In plain words
Food protein-induced enterocolitis syndrome, or FPIES, is a reaction in the gut to a food protein. Milk, soy, and grains are the usual triggers. It causes repeated vomiting about one to four hours after eating. Some babies also have diarrhea, pale skin, sleepiness, or a drop in energy. Severe episodes need urgent care, because dehydration and low blood pressure can develop. A baby with repeated vomiting and pallor or lethargy needs emergency care now. FPIES is different from a typical allergy. It does not usually cause hives or breathing trouble. Your pediatrician guides testing, and any change in formula or diet is best made with that guidance.
The deeper version
FPIES is a non-IgE-mediated gastrointestinal syndrome in which repeated emesis, typically one to four hours after ingestion, can progress to lethargy, pallor, and hypotension with dehydration in acute episodes. Diagnosis is clinical, based on consistent symptom pattern and resolution after elimination, with oral food challenge used to confirm. Cow's milk and soy are the most common triggers in infants. The international consensus guidelines on FPIES (Nowak-Wegrzyn et al., Journal of Allergy and Clinical Immunology, 2017) describe the diagnostic criteria, acute management, and food reintroduction. Acute reactions are treated in emergency settings with fluid resuscitation, and long-term outcomes are favorable for most children, with tolerance usually acquired by early childhood.
Where it comes up
- Dairy and other sensitivities in a breastfed babyFeeding Your Baby
- Formula feeding: choosing, preparing, and doing it wellFeeding Your Baby
- Combo feeding: breast and formulaFeeding Your Baby
- When to call the pediatrician (and when to go in)Baby Basics
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Sources
- Nowak-Wegrzyn A et al. — Food protein-induced enterocolitis syndrome: Joint Task Force practice parameter, 2017