OBJECTIVE:
An overview of the delayed in diagnosis and mismanagement of CMPA cases until failure to thrive occured.

CASES:
Infant A (8 months) and B (5 months) old are boys who suffering recurrent diarrhea and admitted with diagnosis of acute gastroenteritis. They were given antibiotics and milk replacement from low lactose, soy to hydrolyzed formula. Patients were born full term with normal birth weight, 3300 and 2450 grams. When consultation done, their weight were only 4.5 kg and 4.2 kg, length 60 cm and 59 cm). They had severe malnutrition, global developmental delay and failure to thrive.
Infant A had vomiting, repeated bloody diarrhea since 2 months old. Patient given cow’s milk and breastmilk until 2 months with good tolerance. Family history of allergies is denied. Patient diagnosed as severe CMPA and diarrhea due to prolonged antibiotics.
Infant B was exclusively breastfeeding until 3 months old, which was stopped when the baby had recurrent diarrhea, then the baby was given soy milk and low lactose formula. His mother has history of cold allergies and his sibling has food allergies. When consultation done, the patient was weak with signs of dehydration, pallor and high fever. Patients was diagnosed as acute gastroenteritis, moderate dehydration, anemia, with suspected severe CMPA.
Both of these patients were given amino acid formula and other feeding was stopped temporarily. Patients were given proper nutrition management with developmental stimulation. In case A, the antibiotic that given to the patient was stopped. Symptoms disappeared after 3 days. In case B, the patient’s condition improved after 5 days in the hospital. Monitoring subsequently, these 2 patients growth and development are improving.

CONCLUSION:
Infants with recurrent diarrhea caused failure to thrive, the diagnosis of severe CMPA must be considered. Amino acid formula could be the choice of nutrition for these cases.