Cow’s milk protein allergy in infants: Clinical presentations and outcomes

doi:10.5409/wjcp.v15.i1.109301

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World Journal of Clinical Pediatrics

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World J Clin Pediatr. Mar 9, 2026; 15(1): 109301
Published online Mar 9, 2026. doi: 10.5409/wjcp.v15.i1.109301

Cow’s milk protein allergy in infants: Clinical presentations and outcomes

Fareed Khdair Ahmad, Mohammad R Alkayid, Tahani M Ahmad, Reem H Hadidi, Riad M Rahhal

Fareed Khdair Ahmad, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, School of Medicine, The University of Jordan, Amman 11942, Jordan

Fareed Khdair Ahmad, Mohammad R Alkayid, Department of Pediatrics, School of Medicine, Balqa Applied University, As Salt 19117, Al Balqā’, Jordan

Fareed Khdair Ahmad, Department of Pediatrics, Jordan University Hospital, Amman 11942, Jordan

Fareed Khdair Ahmad, Reem H Hadidi, Department of Pediatrics, Hussein New Hospital, Ministry of Health, As Salt 19110, Al Balqā’, Jordan

Tahani M Ahmad, Department of Radiology and Nuclear Medicine, Jordan University Hospital, Amman 11942, Jordan

Tahani M Ahmad, Department of Radiology and Nuclear Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan

Tahani M Ahmad, Department of Radiology, School of Medicine, Dalhousie University, Halifax B3H 4R2, Halifax, Canada

Riad M Rahhal, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children’s Hospital of Illinois, OSF Healthcare, Peoria, IL 61637, United States

Author contributions: Khdair Ahmad F, contributed to the study design and conceptualization; Khdair Ahmad F and Alkayid MR coordinated patient recruitment and data collection; Hadidi RH and Alkayid MR assisted in data verification and clinical documentation; Khdair Ahmad F and Alkayid MR analyzed the data and wrote the manuscript draft; Rahhal RM and Ahmad TM critically reviewed and revised the manuscript; All authors have read and approved the final manuscript.

Institutional review board statement: This study was approved by the Institutional Review Boards of the University of Jordan School of Medicine and the Jordanian Ministry of Health.

Informed consent statement: Written informed consent was obtained from one parent of each participating infant during the clinical visit before study inclusion.

Conflict-of-interest statement: All authors declare that they have no conflicts of interest related to this work.

STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.

Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request. The dataset is stored in Excel format (.xlsx), and access may be granted for academic and non-commercial research purposes, subject to approval by the institutional ethics committee.

Corresponding author: Fareed Khdair Ahmad, Associate Professor, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, School of Medicine, The University of Jordan, Queen Rania Street, Amman 11942, Jordan. fareedpeds@yahoo.com

Received: May 7, 2025
Revised: June 22, 2025
Accepted: November 5, 2025
Published online: March 9, 2026
Processing time: 303 Days and 18.6 Hours

Abstract

BACKGROUND

Cow’s milk protein allergy (CMPA) is the most common food allergy in infants, with significant clinical, nutritional, and economic consequences. In Jordan, the Ministry of Health (MoH) provides specialized formulas for affected infants; however, local data on clinical presentation, treatment duration, costs, and breastfeeding barriers are scarce.

AIM

To evaluate the clinical manifestations and outcomes of infants diagnosed with CMPA in a public hospital in Jordan and to assess treatment costs and maternal breastfeeding barriers.

METHODS

This retrospective cross-sectional study included 38 infants aged < 1 year diagnosed with CMPA at a MoH tertiary hospital in Salt, Jordan, between 2020 and 2023. Data were collected from medical records and caregiver phone interviews. Infants who were exclusively breastfed or received mixed formulas (extensively hydrolyzed formula and amino acid-based formula) were excluded. Statistical analysis included descriptive statistics and Fisher’s exact test to determine associations between breastfeeding barriers and maternal factors.

RESULTS

Constipation (47.4%) and diarrhea (44.7%) were among the most frequent symptoms. One-third of the infants had coexisting food allergies, and elevated liver enzyme levels or isolated jaundice was noted in 21%. The average treatment duration was 13.89 months, with a mean cost of JD 1802 ($2523) per child. Maternal perception of milk insufficiency (36.8%) was the most reported breastfeeding barrier. Maternal employment, but not education (P = 0.22), was significantly associated with breastfeeding challenges (OR = 7.20, P = 0.03).

CONCLUSION

CMPA in Jordanian infants was associated with delayed diagnosis, high treatment costs, and significant breastfeeding barriers, particularly among employed mothers. These findings highlight the need for improved awareness, earlier diagnosis, and supportive policies to promote breastfeeding and reduce the disease burden.

Keywords: Cow’s milk protein allergy; Food hypersensitivity; Infant nutrition; Breastfeeding barriers; Formula feeding; Health care costs; Public health; Jordan

Core Tip: This study provides the first comprehensive analysis of cow’s milk protein allergy (CMPA) in Jordanian infants. It highlights less common clinical presentations, such as constipation and elevated liver enzymes, and evaluates treatment duration, costs, and coexisting food allergies. A novel aspect of the study is its investigation of breastfeeding barriers, revealing a significant association with maternal employment. The findings emphasize the clinical, social, and economic burden of CMPA in a publicly funded healthcare system and underscore the need for targeted education, early diagnosis, and breastfeeding support to improve outcomes and reduce costs.