Formula intolerance, also called adverse reaction to formula, encompasses a wide variety of pathogenetic mechanisms,including allergy. The latter has an immunologic basis. Formula intolerance may occur because of congenital or acquired enzyme deficiencies (eg,disaccharidase), ingestion of toxin or pharmacologic agents (eg, Staphylococcus aureus toxin), or true hypersensitivity that has a proven immunologic mechanism. Whatever the pathophysiology,the physician must try to determine objectively whether signs and symptoms reflect formula intolerance and, if so, which constituent of the formula may be the basis for the problem.

The signs and symptoms of formula intolerance are legion, involve many systems, and can be mimicked by other causes, some of which are minor variants of normal. Therefore, it is essential that the pediatrician be conversant with the normal variation in stool frequency and quality for infants who are either breastfed or bottle-fed. Normal variation in temperament(difficult to sooth versus placid), frequency and quantity of regurgitation,...

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