If you’re anything like me, you have probably got your phone out googling “MSPI baby” during a breastfeeding session, wondering – does my baby have this?! I totally get it. It can be stressful not knowing what’s going on with your baby, especially if you’re seeing symptoms like fussiness that could be related to diet – or could just be due to the fact that it’s a baby!
Since I’ve gone through this personally and professionally, I’m hoping I can share some helpful information to help you better understand MSPI and break down some of the current facts and research on this topic.
Disclaimer: I am not a medical doctor. While I am a Registered Dietitian, this information is for informational purposes only and does not constitute medical advice. Always check with your doctor if you have any questions about your child’s medical status.
What is MSPI?
MSPI – or milk soy protein intolerance – is a condition in which a baby cannot digest the proteins found in dairy products or soy products. For most children, this is a temporary condition that they will outgrow by 1-3 years of age.
Symptoms of MSPI
MSPI symptoms can include any of the following:
- Mucous and/or blood in stools (this is the primary symptom of a food intolerance in an infant)
- Excessive gas
- Trouble sleeping/napping
Of course, note that almost all of these symptoms can be related to other issues (for example, diarrhea may be indicative of a stomach bug) — or can just be a normal part of the baby’s development (i.e. fussiness or skipping naps).
What causes MSPI?
There’s no specific known cause of MSPI. It’s not because of something you ate during pregnancy or breastfeeding, or because you gave your child formula instead of nursing them. You are doing an amazing job, mama!
While there’s no conclusive evidence on what causes it, many doctors believe it may just be an issue of digestive immaturity. In other word’s the baby’s digestive system simply needs some time to become stronger and able to process those proteins better.
Some practitioners also think there may be a link between early antibiotic use disrupting the gut bacteria, and subsequent food allergies. This is just a theory at this point though; there is no conclusive evidence right now. (Interestingly, my son did have antibiotics at 3 days old in the hospital, so I’ve always wondered if that had something to do with it).
It does appear that there may be a familial link, so if you have one child born with it, a future child may be more likely to have it too.
What is the difference between cow’s milk protein intolerance and MSPI?
Cow’s milk protein intolerance refers to the inability to digest dairy. Some babies are born with cow’s milk protein intolerance but they can still tolerate soy. Most research suggests around 1% of breastfed babies have cow’s milk protein intolerance, and about 2-3% of formula fed babies. However, this issue is not well-researched and some professionals believe actual prevalence may be a bit higher – possibly 5-15%.
A fairly large portion of those babies who cannot tolerate dairy also cannot tolerate soy – this would be classified as MSPI.
What’s the difference between MPSI and lactose intolerance?
Babies with MSPI cannot tolerate the protein in milk (and soy). Lactose intolerance, on the other hand, is an inability to digest a certain type of sugar in dairy products. It’s uncommon for lactose intolerance to cause issues in infants.
Because of this, you shouldn’t use lactose-free products as a treatment for MPSI.
For example, if you are nursing, you shouldn’t drink Lactaid milk – this will not help. Instead, nursing moms can choose another dairy-free and soy-free milk alternative, like almond milk or coconut milk.
If you are formula feeding, do not use any type of milk alternative instead of formula if you think your baby has a dairy intolerance. You’ll want to get specific formulas that are made for babies with these issues.
Testing for MSPI
There is no one specific test that conclusively determines if a baby has MSPI. If you bring up your concerns to your pediatrician, they’ll most likely perform a guaiac test on the baby’s stool. This tests for microscopic traces of blood in the stool. If it tests positive, your doctor will likely review the baby’s symptoms and rule out any other potential medical causes for the blood in the stool.
We were lucky to have an amazing pediatrician who took all our concerns seriously, and referred us to a pediatric gastroenterologist for additional reassurance. If you feel in your heart that something is off but your doctor refuses to listen to your concerns (as I’ve heard from some other moms), try getting a second opinion.
If a baby has MSPI, the treatment is to eliminate the proteins from cow’s milk and soy from their diet.
Breastfeeding with MSPI
For breastfeeding moms, this means cutting them out of your own diet. Note that it can take up to two weeks for all traces of dairy and soy to leave your breast milk, so try to be patient as you’re waiting for those symptoms to improve.
I’ll have a comprehensive post up soon about the MSPI diet, but for now here are a few tips:
- Remove all obvious sources – milk, yogurt, cheese, soy milk, tofu, edamame, etc.
- Read labels carefully – dairy and soy are in many products you might not expect, from breads to salad dressings to pasta sauces
- Be cautious about eating out – scope out allergy friendly restaurants (110 Grill is one chain I know of that puts a high priority on allergy awareness)
Formula Feeding with MPSI
For formula fed babies, you’ll want to switch over to a special formula. There are two types:
These still contain milk protein, but it’s been broken down into much smaller pieces that many MSPI babies will be able to tolerate. These formulas include:
If the baby cannot tolerate the formulas above, they will likely need an elemental formula. These specialty formulas do not contain any milk or soy proteins, and include:
Note that some of the formulas in both lists above may include soy oil, however there is no evidence that this should cause issues in those with MPSI. Soy oil is a product made of only fats, while the digestive issue comes from the protein part of the soy.
Tip: If you are formula feeding, check with your insurance company to see if they will cover a medically-necessary formula.
Introducing Solids with MSPI
When you start introducing solid foods to babies with MSPI (around 6 months), you’ll most likely keep dairy and soy products out of their diet for a little while. Your doctor will help determine the best time to trial the trigger foods based on your child’s symptoms and the severity of such.
In our family, we kept everything out of both my diet (since I was nursing) and my son’s diet until he turned a year old. At that point, we gradually reintroduced the foods he had issues with (in our case, eggs along with dairy and soy). We started with eggs, then soy, then dairy. For each, we first trialed through my diet and nursing – knowing he’d get less of a ‘dose’ that way – and then moved forward to trial in his diet. Luckily for us, he had outgrown everything by a year.
I hope this was a helpful overview! If you feel like your baby has MSPI, take a few deep breaths and know that whichever direction you go – nursing while you eliminate food, or going with a special formula – you’re doing what’s best to keep your baby fed and healthy.