Does My Baby Have MSPI?

Black and white photo of baby feet

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)
  • Fussiness
  • Eczema
  • Excessive gas
  • Diarrhea
  • 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.

MSPI Treatment

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:

Hypoallergenic formulas

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:

  • Alimentum
  • Nutramigen

Elemental formulas

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:

  • Elecare
  • Neocate
  • PurAmino

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.

Does my baby have MSPI?

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.

Share with me:  Do you have a MPSI baby?  How is your journey going adjusting your diet or testing different formulas?  What questions do you have about MSPI?

13 thoughts on “Does My Baby Have MSPI?”

  1. Pingback: The Ultimate Guide to Dairy Free Soy Free Protein Powders!

  2. Thank you for this post! My little one is almost 5 months and is very happy and content so I’ve never had a reason to be concerned something it up but I have noticed a bit of blood/mucous in stools of late and she has a little eczema so I’ve been trying to do a little research as I wait for our Doctor’s appointment which is still a couple of weeks away. As she is exclusively breastfed, I’m more than happy to eliminate anything from my diet if need be and am feeling guilty that it’s taken me until now to realize this might be the underlying cause. Does it cause any problems long term to her stomach if I have been feeding her for almost 5 months while I’ve been eating dairy and soy?

    1. Hi AB! First off, no guilt mama – it’s hard to figure out causes of issues! Your last question is a great one to ask your doctor. I can’t give medical advice – however as a personal story, I can tell you I asked the same question to my doctor at the beginning, and I was told there shouldn’t be any long term issues. Luckily, non IgE-mediated issues like MSPI are usually transient and most children outgrow them. Of course, you’ll want to troubleshoot everything with your doctor to determine the appropriate diagnosis and treatment. Good luck! <3

  3. Hi, I found your article when I needed it. I just wanted to share that I was lucky to find out my daughter had this 6 years ago at 5weeks old, I knew something was wrong when we left the hospital however it took 5 brutal long weeks before any health professional would agree that there was a problem. What I wanted to share is that my daughter still has issues with dairy 6 years later. They are minor, but definitely there. If there’s a dairy heavy meal, ice cream and yogurt seem to be the main offenders, because at 6 she naturally knows milk hurts her tummy and just avoids it on her own, however, what I wanted to say is the gastric events are still mildly affecting her 6 years on. I’m not sure what your personal experiences are but just wanted to add some children experience lingering effects for years beyond 3. At three we were definitely not out of the woods. Thank you for your article ❤️ It’s my go to for other moms who I see or suspect struggling with this.

    1. Chrissy Carroll

      Hi Elle – So glad you commented! And yes, you’re completely right – some children do have ongoing issues with dairy or soy into childhood or adulthood. Though many do outgrow it by the toddler years, it’s super individualized and can certainly persist for years afterwards. I hope you get a chance to poke around the website to find some yummy dairy-free recipes for your daughter 🙂

  4. My little has cow’s milk protein intolerance. As we approach his fist birthday I’m looking to start reintroducing dairy into his diet. The only problem is that the only way we even discovered he had this issue was from a stool sample that showed microscopic blood in it. He was otherwise just a very fussy baby with an inability to pass gas. As most 5 week old babies can have gas issues, and fussiness is relative (especially when you have a teething toddler) how else am I supposed to know if he’s reacting negatively to the dairy still? His GI doctor doesn’t recommend another stool sample, just says “eh go ahead and try it, you’ll be able to tell”. HOW??? What did you look for with your little? How did you decide how much dairy and what kinds to give?

    1. Chrissy Carroll

      Hi Courtney! Sorry for the delayed reply here. When we introduced, we actually did exactly what your doctor suggested, which was just give him a little bit of dairy (I think we chose yogurt) and waited to see what happened. That said, I probably wouldn’t have done the same now knowing more about it. 😉 If you google “dairy ladder” there’s a good graphic that is used in other countries which gives a step-by-step progression of introducing dairy. It starts with lower amounts (like dairy baked into to something) and then builds up from there. That can be a good plan for reintroducing. As far as what to look out for, I would personally monitor for fussiness, stool changes, skin changes, etc. Unfortunately with food sensitivities like this, there’s no official test other than monitoring what the original symptoms were and seeing if they come back.*

      *disclosure: not medical advice; always discuss medical concerns with an MD

  5. Hi my son is also bleeding and super unhappy. We’re still trying to figure out what foods is causing it with the dairy and soy. How fast did you find your baby reacted with bleeding after eating the allergens?

    1. Chrissy Carroll

      With dairy, we personally noticed very mucousy diapers the next day after I ate a lot – that’s what got us thinking it may have been a problem with that and brought it to our pediatrician’s attention. I eliminated dairy completely and that seemed to resolve a lot of issues, but then when he still tested positive for microscopic blood, we were advised to eliminate soy/eggs as well (though these weren’t as obvious). That seemed to resolve the issues. I would advise speaking with your son’s doctor about your concerns, and if dairy and soy are causing issue, they’ll probably advise you to eliminate all foods with those completely for a while. Good luck! 🙂

  6. Hi! My little has been dealing with MSPI since she was 2 1/2 months old. She was born at 29 weeks and spent 2 1/2 months in the NICU. While she was there, she didn’t have any issues with my milk. About a week after we brought her home, she started getting fussier, had frequent stools (10-15 a day) and they were all mucousy. We saw her Pediatrician and they tested for blood in her stool- came back positive. I have given up all dairy and soy in my diet; we also supplement with Alimentum as I have always been an under-supplier.
    We weren’t ever directed to introduce solids in any specific manner so we did what I remember from my first two: rice cereal first, vegetables and then fruits. She is now 9 months old and the pediatrician gave the go ahead to try re-introduce dairy and soy. I enjoyed one piece of pizza and some ranch with my chicken and since then, we are back to fussy and irritable baby girl.
    I am going back to my dairy and soy free diet since its pretty obvious she isn’t over this yet, which is very disheartening. My question now is, how much longer will I have to wait to try to reintroduce dairy again? I’ve read it can take 6 months for the gut to “heal” when it is irritated with MSPI.

    1. Hi Andrea! While I can’t provide individualized nutrition advice via comments, in general, current peer-reviewed research (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400851/) suggests “In the case of failure, the trigger should be removed once again from the diet, with new attempts at reintroduction every six months.” This simply gives the gut and immune system longer to mature and potentially handle the protein. However, every situation is different and I would discuss this with your doctor!

      And don’t feel too disheartened if you have to continue the diet a bit longer – we’ve got tons of delicious recipes here, and if there’s something specific you’re looking to eat that you can’t find here – let me know and I can share some other recipes or resources.

      You’ve got this, mama!

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