Initial Intervention:

Around 5 days prior to his referral to the dietitian, Oliver’s GP had commenced him on an amino acid-based infant formula. He was fed 120ml every 3 hours (150ml/kg), but feeds could take as long as 40 minutes to complete. His mother reported that he was fussy with the bottle and that his vomiting had worsened since this course began. His weight had initially dropped to 4.05kg on day 4, which is within normal parameters. At day 13, he was
reapproaching his birth weight at 4.28kg (just under the 75th centile).

Nutritional Intervention with HRF

The dietitian suspected Oliver had cow’s milk protein allergy (CMPA) and noted that, as his symptoms were representative of a non-IgE-mediated allergy and there were no ‘red flags’, she herself would have typically started him on an extensively hydrolysed formula (eHF).

However, instead, she chose to trial Oliver with Arize, a hydrolysed rice formula (HRF), with the addition of Carobel to thicken. Oliver’s acceptance of Arize was immediate, and his symptoms quickly improved, which was a significant relief for his mother.

As part of standard practice, the dietitian encouraged Oliver’s mother to ‘challenge’ the
diagnosis by reintroducing a standard infant formula after 3 weeks on Arize. His mother later reported that Oliver’s symptoms had returned within a single day of reverting, with stringy stools which he was straining to pass, vomiting and high-pitched screaming. She was advised to resume feeding Arize, and Oliver’s symptoms diminished once again within 24 hours.