Vomiting is described as the involuntary forceful muscular expulsion of gastric contents.1 It should not be confused with reflux or regurgitation, which are more passive, effortless actions that usually occur before an infant’s esophagus is fully developed.2

What causes vomiting in infants?

  • In newborns and infants, a food allergy, e.g. Cow’s Milk Protein Allergy (CMPA)
  • A stomach infection, e.g. gastroenteritis, where vomiting is often accompanied by diarrhea and carries the risk of dehydration3

Other causes include gastro-oesophageal reflux, a reaction to a medicine, intestinal obstruction and metabolic disorders.4


Vomiting as a symptom of Cow’s Milk Protein Allergy

In newborns and infants, vomiting is a common symptom of CMPA.5,6 Clinically, it may present both as an immediate (within minutes)7 or a late (few days to a week) reaction.5 Approximately 50% of infants with CMPA present with vomiting as a symptom.8,9

Signs and symptoms related to CMPA

The majority of infants affected with CMPA have at least two symptoms affecting at least two different organ systems.10,11


Having an awareness of the most common symptoms of CMPA can help you to make an earlier diagnosis of CMPA in your patients.

CoMiSS® awareness tool

The Cow’s Milk-related Symptom Score (CoMiSS)® is a simple, fast and easy-to-use awareness tool designed to help you more easily recognise the signs and symptoms that can be cow’s milk-related in infants and young children.

CoMiSS® awareness tool is available in print and online version
If you suspect your patient is suffering from symptoms that may be suggestive of CMPA, use the CoMiSS® tool to score and assess the likelihood of CMPA.



1.    Lightdale JR., et al. Pediatrics. 2013;131:e1684–95

2.    Marseglia L., et al. World J Gastroenterol 2015; 21(28): 8508–15

3.    Guarino A., et al. J Pediatr Gastroenterol Nutr. 2014;59:132–52

4.    Vomiting in the Pediatric Age Group. http://www.medscape.com/viewarticle/711641_3 (Accessed March 2016)

5.    Koletzko S., et al. J Pediatr Gastroenterol Nutr. 2012;55(2):221–9

6.    Ravelli AM., et al. J Pediatr Gastroenterol Nutr. 2001;32:59–64

7.    Vandenplas Y., et al. Arch Dis Child. 2007;92:902–08

8.    Klemola T., et al. J Pediatr. 2002;140(2):219–24

9.    Hill DJ., et al. Clin Allergy. 1988;18(5)481–90

10.  Lifschitz C. and Szajewska H. Eur J Pediatr. 2015;174:141–50

11.  Høst A. Pediatr Allergy Immunol. 1994;5:1–36

IMPORTANT NOTICE: Mothers should be encouraged to continue breastfeeding even when their babies have cow’s milk protein allergy. This usually requires qualified dietary counseling to completely exclude all sources of cow’s milk protein from the mothers’ diet. If a decision to use a special formula intended for infants is taken, it is important to follow the instructions on the label. Unboiled water, unboiled bottles or incorrect dilution can make babies ill. Incorrect storage, handling, preparation and feeding can eventually lead to adverse effects on the health of babies. Formula for special medical purposes intended for infants must be used under medical supervision.