advice was helping:
“Do bicycle kicks.”
“Try the ‘I love you’ massage.”
“Give her a warm bath.”
“Try white noise.”
“Hold her upright after feeds.”
“Give her gas drops.”
At just 5 weeks old, I knew she had something called silent reflux. This appointment was meant to discuss the fact that her prescribed famotidine (baby Pepcid) was not working, and based on my research, I believed the next step would be trying a proton pump inhibitor (PPI).
Before requesting that, though, I wanted to ask whether the pediatrician thought my daughter could also be struggling with CMPA (cow’s milk protein allergy).
I explained all of her symptoms:
- Constant congestion and sounding stuffy
- Extreme gas and bloating — her stomach reminded me of a bowling ball
- Mucus in her stool
- Grunting and pulling her legs up whenever she laid down, making it impossible for her to relax
- Pain during feeds and especially immediately afterward
The pediatrician examined my daughter, palpated her belly, checked her skin, and said:
“No rash, not CMPA.”
I questioned her because my daughter had nearly every other symptom. I asked if CMPA could still be possible without a rash.
The response was that at her age, we “would have known by now” if she were allergic to her formula and that CMPA “almost always” comes with a rash. Her skin was completely clear.
Rash can absolutely be a symptom of CMPA — but it is certainly not required for an accurate diagnosis.
I left that appointment with a prescription for a PPI, hopeful it could help her reflux, but also with a lingering feeling that my concerns about CMPA had been brushed aside.
After researching what testing could be done for CMPA, I learned there is not one definitive test specifically for CMPA. However, there are tests that can strongly support the diagnosis.
One of those tests is a fecal occult blood stool test. “Occult” simply means blood hidden to the eye.
I asked the pediatrician to run the test, and they agreed, requesting a diaper with a stool sample.
At that point, my baby was only pooping once every three days — another concern that had largely been brushed aside.
I finally got a stool diaper later that same day, just 30 minutes before the office closed. I rushed there and handed it over.
The result came through while I was sitting in my car:
Negative for occult blood.
I felt defeated.
It’s not that I wanted her to have CMPA, but if she did, it would at least mean we finally had an answer.
Instead, I felt like we were back at square one, now relying solely on the PPI to resolve all of her symptoms — even the ones that did not seem tied to reflux, like her severe lower belly discomfort.
Looking back now, I wish I had pushed for repeat testing a week or two later.
Three months later — when she was finally 5 months old — we had our first GI appointment (which had originally been requested when she was only 5 weeks old).
At that appointment, the GI doctor requested another stool sample.
Lo and behold:
Positive for occult blood.
After five months of pain and suffering, my daughter finally received her CMPA diagnosis.
At that point, though, I had already switched her through eight different formulas, including two hypoallergenic formulas. I felt devastated that even those did not seem to be helping, especially now that we finally had confirmation of CMPA.
What I did not know at the time was that hypoallergenic formulas like Nutramigen (which we tried early on) and Alimentum (which she was on by the time of her GI appointment) still contain broken-down cow’s milk proteins.
The GI doctor introduced us to something we had never heard of before:
Amino acid formula.
Unlike hypoallergenic formulas, amino acid formulas are completely broken down into individual amino acids, meaning there are no intact milk proteins left.
We chose PurAmino after rushing to my CMPA Facebook support group for advice.
Thank goodness for that group.
That group is actually the reason we suspected CMPA in the first place, because one parent commented:
“My baby was diagnosed with CMPA and never had a rash!”
Once my daughter started PurAmino, I went back to the group and asked:
“How long until I see improvement?”
Many parents said:
“At least three weeks.”
But one or two parents shared something that became incredibly important for us to hear:
“The transition can actually get worse before it gets better. Expect more mucus in the stool while the gut heals after months of irritation. It can take nearly two months.”
I am so thankful for those comments, because it was not until week 5 on PurAmino that my baby finally started feeling better.
By week 8, she had zero remaining CMPA symptoms.
Finally.
I want to be very clear that I am not a medical professional. I am simply sharing information based on my personal experience navigating this journey with my daughter.
If your baby is struggling with suspected CMPA, please refer to the information below and feel free to screenshot it.
Recommended Facebook support group:
CMPA Support for the USA 🇺🇸
Test to request:
Fecal occult blood stool test
Formulas commonly trialed after CMPA diagnosis:
- Hypoallergenic formulas:
- Nutramigen
- Similac Alimentum
- (Ready-to-feed Alimentum is slightly thicker, which may help babies who also struggle with reflux.)
If baby does not improve on hypoallergenic formula, amino acid formulas may be considered. Here are a few common kinds:
- PurAmino
- Neocate
- EleCare
Possible symptoms of CMPA:
- Chronic congestion or sounding stuffy
- Grunting and pulling legs to stomach
- Excessive gas and bloating
- Fussiness during and/or after feeds
- Rash
- Mucus or blood in stool
The Patient Mama 